“Clinicians are already adopting DOACs into practice for these patients and now they have data from this study to indicate that DOACs are potentially safe in cancer patients. We need to be looking at different groups of people and different types of bleeds in more detail, so that we can choose the best treatment for each patient.”
Congress news
Daily pill could reduce blood clot risk in cancer patients
Latest results from the 'Select-D' pilot trial suggest that direct oral anticoagulants (DOACS) could be a safe and more beneficial alternative for treating VTE in certain patients - currently, approximately 1 in 5 cancer patients experience VTE.
The trial enrolled 406 patients with cancer and VTE as participants, 69% of whom were receiving cancer treatment at the time. 50% of the participants were randomly assigned low-molecular-weight heparin (dalteparin) and the remaining participants received a DOAC (rivaroxaban). After 6 months, the rate of VTE recurrence was 11% in the dalteparin group and just 4% in the DOAC group.
However, the group which received the DOAC experienced more major bleeding events (11 patients) and a marked increase in clinically relevant non-major bleeds (25 patients) in contrast with the heparin group (6 patients and 6 patients respectively).
Further detail from the official press release of ASH 2017:
People with cancer have an increased risk of developing blood clots, with roughly one in five experiencing venous thromboembolism (VTE) — blood clots that occur in deep veins like the legs or that travel through the blood stream and get lodged in the small blood vessels in the lungs. International guidelines recommend treatment using low-molecular-weight heparin, an anticoagulant that is injected subcutaneously; however, new results from a large pilot trial suggest that DOACs, newer blood thinners administered as a daily pill, could be a safe and beneficial alternative for treating VTE in selected patients.
Although there are many causes and risk factors for VTE, its increased prevalence in cancer patients is thought to be related to a combination of factors such as immobility from remaining in bed, procoagulants produced by the tumour, and chemotherapy. Because VTE can be life-threatening, blood thinners are used to shrink existing clots and prevent others from forming.
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The Learning Zones are an educational resource for healthcare professionals that provide medical information on the epidemiology, pathophysiology and burden of disease, as well as diagnostic techniques and treatment regimens.
