S0015 Oral Anticoagulants for Venous Thromboembolism (VTE) in Pancreatic Cancer: Friend or Foe

Abstract

INTRODUCTION: Metastatic pancreatic carcinoma (MPC) has traditionally been associated with a higher risk of venous thromboembolism (VTE). However, the relative safety and efficacy of enoxaparin (approved therapy) and conventional medications such as oral anticoagulants (OAC) have never been reported in these patients. METHODS: A single-center retrospective cohort study was performed from January 2017 till March 2019. All patients with a confirmed diagnosis of MPC induced VTE were included. An unadjusted odds ratio (OR) was computed to determine the rate of mortality, adverse events of medications and recurrence of VTE. RESULTS: A total of 835 charts were reviewed and 38 patients were included in the analysis. The mean age was 69.9 years comprising 53% (n = 20) male patients. Of the initial VTE events, 74% of patients had deep vein thrombosis (DVT) or pulmonary embolism (PE), while 26% had splenic or portal vein thrombosis. About 63% (n = 24) of patients received enoxaparin and 37% (n = 14) were treated with one of the OAC (apixaban, rivaroxaban, dabigatran, or warfarin). At a mean follow-up of 6 months, rates of recurrent VTE were numerically lower but statistically non-significant in patients on OAC compared to those receiving enoxaparin (40% vs. 60%, OR 0.86 95% CI 0.12–5.8, P = 0.73). Similarly, the 1-year all-cause mortality of patients on enoxaparin was higher than patients receiving OAC (67% vs. 33%, OR 0.15, 95% CI 0.05–1.58, P = 0.3). There was no significant difference in the odds of major bleeding events (OR 0.15, 95% CI 0.01–1.71, P = 0.26) and the need for transfusions (OR 0.22, 95% CI 0.03–1.45, P = 0.24) in patients on OAC and enoxaparin. CONCLUSION: Oral anticoagulation appears to be a better alternative to enoxaparin, given its clinical feasibility and comparable safety and efficacy. Large scale studies are required to validate our findings.