Observational Studies in Cancer Associated Thrombosis for Rivaroxaban - United States Cohort

Phase

N/A

Condition

Venous Thrombosis

Blood Clots

Thrombosis

Treatment

Rivaroxaban (Xarelto, BAY59-7939)

Low molecular weight heparin (LMWH)

Direct Oral Anticoagulants (DOAC)

Clinical Study ID

NCT04979780

21982

Ages > 18
All Genders

Study Summary

Patients with active cancer are ~5-fold more likely to develop a venous thromboembolism (VTE) than those without. When VTE occurs, cancer patients carry an up to a 3-fold higher rate of thrombosis recurrence and ~twice the risk of bleeding during anticoagulation. Therefore, it is critical to utilize anticoagulants that optimize efficacy while minimizing bleeding risk when treating cancer-associated thrombosis (CAT).

Guidelines list direct-acting oral anticoagulants (DOACs) as an alternative to low molecular-weight heparin (LMWH) for treatment of CAT. The strength-of-recommendation for DOACs is based on data from multiple randomized controlled trials (RCTs) comparing them to LMWHs to treat CAT, with results suggesting DOACs may reduce thrombosis risk but with potentially more frequent bleeding (particularly in those with certain gastrointestinal and genitourinary cancers).

Observational studies evaluating DOACs for CAT treatment have been published, but these studies have been either single-arm, evaluated cancer subtypes not recommended for DOAC treatment, were of limited sample size and/or employed heterogeneous definitions of active cancer. We seek to evaluate the effectiveness and safety of rivaroxaban versus LMWH for CAT treatment in active cancer patients using a large de-identified electronic health record database.

Retrospective cohort analysis using US Optum® De-Identified EHR data. We will use Optum EHR (electronic health records) data from November January 1, 2012 through latest available data (currently September 2020).

Eligibility Criteria

Inclusion

Inclusion Criteria:

Be ≥18 years of age at the time of anticoagulation initiation.
Have active cancer admitted to the hospital, emergency department or observationunit for acute DVT and/or PE.
Treated with rivaroxaban (or any DOAC in secondary analysis) or LMWH as their firstanticoagulant on day 7 post-acute CAT event diagnosis (index date) o increase theprobability of accurately classifying patients' intended outpatient anticoagulantfor CAT treatment and that patients are compared at the same point from diagnosis.
Have been active in the data set for at least 12-months prior to the index event (based on the "First Month Active" field) and had at least one provider visit in the 12-months prior to the acute VTE event (baseline period).

Exclusion

Exclusion Criteria:

Evidence of atrial fibrillation, recent hip/knee replacement (within 35 days ofindex VTE), ongoing VTE treatment, valvular heart disease defined as any rheumaticheart disease, mitral stenosis, or mitral valve repair/replacement.
Pregnancy.
Initiation of rivaroxaban at a dose other than 15 mg twice daily or non-therapeuticdoses of other DOAC or LMWH (e.g., enoxaparin at a dose other than 1 mg/kg twicedaily or 1.5 mg/kg once daily; dalteparin at a dose other than 200 IU/kg of totalbody weight)
Evidence of use of anticoagulation use during the 12-months prior per writtenprescription or patient self-report

Study Design

Rivaroxaban (Xarelto, BAY59-7939)

July 20, 2021

March 31, 2022

Connect with a study center

Many Locations
Multiple Locations, Connecticut 06093
United States
Site Not Available

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