The Efficacy and Safety of Rivaroxaban and Dalteparin in the Treatment of Cancer Associated Venous Thrombosis
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Venous thromboembolism (VTE) is a complication of malignancy that is associated with significant mortality. The CLOT trial showed superiority of dalteparin in comparison to warfarin in preventing VTE recurrence. Rivaroxaban has been approved for treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE). In the absence of large randomized trials in the oncology population, the efficacy and safety of rivaroxaban for the treatment of VTE in cancer patients needs to be assessed. A single-center retrospective chart review was conducted to assess the efficacy and safety of rivaroxaban compared with dalteparin in cancer-associated thrombosis. Out of 671 patients identified, 286 patients (107 in the rivaroxaban group and 179 in the dalteparin group) were eligible for analysis. The rivaroxaban group had a rate of VTE recurrence at 6 months of 4.9 versus 11.1% with dalteparin (p = 0.252). The incidence of recurrent DVT at 6 months was lower in patients treated with rivaroxaban (0%) compared with dalteparin (8.2%) at 6 months (p = 0.025). Incidence of recurrent PE in the rivaroxaban group (5%) versus dalteparin group (3.1%) at 6 months was not statistically significant (p = 0.675). No significant difference was identified between the rivaroxaban group and dalteparin group in the rate of major bleeding (2.8 vs. 1.1%, respectively). Rivaroxaban was comparable to dalteparin in prevention of VTE recurrence while having no significant differences with major or minor bleeding.
KeywordsVenous thrombosis Cancer associated thrombosis Venous thromboembolism Thrombosis Novel anticoagulants
We thank Rasa Hamilton (H. Lee Moffitt Cancer Center & Research Institute) for editorial assistance.
Ateefa Chaudhury, Asha Balakrishnan, Christy Thai, Bjorn Holmstrom, Sowmya Nanjappa, Zhenjun Ma, Michael V. Jaglal: Study conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the manuscript.
Compliance with Ethical Standards
Conflict of interest
The authors declares that they have no conflicts of interest to disclose.
Human and Animal Rights Statement
All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. For studies with human subjects include the following: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
All persons gave their informed consent prior to their inclusion in the study. Informed consent was obtained from all patients for being included in the study.
- 4.(NCCN) NCCN (2015) Venous thromboembolic diseaseGoogle Scholar
- 10.Investigators E (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010:2499–2510Google Scholar
- 13.Prins MH, Lensing AW, Brighton TA et al (2014) Oral rivaroxaban versus enoxaparin with vitamin K antagonist for the treatment of symptomatic venous thromboembolism in patients with cancer (EINSTEIN-DVT and EINSTEIN-PE): a pooled subgroup analysis of two randomised controlled trials. Lancet Haematol 1:e37–e46CrossRefPubMedGoogle Scholar
- 14.Akl EA, Labedi N, Barba M, et al (2011) Anticoagulation for the long‐term treatment of venous thromboembolism in patients with cancer. The Cochrane LibraryGoogle Scholar