DOACs as good as LMWH for recurrent VTE prevention in cancer patients

For patients with cancer who have recurrent venous thromboembolism (VTE), direct oral anticoagulants (DOACs) compare favourably with low-molecular-weight heparin (LMWH) in terms of recurrence prevention, according to a study.

The study included 671 patients with cancer (any invasive solid tumour, lymphoma, multiple myeloma, or chronic lymphocytic leukaemia) who had a new clinical or radiological diagnosis of VTE. These patients were randomly assigned to receive either a DOAC (n=335) or LMWH (n=336) for recurrent VTE prevention.

A total of 638 patients (median age 64 years, 55 percent women) completed the trial, with 330 in the DOAC group and 308 in the LMWH group receiving at least one dose.  The primary endpoint of recurrent VTE rate at 6 months was 6.1 percent in the DOAC group and 8.8 percent in the LMWH group (difference, −2.7 percent, 1-sided 95 percent confidence interval [CI], −100 percent to 0.7 percent), with the difference meeting the prespecified noninferiority criterion.

Data for the prespecified secondary outcomes showed no significant between-group differences.

Major bleeding was documented in 5.2 percent of patients in the DOAC group and in 5.6 percent in the LMWH group (difference, −0.4 percent, 1-sided 95 percent CI, –100 percent to 2.5 percent), and the difference was not statistically significant.

In terms of safety, severe adverse events occurred in 33.8 percent of patients in the DOAC group and 35.1 percent in the LMWH group. The most frequent serious adverse events were anaemia and death.

The present data support the use of a DOAC to prevent recurrent VTE in patients with cancer.