Background: Although not designated as guideline-recommended first-line anticoagulation
therapy, patients are receiving
rivaroxaban for the treatment and
secondary prevention of
cancer-associated
venous thrombosis (CAT). We sought to estimate the cumulative incidence of recurrent
venous thromboembolism (VTE), major
bleeding, and mortality/
hospice care in patients with CAT treated with outpatient
rivaroxaban in routine practice. Methods: Using US MarketScan claims data from January 2012 through June 2015, we identified adults with active
cancer (using SEER program coding) who had ≥1 primary hospitalization or emergency department discharge diagnosis code for VTE (index event) and received
rivaroxaban as their first outpatient
anticoagulant within 30 days of the index VTE. Patients were required to have ≥180 days of continuous medical/prescription benefits prior to the index VTE. Patients with a previous claim for VTE,
atrial fibrillation, or valvular disease or receiving anticoagulation during the baseline period were excluded. We estimated the cumulative incidence with 95% CIs of recurrent VTE, major
bleeding, and mortality or need for
hospice care at 180 days, assuming competing risks. Results: A total of 949 patients with active
cancer were initiated on
rivaroxaban following their index VTE. Time from active
cancer diagnosis to index CAT was ≤90 days for 27% of patients, 91 to 180 days for 19%, and >180 days for 54%. The mean [SD] age of patients was 62.5 [12.8] years, 43.6% had
pulmonary embolism, and metastatic disease was present in 42.6%. During follow-up, there were 37 cases of recurrent VTE, 22 cases of major
bleeding (17 gastrointestinal, 3 intracranial, 1 genitourinary, and 1 other bleed), and 105 deaths/hospice claims. The cumulative incidence estimate was 4.0% (95% CI, 2.8%-5.4%) for recurrent VTE, 2.7% (95% CI, 1.7%-4.0%) for major
bleeding, and 11.3% (95% CI, 9.2%-13.6%) for mortality/
hospice care. Conclusions: Event rates observed in this
rivaroxaban-treated cohort were overall consistent with previous studies of patients with
rivaroxaban- and
warfarin-managed CAT.