Comparison of rivaroxaban and low molecular weight heparin in the treatment of cancer-associated venous thromboembolism: a Swedish national population-based register study.

Abstract

BACKGROUND:

Treating cancer-associated venous thromboembolism (CAT) with anticoagulation prevents recurrent venous thromboembolism (rVTE), but increases bleeding risk.

OBJECTIVES:

To compare incidence of rVTE, major bleeding, and all-cause mortality for rivaroxaban versus low molecular weight heparin (LMWH) in patients with CAT.

METHODS:

We developed a cohort study using Swedish national registers 2013-2019. Patients with CAT (venous thromboembolism within 6 months of cancer diagnosis) were included. Those with other indications or with high bleeding risk cancers were excluded (according to guidelines). Follow-up was from index-CAT until outcome, death, emigration, or end of study. Incidence rates (IR) per 1000 person-years with 95% confidence interval (CI) and propensity score overlap-weighted hazard ratios (HRs) for rivaroxaban versus LMWH were estimated.

RESULTS:

We included 283 patients on rivaroxaban and 5181 on LMWH. The IR for rVTE was 68.7 (95% CI 40.0-109.9) for rivaroxaban, compared with 91.6 (95% CI 81.9-102.0) for LMWH, with adjusted HR 0.77 (95% CI 0.43-1.35). The IR for major bleeding was 23.5 (95% CI 8.6-51.1) for rivaroxaban versus 49.2 (95% CI 42.3-56.9) for LMWH, with adjusted HR 0.62 (95% CI 0.26-1.49). The IR for all-cause mortality was 146.8 (95% CI 103.9-201.5) for rivaroxaban and 565.6 (95% CI 541.8-590.2) for LMWH with adjusted HR 0.48 (95% CI 0.34-0.67).

CONCLUSIONS:

Rivaroxaban performed similarly to LMWH for patients with CAT for rVTE and major bleeding. An all-cause mortality benefit was observed for rivaroxaban which potentially may be attributed to residual confounding.

TRIAL REGISTRATION NUMBER:

NCT05150938 (Registered 9 December 2021).

• Authors: Marie Linder, Anders Ekbom, Gunnar Brobert, Kai Vogtländer, Yanina Balabanova, Cecilia Becattini, Marc Carrier, Alexander T Cohen, Craig I Coleman, Alok A Khorana, Agnes Y Y Lee, George Psaroudakis, Khaled Abdelgawwad, Marcela Rivera, Bernhard Schaefer, Diego Hernan Giunta
• Journal: Journal of thrombosis and thrombolysis (J Thromb Thrombolysis) (May 12 2024) ISSN: 1573-742X [Electronic] Netherlands
• PMID: 38735015 (Publication Type: Journal Article)
• Copyright: © 2024. The Author(s).