PB1453 - The Role of Rivaroxaban in cancer-associated venous thromboembolism prevention in outpatients setting: a systematic review

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

AK

Andree Kurniawan, MD, PhD

Lecturer
Faculty of Medicine, Pelita Harapan University
Jakarta, Jakarta Raya, Indonesia

Co-Author(s)

Dimas Priantono, MD

Haematology and Medical Oncology Trainee
Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
Jakarta Pusat, Jakarta Raya, Indonesia
Ardhi Rahman Ahani, MD

Lecturer
Faculty of Medicine, Universitas Indonesia, Jl Dr Cipto Mangunkusumo Hospital
Jakarta, Jakarta Raya, Indonesia
CS

Chandra Sari

Trainee
Faculty of Medicine, Universitas Indonesia, Jl Dr Cipto Mangunkusumo Hospital
Jakarta, Jakarta Raya, Indonesia
DA

Devi Astri Rivera Amelia

Trainee
Faculty of Medicine, Universitas Indonesia, Jl Dr Cipto Mangunkusumo Hospital
Jakarta, Jakarta Raya, Indonesia
DD

Deden Djatnika

Trainee
Faculty of Medicine, Universitas Indonesia, Jl Dr Cipto Mangunkusumo Hospital
Jakarta, Jakarta Raya, Indonesia
MN

Muhammad Arman Nasution

Trainee
Faculty of Medicine, Universitas Indonesia, Jl Dr Cipto Mangunkusumo Hospital
Jakarta, Jakarta Raya, Indonesia
BS

Brigitta Isabella Bunga Sutrisno

student
Faculty of Medicine, Pelita Harapan University
Tangerang, Banten, Indonesia
IA

Irene Adelia

MD
Siloam Hospital Lippo Karawaci
Jakarta Barat, Jakarta Raya, Indonesia
Mo

Mathhea Thessa ohira

Trainee
Faculty of Medicine
Tangerang, Banten, Indonesia

Background: Patients with cancers are at risk of developing venous thromboembolism (VTE) and anticoagulants should be considered as prophylactic therapy in patients with high risk of cancer-associated VTE (CAT). Previous studies of thromboprophylaxis with low-molecular-weight heparins (LMWH) in ambulatory patients with cancer demonstrated that anticoagulation was associated with a significant reduction in VTE. However, there is limited data the role of rivaroxaban in ambulatory cancer patients.

Aims: To know the current evidence the role of rivaroxaban in prevention of cancer associated VTE in ambulatory settings

Methods: We performed a systematic search from PubMed and Cochrane with the search terms: ‘Cancer’ AND ‘Outpatient’ OR “Ambulatory” AND ‘Rivaroxaban’ AND ‘Vein thrombosis’. The type of study designs included in the review were Randomized Control Trial (RCT), Cohort, and Clinical Trial. The Newcastle Ottawa Scale (NOS) and the JADAD Scale was used as the basis for this review.

Results: A total of 4 studies were included. Rivaroxaban is associated with a reduced risk of recurrent VTE compared to LMWH without a significant impact on composite outcomes, major bleeding, or all-cause mortality. These findings support the use of rivaroxaban as reasonable alternatives to LMWHs for the treatment of CAT when used in accordance with guidelines. In the specific context of ambulatory pancreatic cancer patients, rivaroxaban did not result in a significantly lower incidence of VTE or VTE-related death in the 180-day period. However, during the intervention period, rivaroxaban substantially reduced VTE without increasing major bleeding. All of the studies were in good quality.

Conclusion(s): Rivaroxaban can be considered as one of prevention therapy in ambulatory cancer patient. Further real-world data is needed to evaluate the duration and safety of using rivaroxaban in prevention settings. It should be noted that current guidelines do not recommend the use of rivaroxaban in unresected gastrointestinal tract cancers due to high risk for bleeding events.