Bleeding in Patients With Gastrointestinal Cancer Compared With Nongastrointestinal Cancer Treated With Apixaban, Rivaroxaban, or Enoxaparin for Acute Venous Thromboembolism
| Autor: | Damon E. Houghton, David A. Froehling, Ryan A. Meverden, Robert D. McBane, David O. Hodge, Nichole E Brunton, Lisa G. Peterson, Waldemar E. Wysokinski, Danielle T. Vlazny, Ana I. Casanegra |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Pyridones medicine.drug_class Low molecular weight heparin Hemorrhage Thrombophilia Severity of Illness Index Gastroenterology Rivaroxaban Risk Factors Pancreatic cancer Internal medicine parasitic diseases medicine Humans Prospective Studies Gastrointestinal cancer Enoxaparin Gastrointestinal Neoplasms Venous Thrombosis business.industry Liver Neoplasms Cancer social sciences General Medicine Middle Aged medicine.disease United States Pulmonary embolism Pancreatic Neoplasms Outcome and Process Assessment Health Care Pyrazoles population characteristics Female Apixaban Pulmonary Embolism business human activities geographic locations Factor Xa Inhibitors medicine.drug |
| Zdroj: | Mayo Clinic Proceedings. 96:2793-2805 |
| ISSN: | 0025-6196 |
| DOI: | 10.1016/j.mayocp.2021.04.026 |
| Popis: | Objective To compare the bleeding risk in patients with gastrointestinal (GI) cancer with that in patients with non-GI cancer treated with anticoagulation for acute cancer-associated venous thromboembolism (Ca-VTE). Patients and Methods Consecutive patients with Ca-VTE seen at the Mayo Thrombophilia Clinic between March 1, 2013, and April 20, 2020, were observed prospectively to assess major bleeding and clinically relevant nonmajor bleeding (CRNMB). Results In the group of 1392 patients with Ca-VTE, 499 (35.8%) had GI cancer including 272 with luminal GI cancer (lower GI, 208; upper GI, 64), 176 with pancreatic cancer, and 51 with hepatobiliary cancer. The rate of major bleeding and CRNMB in patients with GI cancer was similar to that in 893 (64.2%) patients with non-GI cancer treated with apixaban, rivaroxaban, or enoxaparin. Apixaban had a higher rate of major bleeding in luminal GI cancer compared with the non-GI cancer group (15.59 vs 3.26 per 100 person-years; P=.004) and compared with enoxaparin in patients with luminal GI cancer (15.59 vs 3.17; P=.04). Apixaban had a lower rate of CRNMB compared with rivaroxaban in patients with GI cancer (3.83 vs 9.40 per 100 person-years; P=.03). Patients treated with rivaroxaban in the luminal GI cancer group had a major bleeding rate similar to that of patients with non-GI cancer (2.04 vs 4.91 per 100 person-years; P=.37). Conclusion Apixaban has a higher rate of major bleeding in patients with luminal GI cancer compared with patients with non-GI cancer and compared with enoxaparin in patients with luminal GI cancer. Rivaroxaban shows no increased risk of major bleeding in patients with GI cancer or luminal GI cancer compared with patients with non-GI cancer. Trial Registration ClinicalTrials.gov identifier: NCT03504007 . |
| Databáze: | OpenAIRE |
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