Contributions
Abstract: EP1329
Type: E-Poster Presentation
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
Low molecular weight heparins (LMWH) have long been the gold standard of the treatment of cancer associated thrombosis (CAT). However the growing use of DOACs as currently recommended by most international guidelines is gradually changing the treatment paradigm in this setting
Aims
To report some real-world experience on the efficacy and safety of DOACs for the treatment of CAT in a community hospital in Spain
Methods
Patients evaluated had been diagnosed with CAT, were referred from the Oncology to the Haematology Department for management of anticoagulant treatment and agreed to start on a DOAC. All patients had active cancer and underwent regular outpatient follow-up in order to make decisions on DOAC treatment duration, perform dose adjustments as required and evaluate any episodes of recurrent VTE or bleeding. DOACs are licensed but not reimbursed in Spain for the treatment of venous thromboembolism (VTE)
Results
Twenty three patients (12 male/11 female) fulfilled criteria mentioned above. Patients were affected by cancers as shown in Table 1. Over 60% (60.8%; 14 patients) had metastatic disease and almost 2 out of 3 (65.2%) were on some type of chemotherapy when VTE was diagnosed. Median age and duration of DOAC therapy were 68 years (range 49-87) and 103 days (range 27-740) respectively; 43.4% (10 cases) were treated for over 6 months. Twenty three patients had received a LMWH (tinzaparin 13, enoxaparin 7) following diagnosis of CAT for a median of 3 months (range 0-15) before switching to a DOAC. Rivaroxaban was the most commonly prescribed DOAC (20 patients; 87%). Edoxaban (2 cases) and apixaban (1 case) accounted for the rest of DOAC prescriptions. Most cases (69.5%) were sorted as having low thrombotic risk according to Khorana score 0-1 and the diagnosis of VTE was incidental in 14 cases (60.8%), this is, all cases of PE and 1 of portal/mesenteric venous thrombosis (Table 1). Only 2 individuals (8.7%) had a prior history of VTE.
Two patients (8.7%) with lung cancer showed thrombotic recurrence during follow-up in association with recurrent and/or locally advanced tumor progression.
No major bleeding episodes (ISTH criteria) were reported throughout the follow-up period. Four patients (17.3%) presented with some episode of clinically relevant non-major bleeding at a median of 2 months (range 1-4) from DOAC start: 3 cases of haematuria (1 patient on rivaroxaban with a urine bladder tumour, and 2 cases of lung cancer) and 1 case of haemoptisis (in a patient on edoxaban with lung metastases of a gynaecological cancer; incidence 1.2 per 100 patients-year). Nine patients (39.1%) died during the follow-up after a median of 88 days of DOAC therapy (range 54-740); in all cases cancer progression was the cause of death
Conclusion
Our real-world experience in an unfavourable-profile cancer patient setting confirms that DOACs are efficient and safe for the treatment of CAT even when prescribed for longer periods than those reported in clinical trials. Although initial treatment with a LMWH before patient referral and DOAC start may bias our results these are clinically applicable. Thus, incidence of thrombotic recurrence was consistent with that reported in pivotal trials of direct factor Xa inhibitors for the treatment of CAT and linked to cancer progression in our experience. Bleeding was always easily manageable with no major bleeding episodes being reported; incidence of other bleeding complications was also consistent with that reported in clinical trials of DOAC treatment for CAT
Keyword(s): Anticoagulants, Cancer, Venous thromboembolism
Abstract: EP1329
Type: E-Poster Presentation
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
Low molecular weight heparins (LMWH) have long been the gold standard of the treatment of cancer associated thrombosis (CAT). However the growing use of DOACs as currently recommended by most international guidelines is gradually changing the treatment paradigm in this setting
Aims
To report some real-world experience on the efficacy and safety of DOACs for the treatment of CAT in a community hospital in Spain
Methods
Patients evaluated had been diagnosed with CAT, were referred from the Oncology to the Haematology Department for management of anticoagulant treatment and agreed to start on a DOAC. All patients had active cancer and underwent regular outpatient follow-up in order to make decisions on DOAC treatment duration, perform dose adjustments as required and evaluate any episodes of recurrent VTE or bleeding. DOACs are licensed but not reimbursed in Spain for the treatment of venous thromboembolism (VTE)
Results
Twenty three patients (12 male/11 female) fulfilled criteria mentioned above. Patients were affected by cancers as shown in Table 1. Over 60% (60.8%; 14 patients) had metastatic disease and almost 2 out of 3 (65.2%) were on some type of chemotherapy when VTE was diagnosed. Median age and duration of DOAC therapy were 68 years (range 49-87) and 103 days (range 27-740) respectively; 43.4% (10 cases) were treated for over 6 months. Twenty three patients had received a LMWH (tinzaparin 13, enoxaparin 7) following diagnosis of CAT for a median of 3 months (range 0-15) before switching to a DOAC. Rivaroxaban was the most commonly prescribed DOAC (20 patients; 87%). Edoxaban (2 cases) and apixaban (1 case) accounted for the rest of DOAC prescriptions. Most cases (69.5%) were sorted as having low thrombotic risk according to Khorana score 0-1 and the diagnosis of VTE was incidental in 14 cases (60.8%), this is, all cases of PE and 1 of portal/mesenteric venous thrombosis (Table 1). Only 2 individuals (8.7%) had a prior history of VTE.
Two patients (8.7%) with lung cancer showed thrombotic recurrence during follow-up in association with recurrent and/or locally advanced tumor progression.
No major bleeding episodes (ISTH criteria) were reported throughout the follow-up period. Four patients (17.3%) presented with some episode of clinically relevant non-major bleeding at a median of 2 months (range 1-4) from DOAC start: 3 cases of haematuria (1 patient on rivaroxaban with a urine bladder tumour, and 2 cases of lung cancer) and 1 case of haemoptisis (in a patient on edoxaban with lung metastases of a gynaecological cancer; incidence 1.2 per 100 patients-year). Nine patients (39.1%) died during the follow-up after a median of 88 days of DOAC therapy (range 54-740); in all cases cancer progression was the cause of death
Conclusion
Our real-world experience in an unfavourable-profile cancer patient setting confirms that DOACs are efficient and safe for the treatment of CAT even when prescribed for longer periods than those reported in clinical trials. Although initial treatment with a LMWH before patient referral and DOAC start may bias our results these are clinically applicable. Thus, incidence of thrombotic recurrence was consistent with that reported in pivotal trials of direct factor Xa inhibitors for the treatment of CAT and linked to cancer progression in our experience. Bleeding was always easily manageable with no major bleeding episodes being reported; incidence of other bleeding complications was also consistent with that reported in clinical trials of DOAC treatment for CAT
Keyword(s): Anticoagulants, Cancer, Venous thromboembolism