Efficacy and safety of rivaroxaban compared to enoxaparin in treatment of cancer-associated venous thromboembolism

Benjamin Simmons, Waldemar Wysokinski, Rayya A. Saadiq, Dalene Bott-Kitslaar, Stanislav Henkin, Ana Casanegra, Charles Lenz, Paul Daniels, Haraldur Bjarnason, Emily Vargas, David Hodge, Sara J. Holton, James R Cerhan, Charles Lawrence Loprinzi, Robert McBane

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Low molecular weight heparin (LMWH) is the guideline-endorsed treatment for cancer-associated venous thromboembolism (cVTE). Study objectives were to compare the efficacy and safety of rivaroxaban and enoxaparin in cVTE. Methods: Using a cohort study design, consecutive patients with cVTE (3/1/2013-7/31/2016), enrolled in the Mayo Thrombophilia Clinic Direct Oral Anticoagulants Registry, were compared to contemporary cancer patients receiving enoxaparin. The cumulative incidence of venous thromboembolism (VTE) recurrence, major and clinically relevant non-major bleeding, and survival were assessed at 3 and 12 months. Results: Ninety-eight patients received rivaroxaban (51% female, mean age 63 ± 12 years) and 168 enoxaparin (34.5% female, mean age 62 ± 15 years). The most common cancers included gastrointestinal/pancreatic, genitourinary and hematologic cancers. More than half of patients had pulmonary emboli at presentation. More than half had metastases, and two-thirds were receiving chemotherapy. At 3 months, there were no differences in VTE recurrence (rivaroxaban 1.0% vs enoxaparin 4.2%; P =.15), major bleeding (rivaroxaban 5.1% vs enoxaparin 3.6%; P =.55), or all-cause mortality (rivaroxaban 4.1% vs enoxaparin 8.9%; P =.14). At 12 months, these outcomes did not differ by treatment strategy. Conclusion: The results of this “real-world” experience with cVTE suggest that rivaroxaban may offer a safe and effective alternative to LMWH.

Original languageEnglish (US)
Pages (from-to)136-142
Number of pages7
JournalEuropean Journal of Haematology
Volume101
Issue number2
DOIs
StatePublished - Aug 1 2018

Fingerprint

Enoxaparin
Second Primary Neoplasms
Venous Thromboembolism
Safety
Low Molecular Weight Heparin
Neoplasms
Urogenital Neoplasms
Hemorrhage
Recurrence
Gastrointestinal Neoplasms
Thrombophilia
Embolism
Anticoagulants
Registries
Rivaroxaban
Cohort Studies
Guidelines
Neoplasm Metastasis
Drug Therapy
Lung

Keywords

  • cancer
  • enoxaparin
  • low molecular weight heparin
  • rivaroxaban
  • venous thromboembolism

ASJC Scopus subject areas

  • Hematology

Cite this

Simmons, B., Wysokinski, W., Saadiq, R. A., Bott-Kitslaar, D., Henkin, S., Casanegra, A., ... McBane, R. (2018). Efficacy and safety of rivaroxaban compared to enoxaparin in treatment of cancer-associated venous thromboembolism. European Journal of Haematology, 101(2), 136-142. https://doi.org/10.1111/ejh.13074

Efficacy and safety of rivaroxaban compared to enoxaparin in treatment of cancer-associated venous thromboembolism. / Simmons, Benjamin; Wysokinski, Waldemar; Saadiq, Rayya A.; Bott-Kitslaar, Dalene; Henkin, Stanislav; Casanegra, Ana; Lenz, Charles; Daniels, Paul; Bjarnason, Haraldur; Vargas, Emily; Hodge, David; Holton, Sara J.; Cerhan, James R; Loprinzi, Charles Lawrence; McBane, Robert.

In: European Journal of Haematology, Vol. 101, No. 2, 01.08.2018, p. 136-142.

Research output: Contribution to journalArticle

Simmons, B, Wysokinski, W, Saadiq, RA, Bott-Kitslaar, D, Henkin, S, Casanegra, A, Lenz, C, Daniels, P, Bjarnason, H, Vargas, E, Hodge, D, Holton, SJ, Cerhan, JR, Loprinzi, CL & McBane, R 2018, 'Efficacy and safety of rivaroxaban compared to enoxaparin in treatment of cancer-associated venous thromboembolism', European Journal of Haematology, vol. 101, no. 2, pp. 136-142. https://doi.org/10.1111/ejh.13074
Simmons, Benjamin ; Wysokinski, Waldemar ; Saadiq, Rayya A. ; Bott-Kitslaar, Dalene ; Henkin, Stanislav ; Casanegra, Ana ; Lenz, Charles ; Daniels, Paul ; Bjarnason, Haraldur ; Vargas, Emily ; Hodge, David ; Holton, Sara J. ; Cerhan, James R ; Loprinzi, Charles Lawrence ; McBane, Robert. / Efficacy and safety of rivaroxaban compared to enoxaparin in treatment of cancer-associated venous thromboembolism. In: European Journal of Haematology. 2018 ; Vol. 101, No. 2. pp. 136-142.
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abstract = "Background: Low molecular weight heparin (LMWH) is the guideline-endorsed treatment for cancer-associated venous thromboembolism (cVTE). Study objectives were to compare the efficacy and safety of rivaroxaban and enoxaparin in cVTE. Methods: Using a cohort study design, consecutive patients with cVTE (3/1/2013-7/31/2016), enrolled in the Mayo Thrombophilia Clinic Direct Oral Anticoagulants Registry, were compared to contemporary cancer patients receiving enoxaparin. The cumulative incidence of venous thromboembolism (VTE) recurrence, major and clinically relevant non-major bleeding, and survival were assessed at 3 and 12 months. Results: Ninety-eight patients received rivaroxaban (51{\%} female, mean age 63 ± 12 years) and 168 enoxaparin (34.5{\%} female, mean age 62 ± 15 years). The most common cancers included gastrointestinal/pancreatic, genitourinary and hematologic cancers. More than half of patients had pulmonary emboli at presentation. More than half had metastases, and two-thirds were receiving chemotherapy. At 3 months, there were no differences in VTE recurrence (rivaroxaban 1.0{\%} vs enoxaparin 4.2{\%}; P =.15), major bleeding (rivaroxaban 5.1{\%} vs enoxaparin 3.6{\%}; P =.55), or all-cause mortality (rivaroxaban 4.1{\%} vs enoxaparin 8.9{\%}; P =.14). At 12 months, these outcomes did not differ by treatment strategy. Conclusion: The results of this “real-world” experience with cVTE suggest that rivaroxaban may offer a safe and effective alternative to LMWH.",
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AU - Bott-Kitslaar, Dalene

AU - Henkin, Stanislav

AU - Casanegra, Ana

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