Effectiveness and safety of anticoagulants among venous thromboembolism cancer patients with and without brain cancer

• Published in: Thrombosis research 2023-06, Vol.226, p.117-126
• Main Authors: Cohen, Alexander, Noxon, Virginia, Dhamane, Amol, Bruette, Robert, Shah, Shrushti, Hines, Dionne M., Alfred, Tamuno, Luo, Xuemei
• Format: Article
• Language: English
• Subjects: Aged; Anticoagulant; Anticoagulants - adverse effects; Brain cancer; Brain Neoplasms - complications; Brain Neoplasms - drug therapy; Hemorrhage - chemically induced; Heparin, Low-Molecular-Weight - adverse effects; Humans; Medicare; Neoplasms - complications; Neoplasms - drug therapy; United States; Venous thromboembolism; Venous Thromboembolism - complications; Venous Thromboembolism - drug therapy; Warfarin - adverse effects
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2023.04.009

Patients with brain cancer are at a high risk of developing venous thromboembolism (VTE) and are underrepresented in clinical trials. This study compared the risk of recurrent VTE (rVTE), major bleeding (MB), and clinically relevant non-major bleeding (CRNMB) among VTE cancer patients initiating apixaban, low molecular weight heparin (LMWH), or warfarin stratified by patients with brain vs other cancer types. Active cancer patients initiating apixaban, LMWH, or warfarin within 30 days after VTE diagnosis were identified from 4 US commercial and the Medicare databases. Inverse probability of treatment weights (IPTW) was used to balance patient characteristics. Cox proportional hazards models were used to evaluate the interaction between brain cancer status and treatment on outcomes (rVTE, MB, and CRNMB), with a p-value  0.1) were found between brain cancer status and anticoagulant treatment across outcomes. The exception was MB for apixaban [vs LMWH (p-value for interaction = 0.091)] with a higher reduction among those with brain cancer (HR = 0.32) than those with (HR = 0.72) other cancer. Among VTE patients with all types of cancer, apixaban (vs LMWH and warfarin) was associated with a lower risk of rVTE, MB, and CRNMB. In general, anticoagulant treatment effects were not significantly different between VTE patients with brain cancer and those with other cancer. •Patients with brain cancer are at a high risk of developing VTE and are underrepresented in clinical trials•Among VTE patients with any cancer type, apixaban (vs other treatment) was associated with a lower risk of rVTE, MB and CRNMB•Anticoagulant treatment effects were not significantly different between VTE cancer patients with and without brain cancer•More research is needed to discern the most effective and safe anticoagulant treatment in VTE patients with brain cancer