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Cancer-associated venous thromboembolism: Treatment and prevention with rivaroxaban.
Res Pract Thromb Haemost. 2020 May; 4(4):532-549.RP

Abstract

Cancer-associated venous thromboembolism (VTE) is a frequent, potentially life-threatening event that complicates cancer management. Anticoagulants are the cornerstone of therapy for the treatment and prevention of cancer-associated thrombosis (CAT); factor Xa-inhibiting direct oral anticoagulants (DOACs; apixaban, edoxaban, and rivaroxaban), which have long been recommended for the treatment of VTE in patients without cancer, have been investigated in this setting. The first randomized comparisons of DOACs against low-molecular-weight heparin for the treatment of CAT indicated that DOACs are efficacious in this setting, with findings reflected in recent updates to published guidance on CAT treatment. However, the higher risk of bleeding events (particularly in the gastrointestinal tract) with DOACs highlights the need for appropriate patient selection. Further insights will be gained from additional studies that are ongoing or awaiting publication. The efficacy and safety of DOAC thromboprophylaxis in ambulatory patients with cancer at a high risk of VTE have also been assessed in placebo-controlled randomized controlled trials of apixaban and rivaroxaban. Both studies showed efficacy benefits with DOACs, but both studies also showed a nonsignificant increase in major bleeding events while on treatment. This review summarizes the evidence base for rivaroxaban use in CAT, the patient profile potentially most suited to DOAC use, and ongoing controversies under investigation. We also describe ongoing studies from the CALLISTO (Cancer Associated thrombosis-expLoring soLutions for patients through Treatment and Prevention with RivarOxaban) program, which comprises several randomized clinical trials and real-world evidence studies, including investigator-initiated research.

Authors+Show Affiliations

Department of Vascular Medicine Klinikum Darmstadt GmbH Darmstadt Germany. Center of Thrombosis and Hemostasis University of Mainz Mainz Germany.Hematology and Medical Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OH USA.British Columbia Cancer Agency University of British Columbia Vancouver BC Canada.Memorial Sloan Kettering Cancer Center New York NY USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32548552

Citation

Bauersachs, Rupert, et al. "Cancer-associated Venous Thromboembolism: Treatment and Prevention With Rivaroxaban." Research and Practice in Thrombosis and Haemostasis, vol. 4, no. 4, 2020, pp. 532-549.
Bauersachs R, Khorana AA, Lee AYY, et al. Cancer-associated venous thromboembolism: Treatment and prevention with rivaroxaban. Res Pract Thromb Haemost. 2020;4(4):532-549.
Bauersachs, R., Khorana, A. A., Lee, A. Y. Y., & Soff, G. (2020). Cancer-associated venous thromboembolism: Treatment and prevention with rivaroxaban. Research and Practice in Thrombosis and Haemostasis, 4(4), 532-549. https://doi.org/10.1002/rth2.12327
Bauersachs R, et al. Cancer-associated Venous Thromboembolism: Treatment and Prevention With Rivaroxaban. Res Pract Thromb Haemost. 2020;4(4):532-549. PubMed PMID: 32548552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cancer-associated venous thromboembolism: Treatment and prevention with rivaroxaban. AU - Bauersachs,Rupert, AU - Khorana,Alok A, AU - Lee,Agnes Y Y, AU - Soff,Gerald, Y1 - 2020/04/04/ PY - 2019/08/14/received PY - 2020/02/17/revised PY - 2020/02/22/accepted PY - 2020/6/18/entrez PY - 2020/6/18/pubmed PY - 2020/6/18/medline KW - anticoagulants KW - cancer KW - neoplasms KW - rivaroxaban KW - thrombosis KW - venous thromboembolism SP - 532 EP - 549 JF - Research and practice in thrombosis and haemostasis JO - Res Pract Thromb Haemost VL - 4 IS - 4 N2 - Cancer-associated venous thromboembolism (VTE) is a frequent, potentially life-threatening event that complicates cancer management. Anticoagulants are the cornerstone of therapy for the treatment and prevention of cancer-associated thrombosis (CAT); factor Xa-inhibiting direct oral anticoagulants (DOACs; apixaban, edoxaban, and rivaroxaban), which have long been recommended for the treatment of VTE in patients without cancer, have been investigated in this setting. The first randomized comparisons of DOACs against low-molecular-weight heparin for the treatment of CAT indicated that DOACs are efficacious in this setting, with findings reflected in recent updates to published guidance on CAT treatment. However, the higher risk of bleeding events (particularly in the gastrointestinal tract) with DOACs highlights the need for appropriate patient selection. Further insights will be gained from additional studies that are ongoing or awaiting publication. The efficacy and safety of DOAC thromboprophylaxis in ambulatory patients with cancer at a high risk of VTE have also been assessed in placebo-controlled randomized controlled trials of apixaban and rivaroxaban. Both studies showed efficacy benefits with DOACs, but both studies also showed a nonsignificant increase in major bleeding events while on treatment. This review summarizes the evidence base for rivaroxaban use in CAT, the patient profile potentially most suited to DOAC use, and ongoing controversies under investigation. We also describe ongoing studies from the CALLISTO (Cancer Associated thrombosis-expLoring soLutions for patients through Treatment and Prevention with RivarOxaban) program, which comprises several randomized clinical trials and real-world evidence studies, including investigator-initiated research. SN - 2475-0379 UR - https://www.unboundmedicine.com/medline/citation/32548552/Cancer-associated_venous_thromboembolism:_Treatment_and_prevention_with_rivaroxaban L2 - https://doi.org/10.1002/rth2.12327 DB - PRIME DP - Unbound Medicine ER -
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