Korean J Clin Pharm.  2016 Sep;26(3):195-200. 10.0000/kjcp.2016.26.3.195.

Comparisons of Bleeding Risks between Rivaroxaban and Dalteparin for Treatment of Venous Thromboembolism in Cancer Patients

• Kim YK
• An SH
• Kim JY
• Chung JE
• Gwak HS

• KMID: 2358234
• DOI: http://doi.org/10.0000/kjcp.2016.26.3.195

Abstract

BACKGROUND
Venous thromboembolism (VTE) is a common and life-threating condition in cancer patients. Low molecular weight heparins (LMWH), such as dalteparin, are recommended in the treatment of VTE. Also, rivaroxaban, an orally administered direct factor Xa inhibitor, was approved for the treatment of VTE. It showed similar efficacy to standard therapy (LMWH or warfarin) and was associated with significantly lower rates of major bleedings. However, in the real world, bleeding has been reported to occur frequently in cancer patient receiving rivaroxaban. The goal of this research was to analyze bleeding risks between rivaroxaban and dalteparin for treatment of VTE in cancer patients.
METHODS
Medical records of oncology patients who were treated with rivaroxaban or dalteparin for VTE from July 2012 to June 2014 were retrospectively reviewed. Data collected were as follows: age, sex, weight, height, cancer types and stages, ECOG (eastern cooperative oncology group) PS (performance score), VTE types, concurrently used medications, study drug information (dose and duration of therapy), INR (international normalized ratio), PT (prothrombin time), and platelet counts. Bleeding was classified into major bleedings, clinically relevant non-major bleedings, and minor bleedings.
RESULTS
A total of 399 patients were included in the study. Of these patients, 246 were treated with rivaroxaban and 153 with dalteparin. Bleeding rates were significantly higher in the rivaroxaban group than in the dalteparin group (adjusted odds ratio (AOR) 2.09, 95% CI 1.22-3.60) after adjusting for confounders. In addition, rivaroxaban remained independently associated with 1.78-fold (95% CI 1.14-2.76) shorter time to bleeding compared to dalteparin after adjusting other factors known to be associated with poor outcomes.
CONCLUSION
This study suggested that rivaroxaban was associated with an increased risk of bleedings in cancer patients.

Keyword

Rivaroxaban; dalteparin; venous thromboembdism; bleeding; cancer parints

MeSH Terms

Dalteparin*
Factor Xa
Hemorrhage*
Heparin, Low-Molecular-Weight
Humans
International Normalized Ratio
Medical Records
Odds Ratio
Platelet Count
Retrospective Studies
Rivaroxaban*
Venous Thromboembolism*
Dalteparin
Factor Xa
Heparin, Low-Molecular-Weight
Rivaroxaban