Key result
Switching to rivaroxaban in cancer-associated thrombosis yields ~4% recurrent VTE over 6 months.
Why the study?
Patients with cancer-associated thrombosis have a high risk of recurrent venous thromboembolic events, and direct oral anticoagulants may provide a convenient treatment option. This study assessed the clinical characteristics and outcomes of patients with active cancer changing to rivaroxaban after at least 4 weeks of standard therapy for VTE in clinical practice.
What are the clinical characteristics and rates of recurrent venous thromboembolism and bleeding in patients with active cancer who switch to rivaroxaban after at least 4 weeks of standard anticoagulation?
Cohort (n=505)
Yes
What are the clinical characteristics and rates of recurrent venous thromboembolism and bleeding in patients with active cancer who switch to rivaroxaban after at least 4 weeks of standard anticoagulation?
In routine clinical practice, switching patients with cancer-associated thrombosis to rivaroxaban after at least 4 weeks of parenteral or VKA therapy is associated with high persistence and low 6-month rates of recurrent VTE (3.6%) and major bleeding (3.6%).
Answers are grounded in this paper and cite their sources.
Supports rivaroxaban switch after initial therapy in cancer-associated thrombosis; extends observational data but leaves randomized confirmation open.
BACKGROUND: Patients with cancer-associated thrombosis (CAT) have a high risk of recurrent venous thromboembolic events, which contribute to significant morbidity and mortality. Direct oral anticoagulants may provide a convenient treatment option for these patients. OBJECTIVES: To assess clinical characteristics and outcomes of patients with active cancer changing to rivaroxaban after ≥4 weeks of standard therapy for the treatment of venous thromboembolism (VTE) in clinical practice. This analysis focused on secondary outcomes of Cancer-associated thrOmboSIs - Patient-reported outcoMes with rivarOxaban (COSIMO). PATIENTS: COSIMO was a multinational, prospective, noninterventional, single-arm cohort study. Overall, 505 patients received at least one dose of rivaroxaban; 96.6% changing from low-molecular-weight heparin, 1.6% from a vitamin K antagonist, and 1.8% from fondaparinux. RESULTS: Most patients had solid tumors (n = 449; 88.9%) and approximately half of these patients had metastases. The qualifying venous thromboembolic event was deep vein thrombosis (DVT) in 45.3% of patients, pulmonary embolism (PE) in 37.2% of patients, DVT with PE in 9.7% of patients, and catheter-associated DVT in 7.5% of patients. Approximately 75.1% of patients received rivaroxaban for at least 3 months; 150 (29.7%) patients received concomitant chemotherapy during the study. VTE recurrence, major bleeding, nonmajor bleeding, and major adverse cardiovascular events occurred in 18 (3.6%), 18 (3.6%), 81 (16.0%), and 12 (2.4%) patients, respectively. CONCLUSIONS: In patients with CAT who changed to rivaroxaban treatment after ≥4 weeks of standard therapy, the observed incidence proportions of recurrent VTE and bleeding events were in keeping with the recognized effectiveness and safety profile of rivaroxaban for the treatment of CAT.
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Maraveyas et al. (2021) conducted a cohort in Cancer-associated thrombosis (CAT) (n=505). Rivaroxaban was evaluated on Recurrent venous thromboembolism (symptomatic or incidental) over 6 months. Rivaroxaban switch after >=4 weeks of standard therapy in cancer-associated thrombosis resulted in 3.6% recurrent VTE and 3.6% major bleeding over 6 months.
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