Comparison of rivaroxaban and low molecular weight heparin in the treatment of cancer-associated venous thromboembolism: A Swedish national population-based register study

• Autores: Linder, Marie; Ekbom, Anders; Brobert, Gunnar; Vogtländer, Kai; Balabanova, Yanina; Becattini, Cecilia; Carrier, Marc; Cohen, Alexander T.; Coleman, Craig I.; Khorana, Alok A.; Lee, Agnes Y. Y.; Psaroudakis, George; Abdelgawwad, Khaled; Rivera, Marcela; Schaefer, Bernhard; Giunta, Diego Hernan
• Año de publicación: 2024
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: Cancer-associated thrombosis; Rivaroxaban; Low molecular weight heparin; Recurrent venous thromboembolism; Major bleeding
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

Background Treating cancer-associated venous thromboembolism (CAT) with anticoagulation prevents recurrent venous thromboembolism (rVTE), but increases bleeding risk. Objectives To compare incidence of rVTE, major bleeding, and all-cause mortality for rivaroxaban versus low molecular weight heparin (LMWH) in patients with CAT. Methods We developed a cohort study using Swedish national registers 2013–2019. Patients with CAT (venous thromboembolism within 6 months of cancer diagnosis) were included. Those with other indications or with high bleeding risk cancers were excluded (according to guidelines). Follow-up was from index-CAT until outcome, death, emigration, or end of study. Incidence rates (IR) per 1000 person-years with 95% confidence interval (CI) and propensity score overlap-weighted hazard ratios (HRs) for rivaroxaban versus LMWH were estimated. Results We included 283 patients on rivaroxaban and 5181 on LMWH. The IR for rVTE was 68.7 (95% CI 40.0–109.9) for rivaroxaban, compared with 91.6 (95% CI 81.9–102.0) for LMWH, with adjusted HR 0.77 (95% CI 0.43–1.35). The IR for major bleeding was 23.5 (95% CI 8.6–51.1) for rivaroxaban versus 49.2 (95% CI 42.3–56.9) for LMWH, with adjusted HR 0.62 (95% CI 0.26–1.49). The IR for all-cause mortality was 146.8 (95% CI 103.9–201.5) for rivaroxaban and 565.6 (95% CI 541.8–590.2) for LMWH with adjusted HR 0.48 (95% CI 0.34–0.67). Conclusions Rivaroxaban performed similarly to LMWH for patients with CAT for rVTE and major bleeding. An all-cause mortality benefit was observed for rivaroxaban which potentially may be attributed to residual confounding.
Fil: Linder, Marie. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia
Fil: Ekbom, Anders. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia
Fil: Brobert, Gunnar. Consultant for Bayer AG; Alemania
Fil: Vogtländer, Kai. Bayer AG; Alemania
Fil: Balabanova, Yanina. Bayer AG; Alemania
Fil: Becattini, Cecilia. Università di Perugia; Italia
Fil: Carrier, Marc. University of Ottawa; Canadá
Fil: Cohen, Alexander T.. Kings College London (kcl);
Fil: Coleman, Craig I.. University of Connecticut; Estados Unidos
Fil: Khorana, Alok A.. Cleveland Clinic and Case Comprehensive Cancer Center; Estados Unidos
Fil: Lee, Agnes Y. Y.. BC Cancer; Canadá. University of British Columbia; Canadá
Fil: Psaroudakis, George. Bayer AG; Alemania
Fil: Abdelgawwad, Khaled. Bayer AG; Alemania
Fil: Rivera, Marcela. Consultant for Bayer AG; Alemania
Fil: Schaefer, Bernhard. Bayer AG; Alemania
Fil: Giunta, Diego Hernan. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia