Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism
IntroductionIt is unclear how drug-interaction with apixaban influences recurrent venous thromboembolism (VTE) and bleedings in cancer patients.MethodsA post-hoc analysis of a single-arm interventional clinical trial on apixaban treatment of cancer patients with VTE to investigate whether the occurr...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1520725/full |
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| author | Marte Svalastoga Trine-Lise Larsen Trine-Lise Larsen Jorunn Brekke Tone Enden Hege Frøen Herish Garresori Eva Marie Jacobsen Alina Carmen Porojnicu Anne Hansen Ree Anne Hansen Ree Dag Torfoss Elin Osvik Velle Hilde Skuterud Wik Waleed Ghanima Waleed Ghanima Per Morten Sandset Per Morten Sandset Anders Erik Astrup Dahm Anders Erik Astrup Dahm |
| author_facet | Marte Svalastoga Trine-Lise Larsen Trine-Lise Larsen Jorunn Brekke Tone Enden Hege Frøen Herish Garresori Eva Marie Jacobsen Alina Carmen Porojnicu Anne Hansen Ree Anne Hansen Ree Dag Torfoss Elin Osvik Velle Hilde Skuterud Wik Waleed Ghanima Waleed Ghanima Per Morten Sandset Per Morten Sandset Anders Erik Astrup Dahm Anders Erik Astrup Dahm |
| author_sort | Marte Svalastoga |
| collection | DOAJ |
| description | IntroductionIt is unclear how drug-interaction with apixaban influences recurrent venous thromboembolism (VTE) and bleedings in cancer patients.MethodsA post-hoc analysis of a single-arm interventional clinical trial on apixaban treatment of cancer patients with VTE to investigate whether the occurrence of any of the endpoints could be associated with the concurrent use of an interacting drug. Drugs taken by the patients during the trial period were categorized as either increasing bleeding risk, increasing thrombosis risk, both or neither.Results298 patients were divided into groups based on whether they used no interacting drugs (controls, n=74), drugs increasing bleeding risk (n=55), drugs increasing thrombosis risk (n=8), or both (n=161). Odds ratios (OR) were calculated for recurrent VTE, clinically relevant non-major bleeding (CRNMB), and major bleeding during the 36-month follow-up period. Each patient took a median of 13 different drugs over the study period. 67% of the patients used drugs expected to both increase bleeding and thrombosis. The use of fluconazole appeared associated with CRNMB (OR 3.6, 95% confidence interval (CI) 0.99-13), but not with major bleeding (OR 0.56, 95% CI 0.06 - 4.8). Non-steroid anti-inflammatory drugs were not associated with CRNMB (OR 1.0, 95% CI 0.25-4.1) or major bleedings (OR 0.72, 95% CI 0.14 - 3.6). Use of antiplatelet therapy was not associated with CRNMB (OR 0.75, 95% CI, 0.22 - 2.58) or major bleeding (OR 0.2, 95% CI, 0.02-1.6). There were no major bleedings in 23 patients using aprepitant nor in the 10 patients taking macrolides. We found no association between drugs and recurrent VTE, except that there were no recurrent VTE in 19 patients using bevacizumab.ConclusionsDespite the high number of drugs taken that could potentially interact with apixaban, none were found to clearly influence clinical outcomes, except that fluconazole may increase the risk of CRNMB. |
| format | Article |
| id | doaj-art-35f21018bada4480897cc32011372530 |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj-art-35f21018bada4480897cc320113725302025-01-27T05:14:32ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-01-011510.3389/fonc.2025.15207251520725Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolismMarte Svalastoga0Trine-Lise Larsen1Trine-Lise Larsen2Jorunn Brekke3Tone Enden4Hege Frøen5Herish Garresori6Eva Marie Jacobsen7Alina Carmen Porojnicu8Anne Hansen Ree9Anne Hansen Ree10Dag Torfoss11Elin Osvik Velle12Hilde Skuterud Wik13Waleed Ghanima14Waleed Ghanima15Per Morten Sandset16Per Morten Sandset17Anders Erik Astrup Dahm18Anders Erik Astrup Dahm19Institute of Clinical Medicine, University of Oslo, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Haematology, Akershus University Hospital, Lørenskog, NorwayDepartment of Oncology, Haukeland University Hospital, Bergen, NorwayDepartment