Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
In Vivo. 2020 Mar-Apr;34(2):829-837. doi: 10.21873/invivo.11845.
BACKGROUND/AIM: The aim of this study was to examine the efficacy and safety of direct oral anticoagulants for cancer-associated venous thromboembolism (VTE) in patients with active cancer.
This study included patients with advanced unresectable/metastatic upper gastrointestinal (GI) or hepatopancreatobiliary (HPB) cancers with high risks of VTE and bleeding.
No significant differences were noted in potential bleeding factors between the rivaroxaban (n=105) and low-molecular-weight heparin (LMWH) (n=69) groups. Rivaroxaban exhibited similar risk of recurrent/aggravated VTE compared with LMWH (p=0.625) but increased risk of major bleeding (17.4% vs. 7.6%; p=0.072), clinically relevant bleeding (31.9% vs. 14.3%; p=0.019), and total bleeding (40.6% vs. 19%; p=0.010). The multivariate analysis regarded rivaroxaban as a significant factor for major bleeding (p=0.043) and clinically relevant bleeding (p=0.043).
Rivaroxaban exhibits comparable efficacy but increases bleeding risks compared with LMWH in patients with active unresectable/metastatic upper GI tract or HPB cancers, requiring extra caution of higher major bleeding risks.
背景/目的：本研究旨在探讨直接口服抗凝剂（DOACs）在伴有活动性癌症的癌症相关静脉血栓栓塞症（VTE）患者中的疗效和安全性。
本研究纳入了患有高 VTE 和出血风险的晚期不可切除/转移性上胃肠道（GI）或肝胆胰腺（HPB）癌症的患者。
在利伐沙班（n=105）和低分子肝素（LMWH）（n=69）组之间，潜在出血因素无显著差异。与 LMWH 相比，利伐沙班的复发性/加重性 VTE 风险相似（p=0.625），但大出血（17.4% vs. 7.6%；p=0.072）、临床相关出血（31.9% vs. 14.3%；p=0.019）和总出血（40.6% vs. 19%；p=0.010）风险增加。多变量分析将利伐沙班视为大出血（p=0.043）和临床相关出血（p=0.043）的显著因素。
与 LMWH 相比，利伐沙班在伴有不可切除/转移性上胃肠道或 HPB 癌症的活动性癌症患者中疗效相当，但出血风险增加，需要特别注意大出血风险较高的情况。
