Abstract Number: PB0921
Meeting: ISTH 2022 Congress
Background: Anti-Xa DOAC (direct oral anticoagulants) is an accepted treatment option for patients with cancer-associated thrombosis (CAT) and is recommended in current guidelines. Their use, however, comes with some safety caveats. Several consensus statements suggest consideration of relative risks for increased bleeding before prescribing an oral anticoagulant vs. low molecular weight heparin.
Aims: Evaluate the safety and efficacy of DOAC prescribing habits in patients with cancer treated in an acute oncology service.
Methods: Retrospectively collected data from the electronic medical record system of a cohort of 449 patients with cancer receiving DOAC, apixaban or rivaroxaban, from September 2019 to August 2020 in HUTH NHS trust. Median follow-up period was 6.6 months. The outcomes studied were recurrent venous thromboembolism (rVTE), major bleeding (MB), and clinically relevant non-major bleeding (CRNMB). We considered the incidence of bleeding events in the presence vs. absence of relative contraindications to DOAC prescription. Analyses were performed with SPSS v27, IBM Corp TM and STATA SE17.
Results: Median age was 75 years, 254 (56.6%) male, 209 (46.5%) had metastatic disease. 197 (43.9%) were on DOAC for CAT, 194 (43.2%) for atrial fibrillation (43.2%). 5/449 (1.1%) had rVTE, all in the CAT cohort. 21 (4.7%) had bleeding with 8 (1.8%) MB. 164 (36.5%) patients had the presence of relative contraindications for DOAC prescription; among them, 10 (6.1%) had bleeding with 3 (1.6%) MB. The odds of bleeding in patients with relative contra-indication was 1.6 (95% CI 0.7, 3.9; p=0.284). Luminal involvement in all tumour types increased the risk of bleeding (OR 2.6; 95% CI 0.9, 7.4, p= 0.075).
Conclusion(s): Despite the more geriatric profile of these patients, overall rVTE and bleeding events were in keeping with rates seen in the registration studies. However, we found a trend for more frequent bleeding events in patients that had DOACs prescribed in the presence of relative contraindications.
To cite this abstract in AMA style:Haque F, Mnyama N, Adeniyi-zaccheus O, Wells R, Brown V, Maraveyas A. Safety and efficacy of direct oral anticoagulant in elderly patients with cancer: real-world challenges [abstract]. https://abstracts.isth.org/abstract/safety-and-efficacy-of-direct-oral-anticoagulant-in-elderly-patients-with-cancer-real-world-challenges/. Accessed October 1, 2023.
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