Rivaroxaban May Reduce Risk of Venous Thromboembolism in Patients With Cancer

Key Points

  • After 6 months of treatment, the VTE recurrence rate was 4% among those treated with rivaroxaban and 11% in those receiving dalteparin.
  • In patients receiving rivaroxaban, there was around the same percentage of major bleeding events (6%) as those receiving dalteparin (4%) but a marked and significant increase in clinically relevant nonmajor bleeds (13%) with rivaroxaban compared to those having low–molecular weight heparin (4%).

Patients with cancer have an increased risk of developing blood clots, with roughly one in five experiencing venous thromboembolism (VTE)—either deep-vein thrombosis (DVT) or pulmonary embolism (PE). Although there are many causes and risk factors for VTE, patients with cancer are particularly at risk due to a combination of factors such as immobility, pancreatic and gastric tumors, and chemotherapy.

Current international guidelines recommend treating patients with cancer with an anticoagulant (a low–molecular weight heparin) to treat and prevent recurrence of VTE. However, new results from the SELECT-D trial at the University of Warwick Medical School suggest that a daily tablet of rivaroxaban (Xarelto) could be a beneficial alternative for treating VTE in selected patients. The findings were published by Young et al in the Journal of Clinical Oncology.

Research led by Annie Young, SRN, PhD, found that prescribing rivaroxaban significantly reduced venous thromboembolism recurrence among patients with cancer and VTE. She said, “Clinicians were already adopting the oral drug into practice for [patients without cancer] 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.”

More on SELECT-D

The trial enrolled 406 patients who had cancer and VTE; most (69%) were receiving cancer treatment (typically chemotherapy) at the time of their VTE. Half were randomly assigned to receive low–molecular weight heparin (dalteparin [Fragmin]) and half were given rivaroxaban. After 6 months of treatment, the VTE recurrence rate was 4% among those treated with 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%) but a marked and significant increase in clinically relevant nonmajor bleeds (13%) with rivaroxaban compared to those having low molecular weight heparin (4%). The reason for increased bleeding is not known, but it may be because rivaroxaban is more potent.

Professor Young added, “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.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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