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Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?

BACKGROUND: Venous thromboembolic events (VTEs) are common and potentially fatal complications in cancer patients, and they are responsible for the second most common cause of death. Low molecular weight heparin (LMWH) is the gold-standard treatment, but the costs involved limit its use, especially...

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Autores principales: Xavier, Flávia Dias, Hoff, Paulo Marcelo Gehm, Braghiroli, Maria Ignez, Paterlini, Ana Carolina Carvalho Rocha, Souza, Karla Teixeira, Faria, Luiza Dib Batista Bugiato, Ferreira, Fernando Sergio Blumm, Machado, Karime Kalil, Fernandes, Gustavo dos Santos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Clinical Oncology 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493228/
https://www.ncbi.nlm.nih.gov/pubmed/28717737
http://dx.doi.org/10.1200/JGO.2015.002527
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author Xavier, Flávia Dias
Hoff, Paulo Marcelo Gehm
Braghiroli, Maria Ignez
Paterlini, Ana Carolina Carvalho Rocha
Souza, Karla Teixeira
Faria, Luiza Dib Batista Bugiato
Ferreira, Fernando Sergio Blumm
Machado, Karime Kalil
Fernandes, Gustavo dos Santos
author_facet Xavier, Flávia Dias
Hoff, Paulo Marcelo Gehm
Braghiroli, Maria Ignez
Paterlini, Ana Carolina Carvalho Rocha
Souza, Karla Teixeira
Faria, Luiza Dib Batista Bugiato
Ferreira, Fernando Sergio Blumm
Machado, Karime Kalil
Fernandes, Gustavo dos Santos
author_sort Xavier, Flávia Dias
collection PubMed
description BACKGROUND: Venous thromboembolic events (VTEs) are common and potentially fatal complications in cancer patients, and they are responsible for the second most common cause of death. Low molecular weight heparin (LMWH) is the gold-standard treatment, but the costs involved limit its use, especially in developing countries. Recently, the oral anticoagulant rivaroxaban, which directly inhibits factor Xa, was approved for VTE treatment. METHODS: We conducted a retrospective analysis from January 2009 to February 2014 with patients who had cancer and VTE who were receiving rivaroxaban. We compared the efficacy, safety, and cost of rivaroxaban and low molecular weight heparin (LMWH) alone or followed by vitamin K antagonists. RESULTS: Forty-one patients were identified, with a median age of 62.5 years. The most frequent tumor histology was adenocarcinoma (78%), which was most often found in the colon (26.8%). Most participants had advanced disease and an implanted central venous catheter. Patients’ VTE risk-assessment scores were low (12.5%), intermediate (50%), and high (35.5%). Pulmonary thromboembolism was reported in 41.4% of patients, but inferior limb thrombosis was reported only in 14.6%; 43.9% of patients received enoxaparin before starting rivaroxaban. Rivaroxaban was used for a median time of 5.5 months. Nonmajor bleeding was reported in 12.2% of patients, and rethrombosis was reported in 12.2%. In our study, rivaroxaban was as safe and effective as enoxaparin/vitamin K antagonists (P = .54 and P = .25, respectively) or LMWH (P = .46 and P = .29, respectively). CONCLUSION: Although our study was a retrospective analysis, our results suggest that in this cohort of oncologic patients, rivaroxaban was safe and effective. Its oral route and lower cost make it an attractive alternative to LMWH, improving management of patients with cancer in low-income countries. Additional studies are necessary to confirm our data.
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spelling pubmed-54932282017-07-17 Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis? Xavier, Flávia Dias Hoff, Paulo Marcelo Gehm Braghiroli, Maria Ignez Paterlini, Ana Carolina Carvalho Rocha Souza, Karla Teixeira Faria, Luiza Dib Batista Bugiato Ferreira, Fernando Sergio Blumm Machado, Karime Kalil Fernandes, Gustavo dos Santos J Glob Oncol ORIGINAL REPORTS BACKGROUND: Venous thromboembolic events (VTEs) are common and potentially fatal complications in cancer patients, and they are responsible for the second most common cause of death. Low molecular weight heparin (LMWH) is the gold-standard treatment, but the costs involved limit its use, especially in developing countries. Recently, the oral anticoagulant rivaroxaban, which directly inhibits factor Xa, was approved for VTE treatment. METHODS: We conducted a retrospective analysis from January 2009 to February 2014 with patients who had cancer and VTE who were receiving rivaroxaban. We compared the efficacy, safety, and cost of rivaroxaban and low molecular weight heparin (LMWH) alone or followed by vitamin K antagonists. RESULTS: Forty-one patients were identified, with a median age of 62.5 years. The most frequent tumor histology was adenocarcinoma (78%), which was most often found in the colon (26.8%). Most participants had advanced disease and an implanted central venous catheter. Patients’ VTE risk-assessment scores were low (12.5%), intermediate (50%), and high (35.5%). Pulmonary thromboembolism was reported in 41.4% of patients, but inferior limb thrombosis was reported only in 14.6%; 43.9% of patients received enoxaparin before starting rivaroxaban. Rivaroxaban was used for a median time of 5.5 months. Nonmajor bleeding was reported in 12.2% of patients, and rethrombosis was reported in 12.2%. In our study, rivaroxaban was as safe and effective as enoxaparin/vitamin K antagonists (P = .54 and P = .25, respectively) or LMWH (P = .46 and P = .29, respectively). CONCLUSION: Although our study was a retrospective analysis, our results suggest that in this cohort of oncologic patients, rivaroxaban was safe and effective. Its oral route and lower cost make it an attractive alternative to LMWH, improving management of patients with cancer in low-income countries. Additional studies are necessary to confirm our data. American Society of Clinical Oncology 2016-06-22 /pmc/articles/PMC5493228/ /pubmed/28717737 http://dx.doi.org/10.1200/JGO.2015.002527 Text en © 2016 by American Society of Clinical Oncology http://creativecommons.org/licenses/by/4.0/ Licensed under the Creative Commons Attribution 4.0 License: http://creativecommons.org/licenses/by/4.0/
spellingShingle ORIGINAL REPORTS
Xavier, Flávia Dias
Hoff, Paulo Marcelo Gehm
Braghiroli, Maria Ignez
Paterlini, Ana Carolina Carvalho Rocha
Souza, Karla Teixeira
Faria, Luiza Dib Batista Bugiato
Ferreira, Fernando Sergio Blumm
Machado, Karime Kalil
Fernandes, Gustavo dos Santos
Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?
title Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?
title_full Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?
title_fullStr Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?
title_full_unstemmed Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?
title_short Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?
title_sort rivaroxaban: an affordable and effective alternative in cancer-related thrombosis?
topic ORIGINAL REPORTS
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493228/
https://www.ncbi.nlm.nih.gov/pubmed/28717737
http://dx.doi.org/10.1200/JGO.2015.002527
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