Warfarin and rivaroxaban were associated with significantly higher 6-month persistence compared to LMWH (61% vs 37%) in patients with cancer-associated thrombosis.
Cohort (n=2,941)
Does warfarin or rivaroxaban improve treatment persistence compared to LMWH in patients with cancer-associated thrombosis?
Effect estimate: HR 0.33 (warfarin), HR 0.38 (rivaroxaban) (95% CI 0.28-0.38 (warfarin), 0.32-0.46 (rivaroxaban))
Absolute Event Rate: 61% vs 37%
BACKGROUND: Recommended therapeutic options for the management of venous thromboembolism (VTE) in patients with cancer are burdensome, and compliance with guidelines is unknown. OBJECTIVES: To describe current treatment patterns and to evaluate patient persistence on various anticoagulants. PATIENTS/METHODS: Medical and pharmacy claims from the Humana Database were analyzed (01/2007-12/2014). Newly diagnosed cancer patients treated with anticoagulants were categorized into one of the following cohorts: low-molecular-weight heparin (LMWH), warfarin, and rivaroxaban. Discontinuation, switching, and persistence with the index therapy were analyzed. RESULTS: A total of 2941 newly diagnosed patients with cancer who developed VTE and received anticoagulation in outpatient settings were identified. Of these, 97% initiated anticoagulation with LMWH (n=735; 25%), warfarin (n=1403; 47.7%), or rivaroxaban (n=709; 24.1%). Median treatment durations for the LMWH, warfarin, and rivaroxaban cohorts were 3.3, 7.9, and 7.9 months, respectively; Kaplan-Meier rates of persistence to the initial therapy were 37%, 61%, and 61% at 6 months. Warfarin and rivaroxaban users were significantly more likely to remain on initial therapy compared to LMWH (adjusted hazard ratios HRs; 95% CI: warfarin, 0.33 0.28-0.38; rivaroxaban, 0.38 0.32-0.46). The proportion of patients that switched from their initial treatment to another anticoagulation treatment was 22.9%, 7.9%, and 4.7% in the LMWH, warfarin, and rivaroxaban cohorts, respectively. CONCLUSIONS: This real-world analysis showed that, despite guideline recommendations, warfarin and rivaroxaban are at least as equally utilized as LMWH for the treatment of cancer-associated thrombosis. LMWH was associated with significantly lower persistence, shorter duration of treatment, and more switching than warfarin and rivaroxaban.
Khorana et al. (Tue,) conducted a cohort in Cancer-associated thrombosis (n=2,941). Warfarin and rivaroxaban vs. Low-molecular-weight heparin (LMWH) was evaluated on Persistence to the initial therapy at 6 months (HR 0.33 (warfarin), HR 0.38 (rivaroxaban), 95% CI 0.28-0.38 (warfarin), 0.32-0.46 (rivaroxaban)). Warfarin and rivaroxaban were associated with significantly higher 6-month persistence compared to LMWH (61% vs 37%) in patients with cancer-associated thrombosis.