| アブストラクト | BACKGROUND: In most patients with cancer-associated venous thromboembolism (CT), essentially those not at high risk of bleeding, guidelines recommend treatment with direct oral anticoagulants as an alternative to low-molecular-weight heparins (LMWHs). Population-based studies comparing these therapies are scarce. OBJECTIVES: To compare the risk of venous thromboembolism (VTE) recurrences, significant bleeding, and all-cause mortality in patients with CT receiving rivaroxaban or LMWHs. PATIENTS/METHODS: Using UK Clinical Practice Research Datalink data from 2013 to 2020, we generated a cohort of patients with first CT treated initially with either rivaroxaban or LMWH. Patients were observed 12 months for VTE recurrences, significant bleeds (major bleeds or clinically relevant nonmajor bleeding requiring hospitalization), and all-cause mortality. Overlap weighted sub-distribution hazard ratios (SHRs) compared rivaroxaban with LMWH in an intention-to-treat analysis. RESULTS: The cohort consisted of 2,259 patients with first CT, 314 receiving rivaroxaban, and 1,945 LMWH, mean age 72.4 and 66.9 years, respectively. In the 12-month observational period, 184 person-years following rivaroxaban and 1,057 following LMWH, 10 and 66 incident recurrent VTE events, 20 and 102 significant bleeds, and 10 and 133 deaths were observed in rivaroxaban and LMWH users, respectively. The weighted SHR at 12 months for VTE recurrences in rivaroxaban compared with LMWH were 0.80 (0.37-1.73); for significant bleeds 1.01 (0.57-1.81); and for all-cause mortality 0.49 (0.23-1.06). CONCLUSION: Patients with CT, not at high risk of bleeding, treated with either rivaroxaban or LMWH have comparable effectiveness and safety outcomes. This supports the recommendation that rivaroxaban is a reasonable alternative to LMWH for the treatment of CT. |
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| ジャーナル名 | Thrombosis and haemostasis |
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| 投稿日 | 2024/2/2 |
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| 投稿者 | Cohen, Alexander T; Wallenhorst, Christopher; Rivera, Marcella; Ay, Cihan; Schaefer, Bernhard; Abdelgawwad, Khaled; Psaroudakis, George; Brobert, Gunnar; Ekbom, Anders; Lee, Agnes Y Y; Khorana, Alok A; Becattini, Cecilia; Carrier, Marc; Coleman, Craig I; Martinez, Carlos |
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| 組織名 | Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust,;King's College London, London, United Kingdom.;Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt am Main,;Germany.;Bayer AG, Berlin, Germany at the time of study conduct, currently affiliated to;Janssen Research and Development, Barcelona, Spain.;Clinical Division of Haematology and Haemostaseology, Department of Medicine I,;Medical University of Vienna, Vienna, Austria.;Bayer AG, Berlin, Germany.;Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institute,;Stockholm, Sweden.;Division of Hematology, University of British Columbia and BC Cancer, Vancouver,;Canada.;Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, Ohio, United;States.;Department of Internal and Emergency Medicine - Stroke Unit, University of;Perugia, Perugia, Italy.;Department of Medicine, Ottawa Hospital Research Institute at the University of;Ottawa, Ottawa, Canada.;Department of Pharmacy Practice, School of Pharmacy, University of Connecticut,;Storrs, Connecticut, United States. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38301711/ |
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