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A Study on the Efficacy and Safety of Rivaroxaban in Urologic Cancer-Associated Venous Thromboembolism

대한비뇨기종양학회지 2019년 17권 3호 p.178 ~ 185
이장호 ( Lee Jang-Ho ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine

유달산 ( You Dal-San ) - University of Ulsan College of Medicine Asan Medical Center Department of Urology
이상도 ( Lee Sang-Do ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
오연목 ( Oh Yeon-Mok ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
이재성 ( Lee Jae-Seung ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine

Abstract


Purpose: Although direct oral anticoagulants (DOACs) are recommended as an alternative to low-molecular weighted heparin for cancer-associated venous thromboembolism (VTE), there is no firm evidence on the efficacy and safety of DOACs in patients with urologic cancer. Therefore, we compared the efficacy and safety of rivaroxaban and dalteparin for treating cancer-associated VTE in urologic cancer.

Materials and Methods: We reviewed the medical records of 124 eligible VTE patients with urologic cancers who were treated with dalteparin or rivaroxaban. The primary outcome was the composite event of clinically relevant bleeding or VTE recurrence. The secondary outcomes were VTE recurrence, clinically relevant bleeding events, and all-cause mortality.

Results: During anticoagulation period, there was no significant difference in primary and secondary outcomes between the groups. In Cox proportional hazards model for composite events, although there was no statistical significance, rivaroxaban presented lower hazard ratio (HR) than dalteparin (HR, 0.472; 95% confidence interval [CI], 0.210-1.060; p=0.069 in univariate analysis; HR, 0.505; 95% CI, 0.206-1.234; p=0.134 in multivariate analysis). In clinically relevant bleeding events, there was no significance difference between rivaroxaban and dalteparin (HR, 0.568; 95% CI, 0.238-1.358; p=0.203 in univariate analysis; HR, 0.617; 95% CI, 0.232-1.636; p=0.331 in multivariate analysis).

Conclusions: Rivaroxaban can be regarded as a valuable option for VTE in urologic cancer. Further prospective studies are warranted to prove the safety or efficacy of rivaroxaban for treating VTE in patients with urologic cancer.

키워드

Anticoagulants; Dalteparin; Rivaroxaban; Urologic neoplasm; Venoms thromboembolism
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