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Anticoagulation prescribing patterns in patients with cancer

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Abstract

Cancer is a known hypercoagulable state that leads to an increased risk of venous thromboembolism (VTE). Low molecular weight heparin remains the preferred anticoagulant for VTE in patients with cancer over vitamin K antagonist. However, the preferred anticoagulant in prevention of stroke and systemic embolism in atrial fibrillation (AF) in patients with cancer has yet to be determined. The direct oral anticoagulants (DOACs) are increasingly being utilized; however their role in cancer has only recently been investigated. The objective of this retrospective cohort was to describe real-world anticoagulation prescribing patterns in cancer patients at a large academic medical center between January 1, 2013 and October 31, 2016. We sought to assess the safety, tolerability, and efficacy of DOACs in patients with cancer for either VTE and/or AF. Patient demographic, clinical characteristics, as well as bleeding and thrombotic events were collected. There were 214 patients in our analysis, of which 71 patients (33%) received a DOAC [apixaban (n = 22), dabigatran (n = 17), and rivaroxaban (n = 32)]. There were fewer bleeding events and/or discontinuations in the DOAC group compared to enoxaparin (13 vs. 27, p = 0.022). There was no difference in major or minor bleeds or thromboembolic events in comparing DOAC to enoxaparin or DOAC to warfarin. This was a retrospective, single-institution study assessing the safety and efficacy of DOACs compared to warfarin or enoxaparin in patients with cancer. DOACs may represent an alternative to warfarin or enoxaparin in patients with cancer for VTE and/or stroke reduction in AF.

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Authors and Affiliations

  1. Department of Pharmacy, PGY-1 Pharmacy Resident, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    Elaine Xiang

  2. Department of Pharmacy, Clinical Pharmacotherapy Manager: Internal Medicine & Anticoagulation, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    Tania Ahuja

  3. Department of Pharmacy, Clinical Pharmacotherapy Specialist: Internal Medicine, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    Veronica Raco

  4. Department of Pharmacy, Clinical Pharmacotherapy Manager: Heamtology/Oncology, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    Frank Cirrone

  5. Department of Medicine, Antithrombotic Therapy Team, Medical Director, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    David Green

  6. Department of Pharmacy, Director of Clinical Pharmacy Services, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    John Papadopoulos

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  1. Elaine Xiang
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  2. Tania Ahuja
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Correspondence to Tania Ahuja.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Xiang, E., Ahuja, T., Raco, V. et al. Anticoagulation prescribing patterns in patients with cancer. J Thromb Thrombolysis 45, 89–98 (2018). https://doi.org/10.1007/s11239-017-1558-1

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