Rivaroxaban: An Affordable and Effective Alternative in Cancer-Related Thrombosis?

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art_XAVIER_Rivaroxaban_An_Affordable_and_Effective_Alternative_in_CancerRelated_2017.PDF (486.13 KB)
Citações na Scopus
12
Tipo de produção
article
Data de publicação
2017
Editora
AMER SOC CLINICAL ONCOLOGY
DOI
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Scopus
Web of Science
PubMed
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Autores
XAVIER, Flavia Dias
HOFF, Paulo Marcelo Gehm
BRAGHIROLI, Maria Ignez
PATERLINI, Ana Carolina Carvalho Rocha
FARIA, Luiza Dib Batista Bugiato
FERREIRA, Fernando Sergio Blumm
MACHADO, Karime Kalil
FERNANDES, Gustavo dos Santos
Autor de Grupo de pesquisa
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Citação
JOURNAL OF GLOBAL ONCOLOGY, v.3, n.1, p.15-22, 2017
Projetos de Pesquisa
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Resumo
Background Venous thromboembolic events (VTEs) are common and potentially fatal complications in cancer patients, and they are responsible for the second most common cause of death. Low molecular weight heparin (LMWH) is the gold-standard treatment, but the costs involved limit its use, especially in developing countries. Recently, the oral anticoagulant rivaroxaban, which directly inhibits factor Xa, was approved for VTE treatment. Methods We conducted a retrospective analysis from January 2009 to February 2014 with patients who had cancer and VTE who were receiving rivaroxaban. We compared the efficacy, safety, and cost of rivaroxaban and low molecular weight heparin (LMWH) alone or followed by vitamin K antagonists. Results Forty-one patients were identified, with a median age of 62.5 years. The most frequent tumor histology was adenocarcinoma (78%), which was most often found in the colon (26.8%). Most participants had advanced disease and an implanted central venous catheter. Patients VTE risk-assessment scores were low (12.5%), intermediate (50%), and high (35.5%). Pulmonary thromboembolism was reported in 41.4% of patients, but inferior limb thrombosis was reported only in 14.6%; 43.9% of patients received enoxaparin before starting rivaroxaban. Rivaroxaban was used for a median time of 5.5 months. Nonmajor bleeding was reported in 12.2% of patients, and rethrombosis was reported in 12.2%. In our study, rivaroxaban was as safe and effective as enoxaparin/vitamin K antagonists (P = .54 and P = .25, respectively) or LMWH (P = .46 and P = .29, respectively). Conclusion Although our study was a retrospective analysis, our results suggest that in this cohort of oncologic patients, rivaroxaban was safe and effective. Its oral route and lower cost make it an attractive alternative to LMWH, improving management of patients with cancer in low-income countries. Additional studies are necessary to confirm our data. (C) 2016 by American Society of Clinical Oncology Licensed under the Creative Commons Attribution 4.0 License
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https://observatorio.fm.usp.br/handle/OPI/31970
Referências
  1. Akl EA, 2014, COCHRANE DB SYST REV, DOI 10.1002/14651858.CD006650.pub4
  2. Buller HR, 2012, NEW ENGL J MED, V366, P1287, DOI 10.1056/NEJMoa1113572
  3. Connell Nathan T, 2015, R I Med J (2013), V98, P32
  4. Falanga A, 2013, J THROMB HAEMOST, V11, P223, DOI 10.1111/jth.12075
  5. Falanga A, 2009, BEST PRACT RES CL HA, V22, P49, DOI 10.1016/j.beha.2008.12.009
  6. Farge D, 2013, J THROMB HAEMOST, V11, P56, DOI 10.1111/jth.12070
  7. Fernandes RS, 2006, J THROMB HAEMOST, V4, P1546, DOI 10.1111/j.1538-7836.2006.01985.x
  8. Heit JA, 2000, ARCH INTERN MED, V160, P809, DOI 10.1001/archinte.160.6.809
  9. Hernandez RK, 2009, CANCER, V115, P4442, DOI 10.1002/cncr.24508
  10. Khorana AA, 2007, J THROMB HAEMOST, V5, P632, DOI 10.1111/j.1538-7836.2007.02374.x
  11. Khorana AA, 2008, BLOOD, V111, P4902, DOI 10.1182/blood-2007-10-116327
  12. Khorana AA, 2012, HEMATOL-AM SOC HEMAT, P626, DOI 10.1182/asheducation-2012.1.626
  13. LENSING AWA, 1995, ARCH INTERN MED, V155, P601, DOI 10.1001/archinte.155.6.601
  14. Levitan N, 1999, MEDICINE, V78, P285, DOI 10.1097/00005792-199909000-00001
  15. Lyman GH, 2015, J CLIN ONCOL, V33, P654, DOI 10.1200/JCO.2014.59.7351
  16. Lyman GH, 2013, J CLIN ONCOL, V31, P2189, DOI 10.1200/JCO.2013.49.1118
  17. Nadir Y, 2008, THROMB HAEMOSTASIS, V99, P133, DOI 10.1055/s-0037-1608919
  18. Nalluri SR, 2008, JAMA-J AM MED ASSOC, V300, P2277, DOI 10.1001/jama.2008.656
  19. Palumbo JS, 2005, BLOOD, V105, P178, DOI 10.1182/blood-2004-06-2272
  20. Pickering W, 2004, J THROMB HAEMOST, V2, P459, DOI 10.1111/j.1538-7836.2004.00607.x
  21. Prandoni P, 2002, BLOOD, V100, P3484, DOI 10.1182/blood-2002-01-0108
  22. Prins MH, 2013, THROMB J, V11, DOI 10.1186/1477-9560-11-21
  23. Reeves BN, 2012, THROMB RES, V129, pS66, DOI 10.1016/S0049-3848(12)70019-1
  24. Rickles FR, 2003, CHEST, V124, p58S, DOI 10.1378/chest.124.3_suppl.58S
  25. Samama MM, 2011, THROMB RES, V127, P497, DOI 10.1016/j.thromres.2010.09.008
  26. Seng S, 2012, J CLIN ONCOL, V30, P4416, DOI 10.1200/JCO.2012.42.4358
  27. Siragusa S, 1996, AM J MED, V100, P269, DOI 10.1016/S0002-9343(97)89484-3

Coleções
Artigos e Materiais de Revistas Científicas - HC/InRad
Artigos e Materiais de Revistas Científicas - ODS/03