Comparison of the efficacy and safety of rivaroxaban and low-molecular-weight heparin in Chinese lung cancer patients with nonhigh-risk pulmonary embolism

Thrombosis Journal

Research

Jun She¹  Yijun Song¹  Dongni Hou¹  Dawei Yang²  Yuanlin Song³ 

[1] Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, China;Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, China;Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China;Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, Shanghai, China;Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, China;Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China;Shanghai Engineering Research Center of Internet of Things for Respiratory Medicine, Shanghai, China;Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China;Shanghai Respiratory Research Institute, Shanghai, China;National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China;Department of Pulmonary Medicine, Zhongshan Hospital, Qingpu Branch, Fudan University, Shanghai, China;Jinshan Hospital of Fudan University, Shanghai, China;

关键词: Lung cancer;    Pulmonary embolism;    Rivaroxaban;    Low-molecular-weight heparin;    Initial anticoagulation;   

DOI  :  10.1186/s12959-023-00453-y

 received in 2022-09-16, accepted in 2023-01-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundData that guide selection of differing anticoagulant regimens for specific cancer-associated venous thromboembolism (VTE) are lacking. We aimed to compare the efficacy and safety of rivaroxaban and low-molecular-weight heparin (LMWH) against nonhigh-risk pulmonary embolism (PE) in Chinese lung cancer patients.MethodsFour hundred forty-six Chinese lung cancer patients with nonhigh-risk PE who initiated treatment with rivaroxaban or LMWH were identified from Zhongshan Hospital database from 2016 to 2020. The primary outcomes were the composite event of VTE recurrence or major bleeding, and all-cause mortality. The secondary outcomes were VTE recurrence, major bleeding and clinically relevant non-major bleeding (CRNMB). Propensity score matching was used to balance baseline covariates. We conducted sensitivity analysis by stabilized inverse probability of treatment weighting and competing risk analysis by a Fine and Gray subdistribution hazard model.ResultsIn propensity score-matched cohorts, rivaroxaban was similar to LMWH in the risks of the composite outcome (hazard ratio (HR), 0.73; 95% confidence interval (CI), 0.45–1.21; P = 0.22), VTE recurrence (HR, 0.69; 95% CI, 0.36–1.34; P = 0.28), major bleeding (HR, 0.79; 95% CI, 0.37–1.68; P = 0.54) and CRNMB (HR, 1.13; 95% CI, 0.62–2.09; P = 0.69). All-cause mortality was significantly lower in rivaroxaban group than LMWH group (HR, 0.52; 95% CI, 0.36–0.75; P < 0.001). The primary and secondary outcomes favored rivaroxaban over LMWH in all the subgroups expect for central PE and intermediate-risk PE. The sensitivity analysis yielded similar results, and competing risk analysis was in accordance with the primary findings.ConclusionsRivaroxaban might be a promising alternative to LMWH as initial treatment for nonhigh-risk PE in lung cancer patients.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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