Longer anticoagulation therapy may reduce VTE recurrence in patients with cancer

CHICAGO — Extending anticoagulation beyond 3 months reduced risk for recurrent clots in patients with cancer, according to results presented at the ASCO Annual Meeting.

The current recommended treatment for venous thromboembolism in patients with cancer includes anticoagulant therapy for a minimum of 3 to 6 months; however, treatment for more than 6 months has not been evaluated.

Alok A. Khorana

“VTE Is an important cause of morbidity and mortality in patients with cancer,” Alok A. Khorana, MD, professor of medicine at Cleveland Clinic Lerner College of Medicine, vice chair for clinical services of the Taussig Cancer Institute and director of the gastrointestinal malignancies program at the Cleveland Clinic, told HemOnc Today. “Randomized trials have only studied anticoagulation up to 6 months; it is unclear how long to extend therapy beyond that time point.”

To evaluate the association between the duration of anticoagulation and VTE recurrence, Khorana and colleagues used health care claims from the Humana database to identify 1,158 patients with newly diagnosed cancer who received low–molecular-weight heparin (n = 376), warfarin (n = 473) or rivaroxaban (Xarelto, Janssen; n = 309) for their first VTE diagnosis.

VTE recurrence occurred most often within the first 3 months of anticoagulation therapy (43.6%).

Adjusted analysis demonstrated lower recurrence rates in patients treated for 3 to 6 months (HR = 0.67; 95% CI, 0.52-0.88), 6 to 9 months (HR = 0.55; 95% CI, 0.40-0.76) and more than 9 months (HR = 0.54; 95% CI, 0.36-0.79) compared with patients treated for only 3 months (P < .01).

“Based on these findings, it appears that protection from recurrent clots persists beyond the 6-month time point and validates current guidelines which suggest treating with anticoagulation for as long as patients have active cancer, such as metastatic disease or systemic therapy,” Khorana said.

Future studies will focus on the transition to newer oral agents, “which have the advantage of being patient friendly and not requiring monitoring,” Khorana added. – by Kristie L. Kahl

Reference: Khorana AA, et al. Abstract 10112. Presented at: ASCO Annual Meeting; June 3-7, 2016; Chicago.

Disclosures: Khorana reports honoraria from AngioDynamics, Boehringer Ingelheim, Daiichi Sankyo, Genentech, Halozyme, Janssen Pharmaceuticals, LEO Pharma, Pfizer and Sanofi; consultant roles with and/or travel accommodations from AngioDynamics, Boehringer Ingelheim, Daiichi Sankyo, Genentech, Halozyme, Janssen Pharmaceuticals, LEO Pharma and Sanofi; receives funding from Amgen and LEO Pharma.