Caroti Kimberly Snow, Becattini Cecilia, Carrier Marc, Cohen Alexander T, Ekbom Anders, Khorana Alok A, Lee Agnes Y Y, Brescia Christopher, Abdelgawwad Khaled, Psaroudakis George, Rivera Marcela, Schaefer Bernhard, Brobert Gunnar, Coleman Craig I
Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, Connecticut, United States.
Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, United States.
TH Open. 2023 Jul 10;7(3):e206-e216. doi: 10.1055/s-0043-1770783. eCollection 2023 Jul.
This retrospective study, utilizing U.S. electronic health record (EHR) data from January 2013 to December 2020, sought to assess whether rivaroxaban and apixaban had similar effectiveness and safety in the treatment of cancer-associated venous thromboembolism (VTE) in patients with a cancer type not associated with a high risk of bleeding. We included adults diagnosed with active cancer, excluding esophageal, gastric, unresected colorectal, bladder, noncerebral central nervous system cancers and leukemia, who experienced VTE and received a therapeutic VTE dose of rivaroxaban or apixaban on day 7 post-VTE, and were active in the EHR ≥12 months prior to the VTE. Primary outcome was the composite of recurrent VTE or any bleed resulting in hospitalization at 3 months. Secondary outcomes included recurrent VTE, any bleed resulting in hospitalization, any critical organ bleed, and composites of these outcomes at 3 and 6 months. Inverse probability of treatment-weighted Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). We included 1,344 apixaban and 1,093 rivaroxaban patients. At 3 months, rivaroxaban was found to have similar hazard to apixaban for developing recurrent VTE or any bleed resulting in hospitalization (HR: 0.87; 95% CI: 0.60-1.27). No differences were observed between cohorts for this outcome at 6 months (HR: 1.00; 95% CI: 0.71-1.40) or for any other outcome at 3 or 6 months. In conclusion, patients receiving rivaroxaban or apixaban showed similar risks of the composite of recurrent VTE or any bleed resulting in hospitalization in patients with cancer-associated VTE. This study was registered at www.clinicaltrials.gov as #NCT05461807. Rivaroxaban and apixaban have similar effectiveness and safety for treatment of cancer-associated VTE through 6 months.Clinicians should therefore consider patient preference and adherence when choosing the optimal anticoagulant.
这项回顾性研究利用2013年1月至2020年12月的美国电子健康记录（EHR）数据，旨在评估利伐沙班和阿哌沙班在治疗非高出血风险癌症类型患者的癌症相关静脉血栓栓塞（VTE）方面是否具有相似的有效性和安全性。我们纳入了被诊断为患有活动性癌症的成年人，排除了食管癌、胃癌、未切除的结直肠癌、膀胱癌、非脑中枢神经系统癌症和白血病，这些患者经历了VTE，并在VTE后第7天接受了治疗性VTE剂量的利伐沙班或阿哌沙班，且在VTE前在EHR中活跃≥12个月。主要结局是3个月时复发性VTE或任何导致住院的出血的复合结局。次要结局包括复发性VTE、任何导致住院的出血、任何关键器官出血以及这些结局在3个月和6个月时的复合结局。采用治疗加权逆概率Cox回归计算风险比（HR）及95%置信区间（CI）。我们纳入了1344例使用阿哌沙班的患者和1093例使用利伐沙班的患者。在3个月时，发现利伐沙班在发生复发性VTE或任何导致住院的出血方面与阿哌沙班具有相似的风险（HR：0.87；�5%CI：0.60-1.27）。在6个月时，该结局在队列之间未观察到差异（HR：1.00；95%CI：0.71-1.40），在3个月或6个月时的任何其他结局也未观察到差异。总之，接受利伐沙班或阿哌沙班治疗的癌症相关VTE患者在复发性VTE或任何导致住院的出血的复合结局方面显示出相似的风险。本研究在www.clinicaltrials.gov上注册为#NCT-05461807。利伐沙班和阿哌沙班在治疗癌症相关VTE方面6个月内具有相似的有效性和安全性。因此，临床医生在选择最佳抗凝剂时应考虑患者的偏好和依从性。
