Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
권호 표지

Comparisons of Bleeding Risks between Rivaroxaban and Dalteparin for Treatment of Venous Thromboembolism in Cancer Patients

암환자의 정맥혈전색전증 치료에서 rivaroxaban과 dalteparin의 출혈 부작용 비교

  • Kim, Yoon Kyung (Graduate School of Clinical Health Sciences, Ewha Womans University) ;
  • An, Sook Hee (College of Pharmacy, Wonkang University) ;
  • Kim, Jae Yeon (Division of Pharmaceutical Services, Asan Medical Center) ;
  • Chung, Jee Eun (College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University) ;
  • Gwak, Hye Sun (Graduate School of Clinical Health Sciences, Ewha Womans University)
  • 김윤경 (이화여자대학교 임상보건과학대학원) ;
  • 안숙희 (원광대학교 약학대학) ;
  • 김재연 (서울아산병원 약제팀) ;
  • 정지은 (이화여자대학교 약학대학) ;
  • 곽혜선 (이화여자대학교 임상보건과학대학원)
  • Received : 2016.03.16
  • Accepted : 2016.09.25
  • Published : 2016.09.30
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Abstract

Background: Venous thromboembolism (VTE) is a common and life-threating condition in cancer patients. Low molecular weight heparins (LMWH), such as dalteparin, are recommended in the treatment of VTE. Also, rivaroxaban, an orally administered direct factor Xa inhibitor, was approved for the treatment of VTE. It showed similar efficacy to standard therapy (LMWH or warfarin) and was associated with significantly lower rates of major bleedings. However, in the real world, bleeding has been reported to occur frequently in cancer patient receiving rivaroxaban. The goal of this research was to analyze bleeding risks between rivaroxaban and dalteparin for treatment of VTE in cancer patients. Methods: Medical records of oncology patients who were treated with rivaroxaban or dalteparin for VTE from July 2012 to June 2014 were retrospectively reviewed. Data collected were as follows: age, sex, weight, height, cancer types and stages, ECOG (eastern cooperative oncology group) PS (performance score), VTE types, concurrently used medications, study drug information (dose and duration of therapy), INR (international normalized ratio), PT (prothrombin time), and platelet counts. Bleeding was classified into major bleedings, clinically relevant non-major bleedings, and minor bleedings. Results: A total of 399 patients were included in the study. Of these patients, 246 were treated with rivaroxaban and 153 with dalteparin. Bleeding rates were significantly higher in the rivaroxaban group than in the dalteparin group (adjusted odds ratio (AOR) 2.09, 95% CI 1.22-3.60) after adjusting for confounders. In addition, rivaroxaban remained independently associated with 1.78-fold (95% CI 1.14-2.76) shorter time to bleeding compared to dalteparin after adjusting other factors known to be associated with poor outcomes. Conclusion: This study suggested that rivaroxaban was associated with an increased risk of bleedings in cancer patients.

Keywords

References

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