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Clinical benefits of oral anticoagulant use in cancer patients at increased risk for venous thromboembolism per khorana index

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dc.contributor.authorChoi, YJ-
dc.contributor.authorChoi, YW-
dc.contributor.authorChae, JW-
dc.contributor.authorYun, HY-
dc.contributor.authorShin, S-
dc.date.accessioned2022-12-16T05:44:29Z-
dc.date.available2022-12-16T05:44:29Z-
dc.date.issued2021-
dc.identifier.urihttp://repository.ajou.ac.kr/handle/201003/23335-
dc.description.abstractBackground: Cancer patients are at increased risk for venous thromboembolism (VTE) due to cancer-induced hypercoagulability. However, current guidelines do not routinely recom-mend prophylactic use of oral anticoagulants to prevent VTE in cancer patients. Objective: To evaluate the efficacy and safety of novel oral anticoagulants (NOACs) versus no anticoagulant use (no-use) and, additionally, differential effects between NOACs and warfarin, in VTE and adverse bleeding prevention among cancer patients, in consideration of risk stratification by gender, high-risk chemotherapy exposure, and Khorana index. Methods: This national health insurance data-based study with a 180-day follow-up enrolled cancer patients with or without oral anticoagulant use in 2017. The primary outcome was VTE risk in oral anticoagulant users vs non-users. Four propensity score-matched comparison pairs were designed: use vs no-use, NOAC vs no-use, warfarin vs no-use, and NOAC vs warfarin. A logistic regression model was used to investigate between-group differences in VTE and bleeding risk. Results: When compared to no-use, NOACs showed substantial effects in preventing VTE complications (OR=0.40, p<0.001), primarily deep vein thrombosis (DVT) events (OR=0.38, p<0.001), in both male and female cancer patients as well as those with a Khorana score ≥1. Adverse bleeding risk was comparable or lower in NOAC-receiving female patients (p=0.13) and male patients (p=0.04), respectively. In contrast, no protective effects were found with warfarin compared to no-use in controlling thrombosis and adverse bleeding risk. In a head-to-head comparison of NOACs versus warfarin, DVT risk in those patients exposed to high-risk chemotherapy was significantly decreased with NOAC use (OR=0.19, p=0.03). Conclusion: NOACs can be a promising thromboprophylactic option in both male and female cancer patients with VTE risk.-
dc.language.isoen-
dc.titleClinical benefits of oral anticoagulant use in cancer patients at increased risk for venous thromboembolism per khorana index-
dc.typeArticle-
dc.identifier.pmid33994816-
dc.identifier.urlhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114826/-
dc.subject.keywordCancer-
dc.subject.keywordKhorana-
dc.subject.keywordOral anticoagulant-
dc.subject.keywordVenous thromboembolism-
dc.contributor.affiliatedAuthorChoi, YW-
dc.type.localJournal Papers-
dc.identifier.doi10.2147/RMHP.S306760-
dc.citation.titleRisk management and healthcare policy-
dc.citation.volume14-
dc.citation.date2021-
dc.citation.startPage1855-
dc.citation.endPage1867-
dc.identifier.bibliographicCitationRisk management and healthcare policy, 14. : 1855-1867, 2021-
dc.identifier.eissn1179-1594-
dc.relation.journalidJ011791594-
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Hematology-Oncology
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