The following article features coverage from the 61st American Society of Hematology Annual Meeting and Exposition. Click here to read more of Hematology Advisor’s conference coverage.

Apixaban, rather than low-molecular-weight heparin (LMWH) or warfarin, may yield improved clinical outcomes among patients with active cancer who experience venous thromboembolism (VTE), according to 2 analyses presented at the 61st American Society of Hematology (ASH) Annual Meeting in Orlando, Florida.1,2

VTE is the second most frequent cause of death among patients with cancer. However, treating VTE in this patient population is difficult because cancer-associated VTE confers a higher rate of major bleeding and recurrent VTE compared with the rate seen among patients without cancer. Furthermore, there is limited real-world evidence supporting the use of LMWH over apixaban or warfarin in this setting.

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For this study and subsequent subgroup analysis, researchers evaluated which of these 3 drugs yielded the best clinical outcomes in a real-world cancer-associated VTE setting. Risk for major bleeding, clinically relevant nonmajor bleeding (CRNMB), and fatal or nonfatal recurrent VTE were the 3 outcomes of interest.

A total of 3393, 6108, and 4585 patients with cancer-related VTE received apixaban, LMWH, and warfarin, respectively. After mean follow-up of 105 days with apixaban, 88 days with LMWH, and 113 days with warfarin, apixaban appeared to yield improved VTE recurrence rates compared with those seen with LMWH (hazard ratio [HR], 0.61; P =.001) and warfarin (HR, 0.68; P =.007). Apixaban also conferred a lower risk of major bleeding (HR, 0.63; P =.003) and CRNMB (HR, 0.81; P =.006) compared with LMWH, though major bleeding and CRNMB rates were similar in the apixaban and warfarin groups.

These findings appeared to remain consistent in subgroup analyses of patients at very high risk for VTE, high risk for VTE, and other cancer groups. Apixaban was associated with decreased risk for VTE recurrence compared with warfarin and decreased risk of bleeding and VTE recurrence compared with LMWH.

“Further studies are needed to evaluate the role of anticoagulants in high-risk subgroups of patients with cancer [who experience VTE],” wrote the researchers.

References

1.     Cohen AT, Keshishian A, Lee T, et al. Safety and effectiveness of apixaban, LMWH, and warfarin among venous thromboembolism patients with active cancer: a retrospective analysis using four US claims databases. Oral presentation at: 61st ASH Annual Meeting and Exposition; December 7-10, 2019; Orlando, FL. Abstract 326.

2.     Cohen AT, Keshishian A, Lee T, et al. Safety and effectiveness of apixaban, LMWH, and warfarin among venous thromboembolism patients with active cancer: a subgroup analysis of VTE risk scale. Oral presentation at: 61st ASH Annual Meeting and Exposition; December 7-10, 2019; Orlando, FL. Abstract 327.