Effectiveness and safety of anticoagulants among venous thromboembolism cancer patients with and without brain cancer.
Anticoagulant
Brain cancer
Venous thromboembolism
Journal
Thrombosis research
ISSN: 1879-2472
Titre abrégé: Thromb Res
Pays: United States
ID NLM: 0326377
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
09
12
2022
revised:
29
03
2023
accepted:
10
04
2023
medline:
23
5
2023
pubmed:
6
5
2023
entrez:
5
5
2023
Statut:
ppublish
Résumé
Patients with brain cancer are at a high risk of developing venous thromboembolism (VTE) and are underrepresented in clinical trials. This study compared the risk of recurrent VTE (rVTE), major bleeding (MB), and clinically relevant non-major bleeding (CRNMB) among VTE cancer patients initiating apixaban, low molecular weight heparin (LMWH), or warfarin stratified by patients with brain vs other cancer types. Active cancer patients initiating apixaban, LMWH, or warfarin within 30 days after VTE diagnosis were identified from 4 US commercial and the Medicare databases. Inverse probability of treatment weights (IPTW) was used to balance patient characteristics. Cox proportional hazards models were used to evaluate the interaction between brain cancer status and treatment on outcomes (rVTE, MB, and CRNMB), with a p-value <0.1 indicating a significant interaction. Of 30,586 patients with active cancer (5 % had brain cancer), apixaban (vs. LMWH and warfarin) was associated with lower risk of rVTE, MB, and CRNMB. Generally, no significant interactions (P > 0.1) were found between brain cancer status and anticoagulant treatment across outcomes. The exception was MB for apixaban [vs LMWH (p-value for interaction = 0.091)] with a higher reduction among those with brain cancer (HR = 0.32) than those with (HR = 0.72) other cancer. Among VTE patients with all types of cancer, apixaban (vs LMWH and warfarin) was associated with a lower risk of rVTE, MB, and CRNMB. In general, anticoagulant treatment effects were not significantly different between VTE patients with brain cancer and those with other cancer.
Identifiants
pubmed: 37146438
pii: S0049-3848(23)00101-9
doi: 10.1016/j.thromres.2023.04.009
pii:
doi:
Substances chimiques
Anticoagulants
0
Warfarin
5Q7ZVV76EI
Heparin, Low-Molecular-Weight
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
117-126Informations de copyright
Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest AC received research support from Pfizer Inc. and Bristol-Myers Squibb Company. VN, RB and SS were paid employees of STATinMED at the time of the study; STATinMED is a paid consultant to Pfizer, Inc. and Bristol-Myers Squibb Company in connection with the development of this manuscript. AD is a paid employee of Bristol-Myers Squibb Company. DMH, TA, and XL are paid employees of Pfizer, Inc.