Oral blood clot drug safe, effective in patients with cancer

Volume 8, Issue 2, June 2019

Summary

Apixaban is easier to use than traditional blood thinners and has fewer side effects, research shows.

Photograph of Robert D. McBane II, M.D.

Robert D. McBane II, M.D.

Mayo Clinic researchers have found that the oral drug apixaban is safe and effective to treat blood clots in patients undergoing cancer therapy. Apixaban was associated with fewer major bleeding events and fewer recurrent blood clots compared with low molecular weight heparin, the researchers concluded after a six-month study.

The study findings were presented at the 2018 annual meeting of the American Society of Hematology by Robert D. McBane II, M.D., a Mayo Clinic cardiologist.

"Nearly 1 in 5 patients with cancer will develop a clot, referred to as either a deep vein thrombosis or pulmonary embolism," Dr. McBane said. "Clotting events can be deadly, with pulmonary embolism being the second most common cause of death in cancer patients."

While twice-daily injections of low molecular weight heparin has been the traditional treatment of choice for cancer patients who have a blood clot, Dr. McBane noted that there are numerous limitations to this therapy.

"These injections can be painful and cause considerable bruising at the injection site," he said. "Injections are expensive, at nearly $100 a day. And cancer patients may experience low platelet counts and be at risk of a clotting disorder called heparin-induced thrombocytopenia." In addition, cancer and cancer treatment can be associated with kidney injury, which can further limit the drug's use. And there isn't a good antidote for low molecular weight heparin should a bleeding problem arise from its use, Dr. McBane said.

"More recently, a number of new blood thinners called direct oral anticoagulants have become available," Dr. McBane said. "As a class, these drugs have a number of advantages, including oral delivery, lack of interactions with foods or other medications, and the lack of a need for monitoring drug levels." He said these qualities make this class of drug much easier to use than are the traditional blood thinners. However, until the recent Mayo Clinic study, it was unclear whether these drugs could be used safely in patients with cancer.

Quality-of-life surveys taken monthly throughout the six-month study showed that patients markedly preferred oral apixaban over injectable dalteparin, Dr. McBane said. "We are hopeful that this medication will also improve medication compliance in cancer patients requiring blood thinner therapy," he said.

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