Bernardi Enrico, Camporese Giuseppe, Bortoluzzi Cristiano, Noventa Franco, Ceccato Davide, Tonello Chiara, Vohong Stefania, Campello Elena, Simion Chiara, Imbalzano Egidio, Di Micco Pierpaolo, Callegari Elena, Simioni Paolo
Emergency Department, Cà Foncello Hospital, Azienda Ulss 2 Marca Trevigiana, Piazzale Ospedale 1, 31100 Treviso, Italy.
UO Internal Medicine, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy.
Life (Basel). 2022 Oct 28;12(11):1725. doi: 10.3390/life12111725.
Extended-phase anticoagulation with direct oral Xa inhibitors (OAXI) is suggested in patients with cancer-associated venous thromboembolism (CAT). We report on patients enrolled in the MAC (Monitoring AntiCoagulants) Project, given rivaroxaban as extended-phase anticoagulation after CAT. The primary efficacy outcome was the incidence of symptomatic recurrent VTE; the primary safety outcomes were incidence of major and non-major clinically relevant bleeding, adverse events, and all-cause mortality. The mean patients' follow-up was 19 months (SD 16); 64/604 (11%) had CAT. Recurrent VTE occurred in 9.3% and in 8.1% of patients with and without CAT (OR 1.2, 95% CI 0.5 to 2.9; = 0.6). Major bleeding occurred in 4.7% and in 2.6%, respectively (OR = 1.8, 95% CI 0.5 to 6.6, = 0.4), and non-major clinically-relevant bleeding in 4.7% and in 4.1% (OR = 1.2, 95% CI 0.3 to 3.9, = 0.7). The relative figures for fatal haemorrhage and all-cause death were 1.6% versus 0%, and 1.6% versus 0.4%. Rivaroxaban appears to be effective and safe as extended-phase anticoagulation in patients with CAT. The mean treatment period was 3-times the standard 6-month course.
对于癌症相关静脉血栓栓塞（CAT）患者，建议使用直接口服Xa因子抑制剂（OAXI）进行长期抗凝治疗。我们报告了参与MAC（抗凝监测）项目的患者情况，这些患者在CAT后接受利伐沙班进行长期抗凝治疗。主要疗效结局是有症状的复发性静脉血栓栓塞（VTE）的发生率；主要安全性结局是主要和非主要临床相关出血的发生率、不良事件及全因死亡率。患者的平均随访时间为19个月（标准差16）；64/604（11%）患有CAT。有和没有CAT的患者中，复发性VTE的发生率分别为9.3%和8.1%（比值比1.2，95%置信区间0.5至2.9；P = 0.6）。主要出血发生率分别为4.7%和2.6%（比值比 = 1.8，95%置信区间0.5至6.6，P = 0.4），非主要临床相关出血发生率分别为4.7%和4.1%（比值比 = 1.2，95%置信区间0.3至3.9，P = 0.7）。致命性出血和全因死亡的相对数据分别为1.6%对0%，以及1.6%对0.4%。利伐沙班作为CAT患者长期抗凝治疗似乎有效且安全。平均治疗期是标准6个月疗程的3倍。
