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Anti-Coagulation Therapy Compliance Poor in Cancer-Associated VTE

June 14, 2022

Mid-July 2022

In real-world clinical practice, patients with cancer-associated venous thromboembolism (VTE) remain on anti-coagulation therapy for a short duration, according to study data that suggest direct oral anticoagulants (DOACs) and warfarin may result in better compliance than low-molecular-weight heparin (LMWH) in these patients. Results from the propensity score weighted analysis were presented at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting.

“Treatment adherence is central to the effectiveness of anticoagulant therapy, and clinical guidelines recommend the continuance of anticoagulant therapy for a minimum of six months in patients with active cancer,” said first author Irbaz Bin Riaz, MD, of Mayo Clinic in Phoenix. “Despite these recommendations, persistence in anticoagulant treatment was low, with less than one-third of patients continuing treatment beyond six months in real-world clinical practice.”

Dr. Riaz and colleagues explained that real-world use and comparative effectiveness of DOACs, LMWH, and warfarin for cancer-associated VTE is poorly understood. Their analysis included administrative claims data from 5,100 adult patients with cancer and active VTE from January 1, 2012, to September 30, 2019. Of the patients, 49.3% filled prescriptions for DOACs (n=2,512), 29.2% for LMWH (n=1,488), and 28.6% for warfarin (n=1,460).

For the analysis, researchers assessed use patterns, recurrent VTE, and major bleeding differences between the three therapies. Median treatment duration was approximately 3.2 months for DOACs and warfarin and 1.8 months for LMWH (p<0.01).

Results showed younger patients were more likely to be prescribed LMWH compared with DOACs (odds ratio [OR] = 0.97, 95% CI 0.97-0.98). Compared with DOACs, patients were also more likely to be prescribed LMWH or warfarin, respectively, for several cancers, including lung (OR=2.07, 95% CI 1.12-3.65 vs. OR=1.87, 95% CI 1.04-3.37), urologic (OR=1.94, 95% CI 1.08-3.49 vs. OR=2.04, 95% CI 1.12-3.73), gynecologic (OR=4.25, 95% CI 2.31-7.82 vs. OR=2.31, 95% CI 1.22-4.39), and colorectal (OR=2.26, 95% CI 1.20-4.32 vs. OR=2.51, 95% CI 1.32-4.79).

“Overall, DOACs appear to be more effective, safer, and more convenient than LMWH and warfarin,” Dr. Riaz said.

VTE recurrences were more frequent for patients receiving LMWH (hazard ratio [HR] = 1.47, 95% CI 1.14-1.90) or warfarin (HR=1.46, 95% CI 1.13-1.87) compared with DOACs. LMWH, but not warfarin, was associated with higher major bleeding rates compared with DOACs (HR=2.27, 95% CI 1.62-3.20). All-cause mortality rates were also significantly higher for those receiving LMWH, but not warfarin, compared with DOACs (HR=1.61, 95% CI 1.15-2.25).

“Every possible effort should be made to increase the adherence to the guideline-recommended duration of therapy,” Dr. Riaz said. “Warfarin may still be considered for patients with contraindications to DOACs and for those who have poor persistence on LMWH.”

Any conflicts of interest declared by the authors can be found in the original abstract.

Reference

Riaz I, Bayne H, Deng Y, et al. Real-world utilization and comparative effectiveness of treatment options in cancer-associated thrombosis: A propensity score weighed analysis. Abstract 6589. Presented at the 2022 American Society of Clinical Oncology Annual Meeting; Chicago, Illinois.

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