The optimal duration of anticoagulation therapy in cancer patients with DVT

Cancer patients with isolated distal deep vein thrombosis (DVT) benefitted more from a 12-monthly regimen with edoxaban than from a 3-monthly treatment with this agent, with regard to venous thromboembolism (VTE). The bleeding risk was not significantly increased for patients on the prolonged anticoagulation regimen.

“Although there are guideline recommendations for the management of isolated distal DVT, the subgroup of cancer patients has not been well studied,” stated Dr Yugo Yamashita (Kyoto University, Japan) [1]. “No randomised-controlled trials have been conducted to establish the optimal duration of anticoagulation therapy in these patients.” The open-label, adjudicator-blinded ONCO DVT study (NCT03895502) compared a 12-month and a 3-month edoxaban treatment period in patients with cancer and newly diagnosed isolated distal DVT. In total, 604 participants were randomised to 1 of the 2 study arms. The primary endpoint was symptomatic recurrent VTE or VTE-related death at 12 months.

Symptomatic recurrent VTE or VTE-related death occurred more frequently in participants who received 3 months of edoxaban therapy than in those who were randomised to the 12-month treatment period (8.5% vs 1.2%; OR 0.13; 95% CI 0.03–0.44; P<0.001; see Figure). There was no significant difference between the prolonged-treatment arm and the short-term treatment arm in the key secondary endpoint of major bleeding (10.2% vs 7.6%; OR 1.34; 95% CI 0.75–2.41). The subgroup analysis did not reveal any significant interaction effects.

Figure: Primary endpoint of symptomatic recurrent VTE or VTE-related death [1]



In summary, cancer patients with isolated distal DVT had a reduced risk for symptomatic recurrent VTE or VTE-related death if they were treated with 12 months rather than 3 months of anticoagulation therapy.

1. 
   
   1. Yamashita Y, et al. Edoxaban for 3 months versus 12 months in cancer patients with isolated distal deep vein thrombosis: ONCO DVT Study. Hot Line Session 9, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.

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Posted on 30 October 202320 February 2024