Comparative Analysis of Enoxaparin versus Rivaroxaban in the Treatment of Cancer Associated Venous Thromboembolism: Experience from a Tertiary Care Cancer Centre

BACKGROUND VTE in cancer patients is associated with poor prognosis and remains a leading cause of mortality and morbidity. The purpose of this study was to access if rivaroxaban, a oral factor Xa inhibitor would be an appealing alternate choice to treat cVTE compared with LMWH. METHODS We conducted a retrospective review of comparison between the efficacy and safety profile of enoxaparin versus rivaroxaban in the treatment of venothromboembolism (VTE) in 150 patients with cancer after developing a symptomatic DVT or PE. Baseline patient characteristics and laboratory values were assessed in each arm. Primary efficacy outcome was measured by radiographically confirmed VTE recurrence at different intervals. Primary safety outcome was measured by presence of major and minor bleeding using the ISTH scale. RESULTS Our results showed that there was no statistically significant difference between the incidence of VTE recurrence at 6 months between the Enoxaparin and Rivaroxaban arm (10% vs 14.2%, p=0.42). Historically significant risk factors for VTE in cancer patients such as high platelet count, high leukocyte count, low hemoglobin level, high risk gastrointestinal, genitourinary and lung cancers were not found to be independently significantly associated with the risk of VTE recurrence. Primary safety outcome analysis also showed no statistically significant difference in major (11.2% vs 11.4%) and minor (15% vs 10%) bleeding between enoxaparin versus rivaroxaban arm respectively, (p=0.65). CONCLUSION We conclude that there was no significant difference seen between the efficacy and safety profile of enoxaparin and rivaroxaban in our cancer patient population.