Background: The growing use of DOACs for the treatment of cancer associated thrombosis (CAT) as recommended by most international guidelines is gradually changing the treatment paradigm in this setting.
Aims: We report some real-world experience on the efficacy and safety of DOACs for the treatment of CAT in a community hospital in Spain.
Methods: Twenty two patients 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 evaluate any episodes of recurrent VTE or bleeding. DOACs are licensed but not reimbursed in Spain for the treatment of venous thromboembolism (VTE).
Results:
Characteristic | N(%) | Characteristic |
N(%) |
Cancer type Lung Breast Lymphoma Colon Gynaecologic Renal Neurinoma Head/neck Prostate Urine bladder Brain Liver Metastatic |
7 (31.8%) 1 (4.5%) 2 (9%) 1 (4.5%) 3 (13.5%) 1 (4.5%) 1 (4.5%) 1 (4.5%) 2 (9%) 1 (4.5%) 1 (4.5%) 1 (4.5%) 13 (59%) |
Khorana score 0 1 2 3 Type VTE event DVT PE DVT+PE Catheter Portal/mesenteric Incidental DOAC prescribed Rivaroxaban Edoxaban Previous VTE Chemotherapy |
5 (22.7%) 6 (27.3%) 20 (91%) |
Table 1 shows patient characteristics. Male/female ratio was 1. Median age and duration of DOAC therapy were 69 years (range 49-87) and 112 days (range 29-740) respectively; 41% were treated for over 6 months. Twenty one patients had been prescribed a low molecular weight heparin for a median of 3 months (range 0-15) before switching to a DOAC. Two patients (9%) showed thrombotic recurrence during follow-up in association with recurrent and/or locally advanced tumor progression.
No major bleeding episodes were reported. Four patients (18.1%) presented with clinically relevant non-major bleeding (3 cases of haematuria, 1 case of haemoptisis; incidence 1.3 per 100 patients-year) at a median of 2 months (range 1-4) from DOAC start. Nine patients died during follow-up (41%) after a median of 88 days of DOAC therapy (range 54-740); in all cases cancer was the cause of death.
Conclusions: Our real-world experience in an unfavourable profile cancer patient setting confirms that DOACs are an efficient and safe for the treatment of CAT even when prescribed for longer periods than those reported in clinical trials.
To cite this abstract in AMA style:
Aguilar C, Valles M, Condori D, B Dueñas A, Sevil f, Dominguez C. Experience with Direct Oral Anticoagulants (Doacs) for the Treatment of Cancer Associated Thrombosis [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/experience-with-direct-oral-anticoagulants-doacs-for-the-treatment-of-cancer-associated-thrombosis/. Accessed April 25, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/experience-with-direct-oral-anticoagulants-doacs-for-the-treatment-of-cancer-associated-thrombosis/