ISTH Congress Abstracts

Official abstracts site for the ISTH Congress

MENU 
  • Home
  • Congress Archive
    • ISTH 2022 Congress
    • ISTH 2021 Congress
    • ISTH 2020 Congress
  • Resources
  • Search

Safety of Direct Acting Oral Anticoagulants (DOACs) in Comparison to Low Molecular Weight Heparin (LWMH) in Gastrointestinal and Genito-urinary Cancers

S. Rahman1, J. Trias1, M. Barouqa1, M. Kushnir1, H. Billett1

1Albert Einstein College of Medicine/ Montefiore Medical Center, New York, United States

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/

Simple Search

Supported By:

Takeda logo

ISTH 2022 Congress site

Visit the official web site for the ISTH 2022 Virtual Congress ยป

  • Help & Support
  • About Us
  • Cookies & Privacy
  • Wiley Job Network
  • Terms & Conditions
  • Advertisers & Agents
Copyright © 2023 John Wiley & Sons, Inc. All Rights Reserved.
Wiley