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Rivaroxaban

Rivaroxaban is a feasible alternative to low-molecular-weight heparin (LMWH) for the treatment of venous thromboembolism (VTE) in cancer patients, according to researchers.

In the SELECT-D trial, cancer patients with VTE received 6 months of treatment with rivaroxaban or the LMWH dalteparin.

Patients who received rivaroxaban had a lower rate of VTE recurrence but higher rates of bleeding than those who received dalteparin.

These results were published in the Journal of Clinical Oncology. The research was supported by Bayer AG.

The trial enrolled 406 patients who had cancer and VTE. Sixty-nine percent of patients were receiving cancer treatment (83% chemotherapy) at baseline, and 58% had metastases.

Patients were randomized to receive dalteparin or rivaroxaban for 6 months. Dalteparin was given at 200 IU/kg daily for the first month, then at 150 IU/kg daily for months 2 to 6. Rivaroxaban was given at 15 mg twice daily for 3 weeks, then at 20 mg once daily for the rest of the treatment period.

The 6-month cumulative VTE recurrence rate was 11% in the dalteparin arm and 4% in the rivaroxaban arm (hazard ratio [HR]=0.43; 95% CI, 0.19 to 0.99).

The 6-month cumulative rate of major bleeding was 4% in the dalteparin arm and 6% in the rivaroxaban arm (HR=1.83; 95% CI, 0.68 to 4.96).

And the 6-month cumulative rate of clinically relevant non-major bleeding was 4% in the dalteparin arm and 13% in the rivaroxaban arm (HR=3.76; 95% CI, 1.63 to 8.69).

The researchers said these results suggest rivaroxaban can be an alternative to LMWH in cancer patients.

“Clinicians were already adopting [rivaroxaban] 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,” said study author Annie Young, SRN, PhD, of Warwick Medical School at University of Warwick in Coventry, UK.

“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.”


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