Risk of recurrence and bleeding in patients with cancer‐associated venous thromboembolism treated with rivaroxaban: A nationwide cohort study
Abstract Background Rivaroxaban could be an attractive alternative to low molecular weight heparin for the treatment of cancer‐associated venous thromboembolism (VTE) but the safety and effectiveness remain unclear. We examined risk of recurrent VTE and major bleeding associated with rivaroxaban tre...
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| Language: | English |
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Wiley
2019-03-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.1997 |
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| author | Mette Søgaard Peter Brønnum Nielsen Flemming Skjøth Jette Nordstrøm Kjældgaard Torben Bjerregaard Larsen |
| author_facet | Mette Søgaard Peter Brønnum Nielsen Flemming Skjøth Jette Nordstrøm Kjældgaard Torben Bjerregaard Larsen |
| author_sort | Mette Søgaard |
| collection | DOAJ |
| description | Abstract Background Rivaroxaban could be an attractive alternative to low molecular weight heparin for the treatment of cancer‐associated venous thromboembolism (VTE) but the safety and effectiveness remain unclear. We examined risk of recurrent VTE and major bleeding associated with rivaroxaban treatment of cancer‐associated VTE. Methods Through linkage of nationwide Danish registries, we identified all adults with cancer‐associated VTE initiating treatment with rivaroxaban, 2012‐2017. We estimated rates and absolute risk of the primary outcome of recurrent VTE and major bleeding; all‐cause mortality was studied as a secondary outcome. Results We identified 8901 patients with cancer‐associated VTE of whom 476 (5.3%) redeemed a prescription for rivaroxaban within 30 days of VTE diagnosis (mean age 71.5 years, 41% females, 57% with pulmonary embolism). Median time from cancer diagnosis to rivaroxaban prescription was 31 days (interquartile range 12‐73 days). Most frequent cancers were gastrointestinal (26.1%), genitourinary (23.3%), and hematological cancer (12.6%). Few had distant metastases (7.1%). At 6 months, recurrent VTE occurred in 6.1% (15.1 events per 100 person‐years) with the highest absolute risks for genitourinary cancer (8.1%), gastrointestinal cancer (7.3%), and breast cancer (6.5%). Major bleeding occurred in 1.9% (5.3 events per 100 person‐years), in particular, in genitourinary cancer (4.5%) and lung cancer (4.2%). Eighty deaths (17.8%) occurred during follow up. Conclusion In this clinical practice setting, rivaroxaban was rarely used for cancer‐associated VTE. However, among those who received rivaroxaban, the treatment appeared safe and effective with rates comparable to previous studies of selected populations. |
| format | Article |
| id | doaj-art-60d86cea45fa4a7780a13c1cc1fc682a |
| institution | Kabale University |
| issn | 2045-7634 |
| language | English |
| publishDate | 2019-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-60d86cea45fa4a7780a13c1cc1fc682a2025-01-31T08:47:42ZengWileyCancer Medicine2045-76342019-03-01831044105310.1002/cam4.1997Risk of recurrence and bleeding in patients with cancer‐associated venous thromboembolism treated with rivaroxaban: A nationwide cohort studyMette Søgaard0Peter Brønnum Nielsen1Flemming Skjøth2Jette Nordstrøm Kjældgaard3Torben Bjerregaard Larsen4Department of Cardiology Aalborg University Hospital Aalborg DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkAalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health Aalborg University Aalborg DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkDepartment of Cardiology Aalborg University Hospital Aalborg DenmarkAbstract Background Rivaroxaban could be an attractive alternative to low molecular weight heparin for the treatment of cancer‐associated venous thromboembolism (VTE) but the safety and effectiveness remain unclear. We examined risk of recurrent VTE and major bleeding associated with rivaroxaban treatment of cancer‐associated VTE. Methods Through linkage of nationwide Danish registries, we identified all adults with cancer‐associated VTE initiating treatment with rivaroxaban, 2012‐2017. We estimated rates and absolute risk of the primary outcome of recurrent VTE and major bleeding; all‐cause mortality was studied as a secondary outcome. Results We identified 8901 patients with cancer‐associated VTE of whom 476 (5.3%) redeemed a prescription for rivaroxaban within 30 days of VTE diagnosis (mean age 71.5 years, 41% females, 57% with pulmonary embolism). Median time from cancer diagnosis to rivaroxaban prescription was 31 days (interquartile range 12‐73 days). Most frequent cancers were gastrointestinal (26.1%), genitourinary (23.3%), and hematological cancer (12.6%). Few had distant metastases (7.1%). At 6 months, recurrent VTE occurred in 6.1% (15.1 events per 100 person‐years) with the highest absolute risks for genitourinary cancer (8.1%), gastrointestinal cancer (7.3%), and breast cancer (6.5%). Major bleeding occurred in 1.9% (5.3 events per 100 person‐years), in particular, in genitourinary cancer (4.5%) and lung cancer (4.2%). Eighty deaths (17.8%) occurred during follow up. Conclusion In this clinical practice setting, rivaroxaban was rarely used for cancer‐associated VTE. However, among those who received rivaroxaban, the treatment appeared safe and effective with rates comparable to previous studies of selected populations.https://doi.org/10.1002/cam4.1997anticoagulantsbleedingcancerrivaroxabanvenous thromboembolism |
| spellingShingle | Mette Søgaard Peter Brønnum Nielsen Flemming Skjøth Jette Nordstrøm Kjældgaard Torben Bjerregaard Larsen Risk of recurrence and bleeding in patients with cancer‐associated venous thromboembolism treated with rivaroxaban: A nationwide cohort study Cancer Medicine anticoagulants bleeding cancer rivaroxaban venous thromboembolism |
| title | Risk of recurrence and bleeding in patients with cancer‐associated venous thromboembolism treated with rivaroxaban: A nationwide cohort study |
| title_full | Risk of recurrence and bleeding in patients with cancer‐associated venous thromboembolism treated with rivaroxaban: A nationwide cohort study |
| title_fullStr | Risk of recurrence and bleeding in patients with cancer‐associated venous thromboembolism treated with rivaroxaban: A nationwide cohort study |
| title_full_unstemmed | Risk of recurrence and bleeding in patients with cancer‐associated venous thromboembolism treated with rivaroxaban: A nationwide cohort study |
| title_short | Risk of recurrence and bleeding in patients with cancer‐associated venous thromboembolism treated with rivaroxaban: A nationwide cohort study |
| title_sort | risk of recurrence and bleeding in patients with cancer associated venous thromboembolism treated with rivaroxaban a nationwide cohort study |
| topic | anticoagulants bleeding cancer rivaroxaban venous thromboembolism |
| url | https://doi.org/10.1002/cam4.1997 |
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