Comparison of Clinical Outcomes in Patients with Active Cancer Receiving Rivaroxaban or Low-Molecular-Weight Heparin : The OSCAR-UK Study
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)..
BACKGROUND: In most patients with cancer-associated venous thromboembolism (CT), essentially those not at high risk of bleeding, guidelines recommend treatment with direct oral anticoagulants as an alternative to low-molecular-weight heparins (LMWHs). Population-based studies comparing these therapies are scarce.
OBJECTIVES: To compare the risk of venous thromboembolism (VTE) recurrences, significant bleeding, and all-cause mortality in patients with CT receiving rivaroxaban or LMWHs.
PATIENTS/METHODS: Using UK Clinical Practice Research Datalink data from 2013 to 2020, we generated a cohort of patients with first CT treated initially with either rivaroxaban or LMWH. Patients were observed 12 months for VTE recurrences, significant bleeds (major bleeds or clinically relevant nonmajor bleeding requiring hospitalization), and all-cause mortality. Overlap weighted sub-distribution hazard ratios (SHRs) compared rivaroxaban with LMWH in an intention-to-treat analysis.
RESULTS: The cohort consisted of 2,259 patients with first CT, 314 receiving rivaroxaban, and 1,945 LMWH, mean age 72.4 and 66.9 years, respectively. In the 12-month observational period, 184 person-years following rivaroxaban and 1,057 following LMWH, 10 and 66 incident recurrent VTE events, 20 and 102 significant bleeds, and 10 and 133 deaths were observed in rivaroxaban and LMWH users, respectively. The weighted SHR at 12 months for VTE recurrences in rivaroxaban compared with LMWH were 0.80 (0.37-1.73); for significant bleeds 1.01 (0.57-1.81); and for all-cause mortality 0.49 (0.23-1.06).
CONCLUSION: Patients with CT, not at high risk of bleeding, treated with either rivaroxaban or LMWH have comparable effectiveness and safety outcomes. This supports the recommendation that rivaroxaban is a reasonable alternative to LMWH for the treatment of CT.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Thrombosis and haemostasis - (2024) vom: 08. Apr. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cohen, Alexander T [VerfasserIn] |
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| Anmerkungen: |
Date Revised 08.04.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1055/a-2259-0662 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367910748 |
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| 100 | 1 | |a Cohen, Alexander T |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparison of Clinical Outcomes in Patients with Active Cancer Receiving Rivaroxaban or Low-Molecular-Weight Heparin |b The OSCAR-UK Study |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 08.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). | ||
| 520 | |a BACKGROUND: In most patients with cancer-associated venous thromboembolism (CT), essentially those not at high risk of bleeding, guidelines recommend treatment with direct oral anticoagulants as an alternative to low-molecular-weight heparins (LMWHs). Population-based studies comparing these therapies are scarce | ||
| 520 | |a OBJECTIVES: To compare the risk of venous thromboembolism (VTE) recurrences, significant bleeding, and all-cause mortality in patients with CT receiving rivaroxaban or LMWHs | ||
| 520 | |a PATIENTS/METHODS: Using UK Clinical Practice Research Datalink data from 2013 to 2020, we generated a cohort of patients with first CT treated initially with either rivaroxaban or LMWH. Patients were observed 12 months for VTE recurrences, significant bleeds (major bleeds or clinically relevant nonmajor bleeding requiring hospitalization), and all-cause mortality. Overlap weighted sub-distribution hazard ratios (SHRs) compared rivaroxaban with LMWH in an intention-to-treat analysis | ||
| 520 | |a RESULTS: The cohort consisted of 2,259 patients with first CT, 314 receiving rivaroxaban, and 1,945 LMWH, mean age 72.4 and 66.9 years, respectively. In the 12-month observational period, 184 person-years following rivaroxaban and 1,057 following LMWH, 10 and 66 incident recurrent VTE events, 20 and 102 significant bleeds, and 10 and 133 deaths were observed in rivaroxaban and LMWH users, respectively. The weighted SHR at 12 months for VTE recurrences in rivaroxaban compared with LMWH were 0.80 (0.37-1.73); for significant bleeds 1.01 (0.57-1.81); and for all-cause mortality 0.49 (0.23-1.06) | ||
| 520 | |a CONCLUSION: Patients with CT, not at high risk of bleeding, treated with either rivaroxaban or LMWH have comparable effectiveness and safety outcomes. This supports the recommendation that rivaroxaban is a reasonable alternative to LMWH for the treatment of CT | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Wallenhorst, Christopher |e verfasserin |4 aut | |
| 700 | 1 | |a Rivera, Marcella |e verfasserin |4 aut | |
| 700 | 1 | |a Ay, Cihan |e verfasserin |4 aut | |
| 700 | 1 | |a Schaefer, Bernhard |e verfasserin |4 aut | |
| 700 | 1 | |a Abdelgawwad, Khaled |e verfasserin |4 aut | |
| 700 | 1 | |a Psaroudakis, George |e verfasserin |4 aut | |
| 700 | 1 | |a Brobert, Gunnar |e verfasserin |4 aut | |
| 700 | 1 | |a Ekbom, Anders |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Agnes Y Y |e verfasserin |4 aut | |
| 700 | 1 | |a Khorana, Alok A |e verfasserin |4 aut | |
| 700 | 1 | |a Becattini, Cecilia |e verfasserin |4 aut | |
| 700 | 1 | |a Carrier, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Coleman, Craig I |e verfasserin |4 aut | |
| 700 | 1 | |a Martinez, Carlos |e verfasserin |4 aut | |
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