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Evaluation

Oral Presentation

Session: The Pill-osophy of Making Medicines Safe

Comparison of switching to direct oral anticoagulants and continuous low-molecular-weight heparin in the treatment of cancer-associated venous thromboembolism in Taiwan

Tuesday, August 27, 2024
1:30 PM – 1:45 PM CEST
Location: Room IV

    Presenting Author(s)

  • Wei Kang, MSc

    PhD student
    The University of Hong Kong, Hong Kong

    Slides

    • Co-Author(s)

  • Chin-Yao Shen, MClinPharm

    Ph.D Candidate
    School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    Institute of Clinical Pharmacy and Pharmaceutical Sciences
    Tainan, Taiwan (Republic of China)

  • Michael Chun-Yuan Cheng, MA (he/him/his)

    Research Associate
    Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)

  • Vincent KC Yan, BPharm

    PhD candidate
    Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong

  • Yue Wei, MPH

    Student
    Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, University of Hong Kong
    The University of Hong Kong
    Hong Kong, Hong Kong

  • TL

    Tung Hiu Li, MPhil

    Student
    Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong

  • CH

    Caige Huang

    Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong

  • Edward Chia-Cheng Lai, PhD (he/him/his)

    Professor
    Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Taiwan
    National Cheng Kung University
    Tainan City, Taiwan (Republic of China)

  • IW

    Ian Chi Kei Wong, PhD (he/him/his)

    Professor
    Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong

  • EC

    Esther W Chan, PhD

    Professor
    Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong

Background: Direct oral anticoagulants (DOACs) have emerged as a new primary treatment choice for patients with cancer-associated venous thromboembolism (CAT). However, the safety and efficacy of switching from the use of low molecular weight heparin (LMWH) to DOACs remains uncertain.

Objectives: To evaluate the effectiveness and safety of continuous use of LMWH versus switching to DOACs in patients with CAT.

Methods: A population-based cohort study using claim databases, including the National Health Insurance Research Database and Taiwan Cancer Registry, to examine patients with CAT between 2013 and 2021. An inverse probability of treatment weighting approach was used to balance the baseline characteristics in the two treatment groups. Cox proportional hazard regression was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for recurrent VTE, major bleeding, and all-cause mortality during a six-month follow-up period. Competing risk analysis using the Fine and Gray proportional sub-hazard model was also performed, considering all-cause mortality as the competing event of interest.

Results: A total of 23,561 patients with CAT were identified between 2013 and 2021 in Taiwan. After applying the exclusion criteria, a cohort of 3,363 patients with CAT was included. The mean (SD) age of the entire cohort at the time of CAT diagnosis was 65.5 (13.7), and within this cohort, 1,808 (53.8%) were women. Among these patients, 1,471 (43.7%) received continuous LMWH therapy. The incidence of recurrent VTE, major bleeding, and all-cause mortality was 7, 36, and 101 per 100 person-year in the switcher groups, 7, 36, and 165 per 100 person-year in the non-switcher groups, respectively. When compared to the persistent use of LMWH, switching to DOACs was associated with no significant difference in recurrent VTE (HR: 1.15 [95% CI 0.66-2.00]; subdistribution HR [SHR]: 1.44 [95% CI 0.85-2.46]), a significantly lower risk of all-cause mortality (HR: 0.71 [95% CI 0.51-0.99]), and a significantly higher risk of major bleeding (HR: 0.92 [95% CI 0.67-1.25]; SHR: 1.34 [95% CI 1.04-1.74]) within a six-month follow-up period.

Conclusions: Switching from continuous use of LMWH to DOACs was found to have a non-inferior risk of recurrent VTE and a significantly decreased risk of all-cause mortality, but a significantly increased risk of major bleeding, in patients with CAT. These findings confirm the effectiveness of switching from LMWH to DOACs among patients with CAT, while emphasizing the importance of closely monitoring major bleeding.