Abstract Number: OC 06.3
Meeting: ISTH 2021 Congress
Theme: Venous Thromboembolism » Cancer Associated Thrombosis
Background: Current guidelines suggest a preference for LMWH over DOACs for the treatment of gastrointestinal (GI) and genito-urinary (GU) cancer-associated thrombosis.
Aims: To investigate the safety of DOACs in GI and GU cancers.
Methods: This was an IRB-approved retrospective single institution cohort study to compare incidence of bleeding with DOACs versus LMWH in patients with active GI/GU cancers and thrombosis. Bleeding events (BE) while on anticoagulation for one year from the initiation date were recorded. BE were classified according to ISTH criteria. Chi-square was used to compare BE.
Results: We identified 206 patients, 159 in the DOAC and 47 in the LWMH groups. Demographics were comparable in both cohorts. Table 1. Within the DOAC group, 86 patients were on apixaban and 73 were on rivaroxaban. In apixaban subgroup, 36% had colon cancer, 18.6% upper GI, 23.2% renal, 12.8% bladder, 9.3% prostate. In rivaroxaban subgroup, 64.4% had colon, 16.4% upper GI, 9.6% renal, 4.1% bladder, 5.4% prostate. Within LMWH subgroup 31.9% had colon, 14.9% upper GI, 6.3% renal, 10.6% bladder and 36.2% had prostate.
| Variables | Apixaban (n=86) | Rivaroxaban (n=73) | Total DOACs (n=159) | Lovenox (n= 47) |
| Age (median) | 71 | 70 | 70 | 73 |
| Gender= Male (%) | 55 (63.9%) | 39 (53.4%) | 94 (59.1%) | 29 (61.7%) |
| BMI (median) | 26.6 | 27 | 26.8 | 25.4 |
| Race | ||||
| White | 11 (12.7%) | 12 (16.4%) | 23 (14.4%) | 6 (12.7%) |
| African American | 28 (32.5%) | 27 (36.9%) | 55 (34.5%) | 20 (42.5%) |
| Other/ Refused | 0 | 0 | 0 | 3 (6.3%) |
| Hispanic | 47 (54.6%) | 34 (46.5%) | 81 (50.9%) | 18 (38.2%) |
| Metastatic primary (%) | 50 (58.1%) | 44 (60.2%) | 94 (59.1%) | 31 (65.9%) |
| Bleeding event, yes (%) | 17 (19.8%) | 24 (32.8%) | 41 (25.7%) | 11 (23.4%) |
Clinical characteristics and results for the patient population. Results are in n (%) unless otherwise noted
Clinically relevant non-major bleeding (CRNMB) and major bleeding rates with apixaban, rivaroxaban and LMWH were 17.4% (15/86), 20.5% (15/73),19.1% (9/47) respectively. The majority of BE on DOACs occurred in same organ system as the primary cancer. Concomitant aspirin intake was 9.4% in DOAC and 4.2% in LMWH groups. Within DOACs we noted no statistically significant difference in the BE with apixaban as compared to rivaroxaban in patients with GI primary, GU primary or all cancer types together, (p=0.46, 0.94 and 0.61 respectively). No statistically significant difference in BE were noted between DOACs and LMWH for GI, GU or all cancer types (p=0.63, 0.74 and 0.96 respectively) either. Table 2.
| Type of AC | GI | GU | TOTAL CR bleeds | |||||
| CR Bleed | Minor/No bleed | Total | Bleed | Minor/No bleed | Total | Bleed | Minor/No bleed | |
| Apixaban | 7 (14.8%) | 40 (85.2%) | 47 | 8 (20.5%) | 31 (79.5%) | 39 | 15 (17.4%) | 71 (82.6%) |
| Rivaroxaban | 12 (20.3%) | 47 (79.7%) | 59 | 3(21.4%) | 11 (78.6%) | 14 | 15(20.5%) | 58 (79.5%) |
| LMWH | 3(13.6%) | 19 (86.4%) | 22 | 6(24%) | 19 (76%) | 25 | 9 (19.1%) | 38 (80.9%) |
Clinically relevant bleeding events
Conclusions: Bleeding rates for patients with GI/GU cancers with LMWH or DOACs were high but not significantly different for either therapeutic class.
To cite this abstract in AMA style:
Rahman S, Trias J, Barouqa M, Kushnir M, Billett H. Safety of Direct Acting Oral Anticoagulants (DOACs) in Comparison to Low Molecular Weight Heparin (LWMH) in Gastrointestinal and Genito-urinary Cancers [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/safety-of-direct-acting-oral-anticoagulants-doacs-in-comparison-to-low-molecular-weight-heparin-lwmh-in-gastrointestinal-and-genito-urinary-cancers/. Accessed November 29, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/safety-of-direct-acting-oral-anticoagulants-doacs-in-comparison-to-low-molecular-weight-heparin-lwmh-in-gastrointestinal-and-genito-urinary-cancers/