Abstract Number: PB0911
Meeting: ISTH 2022 Congress
Background: The risk and benefit for direct oral anticoagulants (DOACs) in patients with venous thromboembolism (VTE) associated with active cancer varies with cancer type and the associated bleeding risk. Current guidelines from the International Society on Thrombosis and Haemostasis (ISTH) recommend caution in patients with some cancer types.
Aims: Estimate the incidence of VTE recurrence, significant bleeding (major or requiring hospitalisation) and all-cause mortality in patients with active cancer and incident VTE, comparing low molecular weight heparin (LMWH) with DOAC.
Methods: OSCAR UK’s source population consists of all patients in the UK Clinical Practice Research Datalink between 01/2013 and 10/2020, with linked information on hospitalisation and cause of death. Adults diagnosed with active cancer (with a record of diagnosis or treatment in the last 6 months), who experienced hospitalisation, emergency department admission or primary care visit with a VTE, and were eligible to receive DOACs according to the ISTH recommendations, were included. Exclusions: therapeutic use of anticoagulants prior to cancer-associated thrombosis (CAT), a history of atrial fibrillation, cardiac valve replacement, VTE other than deep vein thrombosis or pulmonary embolism, end-stage renal failure, thrombocytopenia, initiation of palliative care or current pregnancy.
Propensity scores for DOAC initiation were used to identify comparable groups of CAT patients with DOAC and LMWH treatment. Both exposure cohorts were observed for up to one year. Risks of VTE recurrence and significant bleeding events were estimated with sub-distribution hazard ratios accounting for the competing risk of mortality. All-cause mortality was estimated from hazard ratios.
Results: The CAT cohort comprised > 2,500 patients; 23.5% received DOACs and 76.5% LMWH. The commonest cancer types were in descending order: breast (21.0%), lung (12.6%), prostate (12.1%), and unresected cancers of the lower gastrointestinal tract (9.9%).
Conclusion(s): Benefit–risk of all study outcomes comparing anticoagulation with DOAC vs. LMWH will be presented.
To cite this abstract in AMA style:Cohen A, Wallenhorst C, Becattini C, Schaefer B, Abdelgawwad K, Psaroudakis G, Brobert G, Coleman C, Ekbom A, Ay C, Lee A, Khorana A, Carrier M, Rivera M, Marinez C. Comparison of effectiveness and safety of direct oral anticoagulant versus low molecular weight heparin treatment for venous thromboembolism in patients with active cancer – the OSCAR UK Study [abstract]. https://abstracts.isth.org/abstract/comparison-of-effectiveness-and-safety-of-direct-oral-anticoagulant-versus-low-molecular-weight-heparin-treatment-for-venous-thromboembolism-in-patients-with-active-cancer-the-oscar-uk-study/. Accessed August 16, 2022.
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