Dr Alexander Cohen speaks to ecancer at the ASH 2019 meeting in Orlando about the data he was presenting on the safety and effectiveness of apixaban, low-molecular-weight heparin, and warfarin among venous thromboembolism patients with active cancer.
Well the abstract i’m presenting relates to an observational study where we looked at over 14,000 patients with cancer associated venous thrombosis these were patients with active cancer and they were followed in up to six months and what we found was that when we compared doe x in particular apixaban with low melech weight heparin and with warfarin we found
The patients with a picc seban had a lower rate of major bleeding when compared to low molecular weight heparin and they also had a lower rate of recurrences so there was about a 40% reduction major bleeding the most feared complication of treating patients with ad coagulants and there was about a 40 percent reduction in venous thromboembolism recurrences which
Is the aim of treating those patients to prevent those recurrences and that compared to low molecular temporal and that’s unusual because a lot of the studies particularly the randomised trials have shown the doe acts in this setting might reduce recurrences but they’re often associated with more bleeding but in the case of apixaban we saw the reduction of the
Recurrences associated with about a 40% reduction in major bleeding so we looked at for large us databases we looked at humana optin far metrics and market scan and these have massive amounts of data and we were able to define a cohort of patients with active cancer meaning those patients that have had a recent diagnosis of cancer or who have had recent therapy for
Cancer chemotherapy radiotherapy and so on and we then followed those patients for six months after they developed a venous thromboembolism event so after they developed a dvt or a pommery embolus which is a common complication of in the early phase of active cancer we then carefully match the patient’s so we use propensity score matching with inverse proportional
Treatment ways and we got what we consider were three cohorts that were very similar a cohort on a picture bam a cohort on low molecular weight heparin and a cohort on warfarin and we managed to match them for all the risk factors that would be associated with recurrences and bleeding and then we analyzed these patients using a cox proportional hazards model and
What we showed when we did that were the positive results for a pic seban with the reductions in major bleeding in clinically relevant non major bleeding and recurrences compared to low molecular efrain and when we compared low molecular pirin to warfarin we didn’t see any differences and then we when we compared a pic seban to warfarin we didn’t see differences
In bleeding but we saw differences in recurrences in favor of apixaban so this is very encouraging news for people that want to treat venous thromboembolism associated with active cancer with oral therapies because by far patients prefer oral therapies to injectable therapies for this particular condition so we did a subgroup analysis where we took the whole
Population and we divided them into three cohorts based on a modified khurana score the khurana score looks at the risk of venous thromboembolism it divides patients into very high risk or high risk or not high res and we look very carefully to see if there was any evidence of heterogeneity in the results with respect to the different subgroups and first of all we
Looked at major bleeding and clinically relevant non major bleeding in the patients comparing a picture ban with low molecular heparin in comparing a pixel ban with warfarin and comparing low malaika weight heparin with warfarin and each in each of the three subgroup analyses we saw no evidence of heterogeneity which meant that the results were consistent amongst
All the subgroups and that the advantages of a pixel ban with respect to bleeding were not affected by the risk of venous thrombosis however when we came to recurrences we did see some heterogeneity we saw the main heterogeneity was where we expected to see heterogeneity when we compared low molecular weight heparin to warfarin we’ve known for some time since the
Clot and catch study that patients at very high risk of thrombosis do better with low molecular hip rijn than with warfarin and so we saw heterogeneity there where the advantage for low molecular heparin was clear in the very high risk of thrombosis group there was also some heterogeneity when we compared a picc seban with low molecular heparin overall it favored
Apixaban but when we looked at the subgroups the advantage for apixaban was in the patients at lower risk of venous thrombosis and those at very high risk had similar efficacy to lower liquid heparin well the clinical implications are very good for patients because as i said earlier patients greatly prefer oral therapies to injectable therapies and we know that the
Adherence and persistence with oral therapies is much greater many patients receiving injections stop using them and that affects our parents and if patients had here and persists with therapies then their outcomes are going to be better they’re going to have fewer recurrences and in the case of a pixie ban on the basis of this data they seem to have fewer major
Bleeds as well so that’s really good news for patients well one of the questions that is still unanswered is what is the optimal length of anticoagulant therapy and we know that it’s generally recommended by all the guidelines both in north american europe that these patients are treated for six months and we looked at six months in our study but should they get
Nine months or 12 months and which patients would benefit from longer therapy and we know there are other questions too how do we manage patients with unusual site thrombosis so thrombosis occurring in the splanchnic veins or in the intro cerebral veins how do we deal with catheter-associated thrombosis in cancer patients these are all questions we need to look
Into in the future i think the striking feature of our study was that previous research with dou x compared with low molecular prett have shown advantages with respect to efficacy but at the expense of safety in some patients where there’s more major bleeding with the dou x than with low molecular hip run our study didn’t show that our study showed that we got the
Efficacy benefit with about a 40% improvement in recurrence rates but we also got a safety benefit and that distinguishes our study from other studies in this area
Transcribed from video
Benefits of apixaban among venous thromboembolism patients with active cancer By ecancer
