Direct Oral Anticoagulants Signal Change in VTE Prevention

Brittany Lovely
Published: Monday, Apr 15, 2019
Alok A. Khorana, MD

Alok A. Khorana, MD

Investigators at Cleveland Clinic have demonstrated that the direct oral anticoagulant rivaroxaban (Xarelto) significantly reduces venous thromboembolism (VTE) and VTE-related death for patients with high-risk cancers treated in the outpatient setting.

Many patients with cancer are at extended risk for VTE, and following surgery or hospitalization, most patients are monitored for warning signs of blood clots in their lower extremities; however, that same level of monitoring and care has not extended to the outpatient setting.

The phase IIIB CASSINI trial (NCT02555878) evaluated the safety and efficacy of rivaroxaban in the outpatient setting in high-risk, ambulatory patients with various cancer types, making it the first study to evaluate intervention with direct oral anticoagulants over an extended period in patients with cancer (Figure 1).1

Routine thromboprophylaxis is not recommended in current guidelines, and nearly 80% of clots related to cancer care now occur in the outpatient setting, according to Alok Khorana, MD, who led the multicenter trial. “A number of studies have evaluated whether outpatient thromboprophylaxis could be successful in preventing clots following cancer care without substantially increasing the risk of bleeding,” said Khorana, vice-chair for Clinical Services of the Taussig Cancer Institute and Director of the Gastrointestinal Malignancies Program at the Cleveland Clinic in an interview with OncologyLive®.

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