of Radiology, Oslo University Hospital, Oslo, NorwayDepartment of Medicine, Baerum Hospital, Vestre Viken Hospital Trust, Drammen, NorwayDepartment of Oncology, Stavanger University Hospital, Stavanger, NorwayDepartment of Haematology, Oslo University Hospital, Oslo, NorwayDepartment of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Oncology, Akershus University Hospital, Lørenskog, Norway0Department of Oncology, Oslo University Hospital, Oslo, Norway1Department of Medicine, Volda Hospital, Møre and Romsdal Hospital Trust Volda, Volda, NorwayDepartment of Haematology, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, Norway2Clinic of Internal Medicine, Østfold Hospital, Grålum, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Haematology, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Haematology, Akershus University Hospital, Lørenskog, NorwayIntroductionIt is unclear how drug-interaction with apixaban influences recurrent venous thromboembolism (VTE) and bleedings in cancer patients.MethodsA post-hoc analysis of a single-arm interventional clinical trial on apixaban treatment of cancer patients with VTE to investigate whether the occurrence of any of the endpoints could be associated with the concurrent use of an interacting drug. Drugs taken by the patients during the trial period were categorized as either increasing bleeding risk, increasing thrombosis risk, both or neither.Results298 patients were divided into groups based on whether they used no interacting drugs (controls, n=74), drugs increasing bleeding risk (n=55), drugs increasing thrombosis risk (n=8), or both (n=161). Odds ratios (OR) were calculated for recurrent VTE, clinically relevant non-major bleeding (CRNMB), and major bleeding during the 36-month follow-up period. Each patient took a median of 13 different drugs over the study period. 67% of the patients used drugs expected to both increase bleeding and thrombosis. The use of fluconazole appeared associated with CRNMB (OR 3.6, 95% confidence interval (CI) 0.99-13), but not with major bleeding (OR 0.56, 95% CI 0.06 - 4.8). Non-steroid anti-inflammatory drugs were not associated with CRNMB (OR 1.0, 95% CI 0.25-4.1) or major bleedings (OR 0.72, 95% CI 0.14 - 3.6). Use of antiplatelet therapy was not associated with CRNMB (OR 0.75, 95% CI, 0.22 - 2.58) or major bleeding (OR 0.2, 95% CI, 0.02-1.6). There were no major bleedings in 23 patients using aprepitant nor in the 10 patients taking macrolides. We found no association between drugs and recurrent VTE, except that there were no recurrent VTE in 19 patients using bevacizumab.ConclusionsDespite the high number of drugs taken that could potentially interact with apixaban, none were found to clearly influence clinical outcomes, except that fluconazole may increase the risk of CRNMB.https://www.frontiersin.org/articles/10.3389/fonc.2025.1520725/fullvenous thromboembolismapixabancancerdrug-drug interactionbleeding |
| spellingShingle | Marte Svalastoga Trine-Lise Larsen Trine-Lise Larsen Jorunn Brekke Tone Enden Hege Frøen Herish Garresori Eva Marie Jacobsen Alina Carmen Porojnicu Anne Hansen Ree Anne Hansen Ree Dag Torfoss Elin Osvik Velle Hilde Skuterud Wik Waleed Ghanima Waleed Ghanima Per Morten Sandset Per Morten Sandset Anders Erik Astrup Dahm Anders Erik Astrup Dahm Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism Frontiers in Oncology venous thromboembolism apixaban cancer drug-drug interaction bleeding |
| title | Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism |
| title_full | Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism |
| title_fullStr | Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism |
| title_full_unstemmed | Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism |
| title_short | Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism |
| title_sort | effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism |
| topic | venous thromboembolism apixaban cancer drug-drug interaction bleeding |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1520725/full |
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