Use of direct oral anticoagulants in cancer patients.

Abstract

Introduction: The appearance of thromboembolic events is a frequent complication in cancer patients. It is a population that is difficult to treat because it has a higher prevalence of recurrent thrombosis with an annual risk of occurrence of 20%; and hemorrhages with an annual risk of occurrence of 12%. Aims: to describe our population with thrombosis and cancer on DOACs (rivaroxaban and apixaban) at Clínica Universitaria Reina Fabiola. To identify bleeding complications, major bleeding (MB) and clinically relevant non-major bleeding (CNRMB). To identify recurrent thrombosis. Materials and methods: retrospective descriptive study. People over 18 years of age with active cancer and venous thromboembolism on treatment with direct oral anticoagulants (DOACs): rivaroxaban and apixaban. Patients with thrombosis in unusual sites were included. Results: The population was 49 patients. 61% were female, and the average age was 60 years. The average number of days of anticoagulant treatment that each patient received was 314 days. The primary tumor site was: 21% of cases breast (n 10), 14% (n 7) gastrointestinal tract tumors and 14% (n 7) lung tumors. Other locations were: kidney, melanoma, gallbladder, prostate, bladder, pancreas, lymphoma, myeloma, central nervous system. 16% of patients presented CNS involvement (2% (n 1) glioblastoma, 14% (n 7) brain metastases). Regarding oncological therapy, 12 patients (25%) received target therapy, 24 patients (50%) monoclonal antibodies, 27 patients (55%) traditional chemotherapy, 2 patients received immunomodulatory drugs, 1 patient received only surgical treatment and 2 patients added radiotherapy. During treatment, 14 (28.5%) patients received dose reduction of the anticoagulant drug. Of the remaining subpopulation of 35 patients, 7 cases (20%) of the patients presented episodes of intratreatment thrombosis and 8 patients (23%) presented episodes of hemorrhage (9% SM and 14% SCR). Discussion: Compared to the literature, our population presented a higher percentage of recurrent thrombosis as well as bleeding. No statistically significant relationship was found between the type of anticoagulant, tumor location, the presence of metastasis in the central nervous system, extreme weight, alteration of kidney or liver function or the type of oncological treatment received. Conclusion: Major rates of recurrent thrombosis and bleeding were associated with DOACs treatment in our cancer patients. Larger numbers of patients are needed to determine the safety and efficacy of DOACs in real-life oncology patients (excluded from clinical trials).