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Rivaroxaban treatment of cancer‐associated venous thromboembolism: Memorial Sloan Kettering Cancer Center institutional experience

BACKGROUND: Low‐molecular‐weight heparin has been the preferred treatment of cancer‐associated thrombosis (CAT); however, emerging data support the use of direct oral anticoagulants (DOACs). OBJECTIVES: The Memorial Sloan Kettering Cancer Center Clinical Pathway has served as the institutional guide...

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Autores principales: Soff, Gerald A., Mones, Jodi, Wilkins, Cy, Devlin, Sean, Haegler‐Laube, Eva, Wills, Jonathan, Sarasohn, Debra M., Juluru, Krishna, Singer, Michael, Miao, Yimei, Batista, Jeanette, Mantha, Simon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611365/
https://www.ncbi.nlm.nih.gov/pubmed/31294321
http://dx.doi.org/10.1002/rth2.12215
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author Soff, Gerald A.
Mones, Jodi
Wilkins, Cy
Devlin, Sean
Haegler‐Laube, Eva
Wills, Jonathan
Sarasohn, Debra M.
Juluru, Krishna
Singer, Michael
Miao, Yimei
Batista, Jeanette
Mantha, Simon
author_facet Soff, Gerald A.
Mones, Jodi
Wilkins, Cy
Devlin, Sean
Haegler‐Laube, Eva
Wills, Jonathan
Sarasohn, Debra M.
Juluru, Krishna
Singer, Michael
Miao, Yimei
Batista, Jeanette
Mantha, Simon
author_sort Soff, Gerald A.
collection PubMed
description BACKGROUND: Low‐molecular‐weight heparin has been the preferred treatment of cancer‐associated thrombosis (CAT); however, emerging data support the use of direct oral anticoagulants (DOACs). OBJECTIVES: The Memorial Sloan Kettering Cancer Center Clinical Pathway has served as the institutional guideline for the use of rivaroxaban to treat CAT since 2014. Key elements are to recommend against use of a DOAC in patients with active gastrointestinal (GI) or genitourinary tract lesions, and a prespecified dose reduction in the elderly (75+ years old). We present our institutional experience for treatment of CAT. METHODS: From January 2014 through September 2016, 1072 patients began rivaroxaban treatment for CAT; 91.9% had a solid tumor, 8.1% had hematologic malignancies, and 75% of patients with solid tumors had metastatic disease. All patients with CAT treated with rivaroxaban were included in this analysis, regardless of adherence to the Clinical Pathway. RESULTS: The 6‐month cumulative incidence of recurrent venous thromboembolism and major bleeding were 4.2% (95% confidence interval [CI], 2.7%‐5.7%) and 2.2% (95% CI, 1.1%‐3.2%), respectively. The incidence of clinically relevant non–major bleeding leading to discontinuation of rivaroxaban for at least 7 days was 5.5% (95% CI,  3.7%‐7.1%), and 73.3% of major bleeds occurred in the GI tract. The 6‐month cumulative mortality rate was 22.2% (95% CI, 19.4%‐24.9%). The elderly had similar rates of recurrent thrombosis and bleeding as those aged under 75 years. CONCLUSION: Our institutional experience suggests that in appropriately selected patients, rivaroxaban may be used for treatment of CAT with promising safety and efficacy.
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spelling pubmed-66113652019-07-10 Rivaroxaban treatment of cancer‐associated venous thromboembolism: Memorial Sloan Kettering Cancer Center institutional experience Soff, Gerald A. Mones, Jodi Wilkins, Cy Devlin, Sean Haegler‐Laube, Eva Wills, Jonathan Sarasohn, Debra M. Juluru, Krishna Singer, Michael Miao, Yimei Batista, Jeanette Mantha, Simon Res Pract Thromb Haemost Original Articles: Thrombosis BACKGROUND: Low‐molecular‐weight heparin has been the preferred treatment of cancer‐associated thrombosis (CAT); however, emerging data support the use of direct oral anticoagulants (DOACs). OBJECTIVES: The Memorial Sloan Kettering Cancer Center Clinical Pathway has served as the institutional guideline for the use of rivaroxaban to treat CAT since 2014. Key elements are to recommend against use of a DOAC in patients with active gastrointestinal (GI) or genitourinary tract lesions, and a prespecified dose reduction in the elderly (75+ years old). We present our institutional experience for treatment of CAT. METHODS: From January 2014 through September 2016, 1072 patients began rivaroxaban treatment for CAT; 91.9% had a solid tumor, 8.1% had hematologic malignancies, and 75% of patients with solid tumors had metastatic disease. All patients with CAT treated with rivaroxaban were included in this analysis, regardless of adherence to the Clinical Pathway. RESULTS: The 6‐month cumulative incidence of recurrent venous thromboembolism and major bleeding were 4.2% (95% confidence interval [CI], 2.7%‐5.7%) and 2.2% (95% CI, 1.1%‐3.2%), respectively. The incidence of clinically relevant non–major bleeding leading to discontinuation of rivaroxaban for at least 7 days was 5.5% (95% CI,  3.7%‐7.1%), and 73.3% of major bleeds occurred in the GI tract. The 6‐month cumulative mortality rate was 22.2% (95% CI, 19.4%‐24.9%). The elderly had similar rates of recurrent thrombosis and bleeding as those aged under 75 years. CONCLUSION: Our institutional experience suggests that in appropriately selected patients, rivaroxaban may be used for treatment of CAT with promising safety and efficacy. John Wiley and Sons Inc. 2019-05-24 /pmc/articles/PMC6611365/ /pubmed/31294321 http://dx.doi.org/10.1002/rth2.12215 Text en © 2019 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals, Inc on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles: Thrombosis
Soff, Gerald A.
Mones, Jodi
Wilkins, Cy
Devlin, Sean
Haegler‐Laube, Eva
Wills, Jonathan
Sarasohn, Debra M.
Juluru, Krishna
Singer, Michael
Miao, Yimei
Batista, Jeanette
Mantha, Simon
Rivaroxaban treatment of cancer‐associated venous thromboembolism: Memorial Sloan Kettering Cancer Center institutional experience
title Rivaroxaban treatment of cancer‐associated venous thromboembolism: Memorial Sloan Kettering Cancer Center institutional experience
title_full Rivaroxaban treatment of cancer‐associated venous thromboembolism: Memorial Sloan Kettering Cancer Center institutional experience
title_fullStr Rivaroxaban treatment of cancer‐associated venous thromboembolism: Memorial Sloan Kettering Cancer Center institutional experience
title_full_unstemmed Rivaroxaban treatment of cancer‐associated venous thromboembolism: Memorial Sloan Kettering Cancer Center institutional experience
title_short Rivaroxaban treatment of cancer‐associated venous thromboembolism: Memorial Sloan Kettering Cancer Center institutional experience
title_sort rivaroxaban treatment of cancer‐associated venous thromboembolism: memorial sloan kettering cancer center institutional experience
topic Original Articles: Thrombosis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611365/
https://www.ncbi.nlm.nih.gov/pubmed/31294321
http://dx.doi.org/10.1002/rth2.12215
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