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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

Kimberly Snow Caroti
1   Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, Connecticut, United States
2   Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, United States
,
Cecilia Becattini
3   Department of Internal and Emergency Medicine – Stroke Unit, University of Perugia, Perugia, Italy
,
Marc Carrier
4   Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Canada
,
Alexander T. Cohen
5   Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
,
Anders Ekbom
6   Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
,
Alok A. Khorana
7   Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, Ohio, United States
,
Agnes Y.Y. Lee
8   Department of Medicine, University of British Columbia and BC Cancer, Vancouver, Canada
,
Christopher Brescia
9   Freshtech IT, LLC, East Hartford, Connecticut, United States
,
Khaled Abdelgawwad
10   Pharmacoepidemiology Group, Bayer AG, Berlin, Germany
,
George Psaroudakis
10   Pharmacoepidemiology Group, Bayer AG, Berlin, Germany
,
Marcela Rivera   a
10   Pharmacoepidemiology Group, Bayer AG, Berlin, Germany
,
Bernhard Schaefer   b
10   Pharmacoepidemiology Group, Bayer AG, Berlin, Germany
,
Gunnar Brobert   b
10   Pharmacoepidemiology Group, Bayer AG, Berlin, Germany
,
Craig I. Coleman 
1   Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, Connecticut, United States
2   Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, United States
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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

a At time of study conduct, currently affiliated with Janssen Research and Development, Barcelona, Spain.


b At time of study conduct, currently consultant for Bayer AG.


Supplementary Material



Publication History

Received: 03 March 2023

Accepted: 17 May 2023

Article published online:
10 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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