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February 20, 2018Journal of Oncology Pharmacy Practice

A single center retrospective cohort study comparing low-molecular-weight heparins to direct oral anticoagulants for the treatment of venous thromboembolism in patients with cancer – A real world experience

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Key result

Direct oral anticoagulants showed no significant difference in recurrent thrombosis (6.3% vs 7.2%, p=0.71) or major bleeding (2.6% vs 7.6%, p=0.08) compared to low-molecular-weight heparins.

Why the study?

Does direct oral anticoagulant use reduce recurrent cancer-associated thrombosis and major bleeding compared to low-molecular-weight heparin in adults with cancer-associated thrombosis?

Population

480 adults with cancer-associated thrombosis (VTE) treated between 2010 and 2016 at the Ohio State University

Comparison

Direct oral anticoagulant (DOAC) vs Low-molecular-weight heparin (LMWH)

Design

Cohort

Follow-up

6 months

Authors

MPMegan PhelpsTWTracy WiczerHEH. Paige Erdeljac

Discussion

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Overview

May support DOAC use versus LMWH in select lower-risk cancer VTE; leaves open confirmation in randomized trials.

Study Design

Type

Cohort (n=480)

Multicenter

No

Structured PICO

Does direct oral anticoagulant use reduce recurrent cancer-associated thrombosis and major bleeding compared to low-molecular-weight heparin in adults with cancer-associated thrombosis?

P
Population
480 adults with cancer-associated thrombosis treated with low-molecular-weight heparin or direct oral anticoagulants, followed for up to 6 months.
E
Exposure
Direct oral anticoagulant (DOAC)
C
Comparator
Low-molecular-weight heparin (LMWH)
O
Outcome
Rate of recurrent cancer-associated thrombosis and major bleeding within 6 months of starting anticoagulationhard clinical

Main Result

Absolute Event Rate: 6.3% vs 7.2%

p-value: p=0.71

In a select population of cancer patients with VTE, DOACs appear as effective and safe as standard therapy with LMWH, though DOAC patients had lower baseline risk.

Limitations

  • Retrospective design
  • Baseline differences between groups (DOAC patients had lower risk features)

Cite This Study

Phelps et al. (2018) conducted a cohort in cancer-associated thrombosis (n=480). Direct oral anticoagulants vs. Low-molecular-weight heparins was evaluated on recurrent cancer-associated thrombosis (p=0.71). Direct oral anticoagulants showed no significant difference in recurrent thrombosis (6.3% vs 7.2%, p=0.71) or major bleeding (2.6% vs 7.6%, p=0.08) compared to low-molecular-weight heparins.

synapsesocial.com/papers/6a980d4a713b4e110fe350dbhttps://doi.org/10.1177/1078155218757856
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Edoxaban for treatment of venous thromboembolism in patients with cancer2015 · 83 citations
  2. 2Comparison of Low-Molecular-Weight Heparin and Warfarin for the Secondary Prevention of Venous Thromboembolism in Patients With Cancer2002 · 801 citations
  3. 3Low-Molecular-Weight Heparin versus a Coumarin for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer2003 · 2,542 citations
  4. 4Safe and effective use of rivaroxaban for treatment of cancer-associated venous thromboembolic disease: a prospective cohort study2016 · 103 citations
  5. 5Tinzaparin vs Warfarin for Treatment of Acute Venous Thromboembolism in Patients With Active Cancer2015 · 615 citations