Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer
RCT (n=1,155) found that apixaban was non-inferior to subcutaneous dalteparin for recurrent VTE (5.6% vs 7.9%, p<0.001 for non-inferiority). Major bleeding rates were similar (3.8% vs 4.0%, HR 0.82, p=0.60 for difference).
Source:
New England Journal of Medicine
SPS commentary:
A related editorial states that although these data are positive, clinicians need to careful as to choosing anticoagulants in this scenario. For example, patients with primary brain tumours, known intracerebral metastases, or acute leukaemia were excluded from participating in this study. Also, low-molecular-weight heparin is likely to be preferred in patients in whom drug–drug interaction is a concern and in those who have undergone surgery involving the upper gastrointestinal tract because absorption of all direct oral anticoagulants occurs in the stomach or proximal small bowel.
It concludes however that since the landscape of cancer therapy and survival is rapidly changing, anticoagulant therapy in patients with cancer needs to keep pace. Direct oral anticoagulants mark a welcome step forward in providing effective and safe therapeutic choices for patients with cancer and venous thromboembolism.