Rivaroxaban versus Apixaban for Treatment of Cancer-Associated Venous Thromboembolism in Patients at Lower Risk of Bleeding

Kimberly Snow Caroti; Cecilia Becattini; Marc Carrier; Alexander T. Cohen; Anders Ekbom; Alok A. Khorana; Agnes Y.Y. Lee; Christopher Brescia; Khaled Abdelgawwad; George Psaroudakis; Marcela Rivera; Bernhard Schaefer; Gunnar Brobert; Craig I. Coleman

doi:10.1055/s-0043-1770783

TH Open, Inhaltsverzeichnis

CC BY 4.0 · TH Open 2023; 07(03): e206-e216
DOI: 10.1055/s-0043-1770783

Original Article

Rivaroxaban versus Apixaban for Treatment of Cancer-Associated Venous Thromboembolism in Patients at Lower Risk of Bleeding

Autor*innen

Kimberly Snow Caroti

¹Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, Connecticut, United States

²Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, United States
Cecilia Becattini

³Department of Internal and Emergency Medicine – Stroke Unit, University of Perugia, Perugia, Italy
Marc Carrier

⁴Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Canada
Alexander T. Cohen

⁵Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
Anders Ekbom

⁶Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
Alok A. Khorana

⁷Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, Ohio, United States
Agnes Y.Y. Lee

⁸Department of Medicine, University of British Columbia and BC Cancer, Vancouver, Canada
Christopher Brescia

⁹Freshtech IT, LLC, East Hartford, Connecticut, United States
Khaled Abdelgawwad

¹⁰Pharmacoepidemiology Group, Bayer AG, Berlin, Germany
George Psaroudakis

¹⁰Pharmacoepidemiology Group, Bayer AG, Berlin, Germany
Marcela Rivera^a

¹⁰Pharmacoepidemiology Group, Bayer AG, Berlin, Germany
Bernhard Schaefer^b

¹⁰Pharmacoepidemiology Group, Bayer AG, Berlin, Germany
Gunnar Brobert^b

¹⁰Pharmacoepidemiology Group, Bayer AG, Berlin, Germany
Craig I. Coleman

¹Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, Connecticut, United States

²Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, United States

Abstract

This retrospective study, utilizing U.S. electronic health record (EHR) data from January 2013 to December 2020, sought to assess whether rivaroxaban and apixaban had similar effectiveness and safety in the treatment of cancer-associated venous thromboembolism (VTE) in patients with a cancer type not associated with a high risk of bleeding. We included adults diagnosed with active cancer, excluding esophageal, gastric, unresected colorectal, bladder, noncerebral central nervous system cancers and leukemia, who experienced VTE and received a therapeutic VTE dose of rivaroxaban or apixaban on day 7 post-VTE, and were active in the EHR ≥12 months prior to the VTE. Primary outcome was the composite of recurrent VTE or any bleed resulting in hospitalization at 3 months. Secondary outcomes included recurrent VTE, any bleed resulting in hospitalization, any critical organ bleed, and composites of these outcomes at 3 and 6 months. Inverse probability of treatment-weighted Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). We included 1,344 apixaban and 1,093 rivaroxaban patients. At 3 months, rivaroxaban was found to have similar hazard to apixaban for developing recurrent VTE or any bleed resulting in hospitalization (HR: 0.87; 95% CI: 0.60–1.27). No differences were observed between cohorts for this outcome at 6 months (HR: 1.00; 95% CI: 0.71–1.40) or for any other outcome at 3 or 6 months. In conclusion, patients receiving rivaroxaban or apixaban showed similar risks of the composite of recurrent VTE or any bleed resulting in hospitalization in patients with cancer-associated VTE. This study was registered at www.clinicaltrials.gov as #NCT05461807.

Key Points

Rivaroxaban and apixaban have similar effectiveness and safety for treatment of cancer-associated VTE through 6 months.
Clinicians should therefore consider patient preference and adherence when choosing the optimal anticoagulant.

Keywords

apixaban - rivaroxaban - venous thromboembolism - cancer-associated VTE

Volltext

Referenzen

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