PB0934 - The Safety and Efficacy of Direct Oral Anticoagulants (DOACs) Versus Low Molecular Weight Heparin (LMWH) in the Treatment of Thromboembolism (TE) in Patients with Hematological Malignancies

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

Doaa Attia, MD, MSc, PhD, PgCert (she/her/hers)

Research Fellow
Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH. Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH.

Co-Author(s)

WW

Wei Wei

Statistician
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
Cleveland, Ohio, United States
MW

Mailey Wilks

Certified Nurse Practitioner
Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
Cleveland, Ohio, United States
PH

Peter Hakos

Certified Nurse Practitioner
Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
Cleveland, Ohio, United States
TE

Tracy Evans-Walker

Certified Nurse Practitioner
1Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
Cleveland, Ohio, United States
KM

Keith R. McCrae

Director. Benign Hematology, Taussig Cancer Institute
Cleveland Clinic Foundation, Cleveland, OH, USA
Clevelend, Ohio, United States

Presenting Author(s)

Alok A. Khorana, MD (he/him/his)

Professor of Medicine
Cleveland Clinic and Case Comprehensive Cancer Center
Cleveland, Ohio, United States

Co-Author(s)

DA

Dana E. Angelini

Assistant Professor of Medicine
Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
Cleveland, Ohio, United States

Background: Hematological malignancies represent a non-transient risk factor for VTE onset.LMWH has been the recommended anticoagulant for the treatment of such patients and the treatment is predominantly based on the recommendations of the randomized controlled trials for solid tumors.Although DOACs have proven their efficacy in the management of VTE in cancer patients,their use could be challenging due to increased competing risk of bleeding,thrombocytopenia,and possibility of coagulopathy

Aims: To evaluate the safety and efficacy of DOACs Vs. LMWH in the treatment of VTE in patients with hematological malignancies in our centralized cancer-associated thrombosis (CAT) clinic

Methods: We prospectively followed2382cancer patients referred to our CAT clinic from8/2014to10/2021.672 hematological cancer patients were referred to the clinic,of whom 163 were diagnosed with an acute VTE.The comparison of bleeding rates(defined using ISTH criteria for major and clinically relevant non-major bleeding,CRNMB)among treatment groups(LMWH vs. DOACs)was examined using Fisher’s exact test.Rate of recurrent VTE was estimated using competing risk model in which death was treated as competing risk.Overall survival(OS) was estimated by Kaplan-Meier method and compared by log rank test

Results: Total of 163patients(Table1).Of these,64(39%)received LMWH,86(53%)received DOACs,and13(8%)received other agents including warfarin for initial anticoagulation.Overall, the 6-month,1-year,and 2-year VTE recurrence rate was1.3%,2.6%,3.9%respectively.2-year recurrent VTE rates were3.3%,2.5%,and1.9% for LMWHs, DOACs and other agents (P0.21).4 patients discontinued anticoagulants during disease progression due to bleeding after a median follow-up time of 6 months.Of 162 patients for whom 6-month follow-up was available,17(10%) had bleeding event, of which2(1%)had major bleeding and 15 (9%) CRNMB.Overall bleeding rates were 10%,20%,and8% in DOAC,LMWH,and other treatment groups (p0.21).2-year OS rate of patients on DOACs,LMWH,and other treatment were71%,62%,and81% respectively(p0.16)with median follow-up of 45.5 months

Conclusion(s): In this real-world practice setting,rates of recurrent VTE and bleeding were similar for DOAC and LMWH, suggesting that DOAC could be safe option in those patients.There is still a need for larger prospective studies to confirm the findings