ORLANDO — Apixaban reduced the risk for recurrent venous thromboembolism compared with low-molecular-weight heparin and warfarin, according to results of a large epidemiology study presented at the ASH Annual Meeting and Exposition.
Additionally, Alexander T. Cohen, MBBS, MSc, MD, FRACP, FESC, vascular physician and epidemiologist at Guy’s and St. Thomas’ Hospital, King’s College in London, reported that apixaban (Eliquis, Bristol-Myers Squibb) was associated with a lower risk for major bleeding and clinically relevant non-major bleeding vs. low-molecular-weight heparin in patients with cancer-associated venous thromboembolism (VTE).
Cohen and colleagues used data from four U.S. claims databases to compare the effects of apixaban, low-molecular-weight heparin and warfarin in more than 14,000 patients with cancer-associated venous thromboembolism.
“When we looked at the overall population, the use of apixaban for the treatment of active cancer-associated venous thrombosis was associated with a roughly 40% decrease in major bleeding and a roughly 40% decrease in recurrent VTE,” Cohen told Healio. “Clinically relevant non-major bleeding, which is the commonest type of bleeding, was also decreased significantly by around 20%.”
A subgroup analysis stratified by very high VTE risk, high VTE risk and lower VTE risk patients yielded similar results in terms of bleeding events.
“However, when we looked at recurrences, we saw that there was an interaction between low-molecular-weight heparin and warfarin,” Cohen said. “This interaction was very consistent with the clinical trials where we saw the patients with very high risk for venous thrombosis did relatively better with low-molecular weight heparin than with warfarin.”
The researchers also found that the overall favorable effect of apixaban vs. low-molecular-weight heparin on recurrences was greatest among patients at lower risk for VTE. In contrast, there was no significant difference in recurrences among patients at very high risk for VTE.
“But overall, the study results should be very encouraging for doctors using [direct oral anticoagulants (DOACs)] for the treatment of venous thrombosis,” Cohen said. “It shows that apixaban not only prevents recurrences, which is consistent with the other DOACs, but shows a unique feature where, in this study, it was associated with a reduced risk of bleeding, which must be even more reassuring for doctors treating cancer-associated venous thrombosis.”
Cohen AT, et al. Abstract 326; Presented at: ASH Annual Meeting and Exposition; Dec. 7-10, 2019; Orlando.
Cohen AT, et al. Abstract 327; Presented at: ASH Annual Meeting and Exposition; Dec. 7-10, 2019; Orlando.
Disclosure: Cohen reports serving in consultancy roles for AbbVie, ACI Clinical, Aspen, Bayer, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, CSL Behring, Daiichi-Sankyo, GlaxoSmithKline, GLC, Guidepoint Global, Johnson and Johnson, Leo Pharma, Medscape, Navigant, McKinsey, ONO, Pfizer, Portola, Sanofi, Takeda, Temasek Capital and TRN, and membership/advisory roles for Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Johnson and Johnson, Lifeblood, ONO, Pfizer, Portola, Sanofi, and the UK Government Health Select Committee. He also reports receiving speaker’s bureau fees from Aspen, Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, GlaxoSmithKline, Johnson and Johnson, Medscape, Pfizer and Portola, as well as research funding and honoraria from Bayer and Bristol-Myers Squibb.