Anticoagulation prescribing patterns in patients with cancer

Area of Science:

• Oncology
• Hematology
• Pharmacology

Background:

• Cancer patients have a higher risk of venous thromboembolism (VTE) due to hypercoagulable state.
• Low molecular weight heparin is preferred for VTE in cancer, but optimal anticoagulation for atrial fibrillation (AF) remains unclear.
• Direct oral anticoagulants (DOACs) are emerging as potential alternatives, with their role in cancer patients under recent investigation.

Purpose of the Study:

• To analyze real-world anticoagulation prescribing patterns in cancer patients.
• To evaluate the safety, tolerability, and efficacy of DOACs versus traditional anticoagulants (enoxaparin, warfarin) for VTE and/or AF in cancer patients.

Main Methods:

• Retrospective cohort study of 214 cancer patients from January 2013 to October 2016.
• Collected data on patient demographics, clinical characteristics, bleeding events, and thrombotic events.
• Compared outcomes between patients receiving DOACs (apixaban, dabigatran, rivaroxaban) and those receiving enoxaparin or warfarin.

Main Results:

• 71 patients (33%) received a DOAC.
• The DOAC group experienced fewer bleeding events and/or discontinuations compared to enoxaparin (13 vs. 27, p=0.022).
• No significant differences were observed in major/minor bleeds or thromboembolic events between DOACs and enoxaparin or warfarin.

Conclusions:

• DOACs demonstrated comparable efficacy and safety to enoxaparin and warfarin in cancer patients for VTE and/or AF.
• DOACs may serve as a viable alternative anticoagulant strategy in cancer patients, offering potential benefits in reducing bleeding events.