Patterns of VTE treatment with rivaroxaban in cancer patients – Results of the prospective Dresden NOAC registry (NCT01588119)

S. Endig, S. Marten, A. Reitter, K. Daschkow, L. Tittl, J. Beyer-Westendorf (Dresden, Germany)

Venous Thrombosis
Date: 17.02.2017,
Time: 08:00 - 09:15

Objective: For patients with cancer associated thrombosis (CAT), treatment with low-molecular weight heparin (LMWH) is recommended but direct oral anticoagulants such as rivaroxaban are used in some patients. However, data on characteristics and outcomes of CAT patients receiving rivaroxaban treatment in daily care are scarce. To evaluate the effectiveness and safety of CAT treatment with rivaroxaban in daily care.

Methods: From the multicentric Dresden NOAC Registry a subgroup of cancer patients receiving CAT therapy with rivaroxaban was evaluated. Start of the prospective follow up (FU; phone visits at day 30 day and quarterly thereafter) was the start of rivaroxaban therapy.

Results: Of the 871 VTE patients receiving rivaroxaban for VTE in the registry, 121 patients (13.9%) also had a cancer diagnosis (mean age 70.3 years; 52.1% male; cancer reported as inactive in 74 cases, active in 34 cases and in 13 cases diagnosed after VTE diagnosis, 110 solid malignancies, 11 hematologic malignancies; table 1; figure 1). During follow-up (mean 28.9 months, range 0.6 – 54.2), 11 patients (9.1 %) experienced recurrent VTE events (2 during rivaroxaban treatment, 9 after discontinuation or prolonged interruption >3d). Major bleeding occurred in 10 patients (8.3%) and predominantly occurred in patients with active cancer at baseline or diagnosed during VTE treatment (6/10). 24 patients died during FU (19.8%), of which 11 deaths occurred during or within 3 days after last intake of rivaroxaban. Most common causes of death were terminal malignant disease (n=11), followed by fatal cardiovascular event (n=4), age related death (n=4), fatal bleeding (n=3), sepsis/infection (n=1) and other reasons (n=1).

Conclusion: The majority of patients with cancer and VTE receive rivaroxaban only late after VTE diagnosis. For CAT patients with active cancer, LMWH is the predominant anticoagulant during the acute phase but a relevant number seems to be switched to rivaroxaban within weeks after VTE diagnosis. During rivaroxaban therapy, rates of recurrent VTE and major bleeding seem comparable to the rates seen with LMWH in CAT trials. Prospective RCTs should investigate the effectiveness and safety of rivaroxaban in CAT.