Infrequent transition to direct oral anticoagulants in patients with cancer.

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Danish medical journal Pub Date : 2024-01-25 DOI:10.61409/A05230278

Nina Nouhravesh, Caroline Sindet-Pedersen, Maja Hellfritzsch, Ali Akil Al-Alak, Thomas Kümler, Erik L Grove, Morten Lamberts

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引用次数: 0

Abstract

Introduction: Pharmacokinetic drug-drug interactions (DDIs) are challenging aspects of direct oral anticoagulant (DOAC) therapy in patients with cancer. We evaluated the prevalence of potential DOAC/antineoplastic agent DDIs and the one-year cumulative incidence of switching from low-molecular-weight heparin (LMWH) to a DOAC in patients with cancer.

Methods: Patients with cancer and an indication of LMWH were included from Herlev and Gentofte Hospital, Denmark, in the 2014-2019 period. Follow-up was initiated when the first dose of LMWH was dispensed. Data were obtained from electronic medical records. One-year cumulative incidence of switching from LMWH to DOAC was estimated using the Aalen-Johansen estimator. Potential DDIs were evaluated using a report from the European Heart Rhythm Association (EHRA) and a review by Hellfritzsch et al. RESULTS. A total of 161 patients were included with a median age of 70.8 (interquartile range: 64.2-76.1) years. The one-year cumulative incidence of switching from LMWH to DOAC was 32% (95% confidence intervals: 21-43%) in patients eligible for DOACs. Using the EHRA report, a total of 24% of antineoplastic agents were not identified. This percentage decreased to 8% using data from Hellfritzsch et al. CONCLUSIONS. In patients with cancer, the one-year cumulative incidence of switching from LMWH to DOAC was less-t 35% in patients eligible for DOAC, revealing a potential for improved anticoagulant treatment. Furthermore, contemporary data elaborated on potential DDIs between DOACs/antineoplastic agents.

Funding: "Helsefonden" (21-B-0350) and the "Karen Elise Jensens Fonden" (29-4-2021) funded the study.

Trial registration: Not relevant.

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癌症患者很少转用直接口服抗凝剂。

简介：药代动力学药物相互作用（DDI）是癌症患者接受直接口服抗凝剂（DOAC）治疗时面临的挑战。我们评估了潜在的 DOAC/抗肿瘤药物 DDI 的发生率，以及癌症患者从低分子量肝素（LMWH）转用 DOAC 的一年累计发生率：纳入2014-2019年期间丹麦赫勒夫和根托夫特医院的癌症患者和LMWH适应症患者。随访从配发第一剂 LMWH 开始。数据来自电子病历。使用 Aalen-Johansen 估计器估算了从 LMWH 转用 DOAC 的一年累计发生率。使用欧洲心脏节律协会 (EHRA) 的报告和 Hellfritzsch 等人的综述对潜在的 DDI 进行了评估。共纳入 161 名患者，中位年龄为 70.8 岁（四分位间距：64.2-76.1）。在符合 DOACs 使用条件的患者中，从 LMWH 转用 DOAC 的一年累计发生率为 32%（95% 置信区间：21-43%）。根据 EHRA 报告，共有 24% 的抗肿瘤药物未被确定。结论。在癌症患者中，有资格使用 DOAC 的患者从 LMWH 转为 DOAC 的一年累计发生率不到 35%，这揭示了改善抗凝治疗的潜力。此外，当代数据还阐述了 DOAC/抗肿瘤药物之间潜在的 DDIs："Helsefonden"（21-B-0350）和 "Karen Elise Jensens Fonden"（29-4-2021）资助了这项研究：不相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Danish medical journal MEDICINE, GENERAL & INTERNAL-

CiteScore

2.30

自引率

6.20%

发文量

审稿时长

3-8 weeks

期刊介绍： The Danish Medical Journal (DMJ) is a general medical journal. The journal publish original research in English – conducted in or in relation to the Danish health-care system. When writing for the Danish Medical Journal please remember target audience which is the general reader. This means that the research area should be relevant to many readers and the paper should be presented in a way that most readers will understand the content. DMJ will publish the following articles: • Original articles • Protocol articles from large randomized clinical trials • Systematic reviews and meta-analyses • PhD theses from Danish faculties of health sciences • DMSc theses from Danish faculties of health sciences.