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    Oral Communication

    Arterial Thromboembolism

    Cerebrovascular Disease: Bench to Bedside

    OC 03.5 - Arterial events in cancer patients treated with apixaban for venous thrombosis

    Saturday, June 24, 2023
    14:00 – 14:15 ET
    Room: 710B
    Session Available As: On-Demand
    Background: Arterial thromboembolism is a rising concern in patients with cancer. Registry data show high risk of arterial events in the time after cancer diagnosis, similar to venous thromboembolism. In the CAP study we observed that cancer patients with a newly diagnosed venous thromboembolism had high risk of recurrent arterial thromboembolism, even if they were treated with full-dose apixaban.

    Aims: The aim of this analysis was to assess risk factors associated with arterial events in cancer patients treated with apixaban.

    Methods: A total of 298 cancer patients with venous thromboembolism were treated up to six months with apixaban 5 mg twice daily. Patients eligible for secondary prophylaxis recieved apixaban 2.5 mg twice daily for up to 30 months. Arterial thromboembolism was registered as a serious adverse event. We assessed risk factors associated with arterial thromboembolism during treatment and secondary prophylaxis.

    Results: Arterial events were registered in 16/298 (5.4%, CI: 3.1-8.6) patients. Leucocyte count at baseline were higher (p < 0.01) in patients with arterial thromboembolism compared with patients without arterial thromboembolism. Arterial thromboembolism were associated with pancreatic cancer (OR: 11.0, 95% CI: 3.8-34), ovarian cancer (OR: 20.0, 95% CI: 2.6-152.6), BMI < 25 percentile (OR: 3.1,95 % CI: 1.12-8.8), the use of NSAIDs (OR: 4.9, 95 % CI: 1-26) and previous venous thromboembolism before inclusion to this trial (OR: 4.7, 95% CI: 1.5-14.5). Patients with pancreatic cancer had a cumulative incidence of arterial thromboembolism of 36 % compared to 0.8 % for all other cancers (p < 0.01). All patients with pancreatic cancer had stroke as their arterial event.

    Conclusion(s): In cancer patients treated for venous thromboembolism with apixaban, recurrent arterial events were associated with pancreatic cancer, ovarian cancer, low BMI, previous venous thromboembolism, NSAID usage and high leukocyte count at baseline.

    Learning Objectives:

    • Recognize arterial thrombosis as a complication in patients with cancer.
    • Associate tumor type as an important risk factor for cancer-associated arterial thrombosis.
    • Improve awareness of stroke as a frequent complication in pateints with pancreatic cancer.