Rivaroxaban Better for Clots in Cancer Patients

June 1, 2018

Oral rivaroxaban may be preferable to injections of low-molecular-weight heparins for patients being treated for cancer.

The oral blood thinner rivaroxaban (Xarelto, Janssen) could be a good alternative for treating venous thromboembolism (VTE) in cancer patients, according to new research.

Cancer patients have an increased risk of developing blood clots, with roughly one in five experiencing VTE-either as a deep vein thrombosis (DVT) or a pulmonary embolism (PE). Current international guidelines recommend cancer patients be given injections of a low-molecular-weight heparin (LMWH) to treat and prevent recurrence of VTE.

However, new data, published in the Journal of Clinical Oncology, found that prescribing rivaroxaban significantly reduced VTE recurrence among patients with cancer and VTE.

“Clinicians were already adopting the oral drug into practice for non-cancer patients and now they have data from this study to indicate that this form of treatment is an alternative option for many cancer patients who have a clot,” says Annie Young, SRH, PhD, professor of nursing at the University of Warwick Medical School in Coventry, United Kingdom, in a statement.

The multicenter randomized open-label pilot trial in the United Kingdom included 406 patients with active cancer who had symptomatic pulmonary embolism (PE), incidental PE, or symptomatic lower-extremity proximal deep vein thrombosis (DVT). Half the patients were given the LMWH dalteparin (Fragmin, Pfizer) 200 IU/kg subcutaneously daily for the first month, and then 150 IU/kg daily for months 2 through 6. The other half were given rivaroxaban 15 mg twice daily by mouth for 3 weeks, and then 20 mg once daily for a total of 6 months).

After six months of treatment, the VTE recurrence rate was 4% among those taking rivaroxaban and 11% in those receiving dalteparin.

The results for secondary outcomes were mixed. In patients receiving rivaroxaban, there were around the same percentage of major bleeding events (6%) as those receiving dalteparin (4%). However, there was a significant increase in clinically relevant nonmajor bleeds (13%) in the rivaroxaban group, compared to the group taking dalteparin (4%).

The reason for increased bleeding is not unknown, but it may be because rivaroxaban is more potent, Young writes. “Rivaroxaban reduced the rate of recurrent VTE compared with LMWH, but at the cost of more bleeding. Oral administration [with rivaroxaban] is more convenient than daily subcutaneous injections,” she notes and adds that rivaroxaban should be used with particular caution in patients with esophageal cancer.

A patient’s preference for a specific anticoagulant should be based on a careful discussion between patient and physician about the benefits and risks of treatment alternatives, Young says. “We now need to be sitting down with each one of our cancer patients with VTE, discussing their preference alongside looking at all their clinical details - including whether the cancer lesion is still there, what other medications are being taken and what other conditions the patient has, so that we can choose the optimal VTE treatment for each patient.”