Background: Current guidelines either recommend low molecular weight heparin or advise caution when using direct oral anticoagulants for patients with cancer-associated venous thromboembolism (Ca-VTE) of genitourinary (GU) system.
Aims: Compare major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) rates in patients with GU to non-GU cancers treated with apixaban, rivaroxaban or enoxaparin.
Methods: Consecutive patients (n=3,758) with acute VTE between 03/01/2013 and 04/30/2021 were followed prospectively through the Mayo Clinic VTE registry (ClinicalTrials.gov: NCT03504007).
Results: Among 1,702 Ca-VTE patients, 420 (mean age 64.8 years, 52.9% female) had GU cancers (163 urinary bladder/ureteral, 109 ovarian, 75 renal, 73 prostate) treated with apixaban (n=174), rivaroxaban (n=72), or enoxaparin (n=132), and 1,282 (mean age 62.0 years, 43.0% female) with non-GU cancers receiving apixaban (n=520), rivaroxaban (n=263), or enoxaparin (n=424). The rates (all 100 person-years) of MB [9.12 vs 6.01, hazard ratio (HR) 1.49, 95% confidence limit (95% Cl) 0.97, 2.28] and CRNMB (8.72 vs 6.04, HR 1.43, 95% Cl 0.93, 2.20) were similar in GU compared to non-GU cancers treated with any anticoagulant. Rivaroxaban had higher MB rate in GU versus non-GU cancers (10.43 vs 3.26, HR 2.90, 95%Cl 1.09, 7.72) (Table 1). Patients with GU cancers receiving apixaban had lower MB rate (3.05) compared to rivaroxaban (10.43, HR 0.25, 95%CI 0.07, 1.84) and enoxaparin (10.82, HR 0.27, 95%Cl 0.08, 0.83) (Table 2). All differences remain significant after adjusting for age and renal function. CRNMB rates were similar throughout all comparisons. Separate analysis of patients with cancer involving only urinary bladder/ureteral showed similar MB and CRNMB rates compared to non-GU cancers and amongst anticoagulants (data not shown).
Conclusion(s): Treatment with rivaroxaban is associated with higher MB rate in GU compared to non-GU cancers. In GU group, apixaban has a lower rate of MB compared to rivaroxaban or enoxaparin.
To cite this abstract in AMA style:
Lang T, Vlazny D, Houghton D, Casanegra A, Meverden R, Froehling D, Hodge D, Peterson L, McBane R, Wysokinski W. Bleeding in Patients with Genitourinary Cancer compared to Non-Genitourinary Cancer Treated with Apixaban, Rivaroxaban, or Enoxaparin for Acute Venous Thromboembolism [abstract]. https://abstracts.isth.org/abstract/bleeding-in-patients-with-genitourinary-cancer-compared-to-non-genitourinary-cancer-treated-with-apixaban-rivaroxaban-or-enoxaparin-for-acute-venous-thromboembolism/. Accessed September 22, 2023.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/bleeding-in-patients-with-genitourinary-cancer-compared-to-non-genitourinary-cancer-treated-with-apixaban-rivaroxaban-or-enoxaparin-for-acute-venous-thromboembolism/