Audio Library

Venous Thromboembolism

Treatment of cancer-associated thrombosis: What is the evidence for rivaroxaban?

In this episode, Professor Cihan Ay and Dr Jeffrey Weitz and provide an overview of the evidence base for the use of rivaroxaban in CAT, including randomized controlled clinical trials, real-world studies and data regarding patient satisfaction and quality of life.

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The paper on the CLOT trial investigating the efficacy of dalteparin versus oral anticoagulation in preventing recurrent thrombosis in patients with cancer is available here: https://www.nejm.org/doi/full/10.1056/nejmoa025313
Papers on the five randomized controlled trials comparing NOACs with dalteparin for the treatment of CAT can be accessed here: SELECT-D and CASTA DIVA with rivaroxaban (https://ascopubs.org/doi/10.1200/JCO.2018.78.8034 and https://journal.chestnet.org/article/S0012-3692(21)04079-4/fulltext), ADAM VTE and Caravaggio with apixaban (https://onlinelibrary.wiley.com/doi/full/10.1111/jth.14662 and https://www.nejm.org/doi/full/10.1056/NEJMoa1915103) and Hokusai VTE Cancer with edoxaban (https://www.nejm.org/doi/full/10.1056/NEJMoa1711948)
Information on the CALLISTO programme can be found here: https://onlinelibrary.wiley.com/doi/10.1002/rth2.12327
Details on the COSIMO study are available here: https://thrombosisjournal.biomedcentral.com/articles/10.1186/s12959-018-0176-2 and https://ashpublications.org/blood/article/134/Supplement_1/2161/427953/Baseline-Characteristics-and-Clinical-Outcomes
Information on the CONKO-011 study can be accessed here: https://abstracts.isth.org/abstract/improved-patient-reported-treatment-satisfaction-with-rivaroxaban-as-compared-to-low-molecular-weight-heparins-for-cancer-patients-with-acute-venous-thromboembolism-results-from-the-conko-011-trial/ and https://clinicaltrials.gov/ct2/show/NCT02583191
Study information for the OSCAR studies can be found here for OSCAR-US (https://clinicaltrials.gov/ct2/show/NCT04979780), OSCAR-UK (https://clinicaltrials.gov/ct2/show/NCT05112666) and OSCAR-SE (https://clinicaltrials.gov/ct2/show/NCT05150938)
The abstract of the OSCAR-US presentation at ASH 2021 is available here: https://ash.confex.com/ash/2021/webprogram/Paper151566.html
The American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer guidelines can be accessed here: https://ashpublications.org/bloodadvances/article-lookup/doi/10.1182/bloodadvances.2020003442

Extended anticoagulation in patients with VTE: Balancing risks and benefits

In this episode, Professor Stavros Konstantinides and Professor Ander Cohen discuss practical considerations for how physicians should decide whether to extend anticoagulation at 6 months following the initiation of treatment for venous thromboembolism.

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The EINSTEIN-Extension study on the extended use of rivaroxaban in patients with VTE can be found here: https://www.nejm.org/doi/full/10.1056/NEJMoa1007903
The AMPLIFY-EXT study on the extended use of apixaban in patients with VTE can be found here: https://www.nejm.org/doi/full/10.1056/nejmoa1207541
The 2019 European Society of Cardiology (ESC) guidelines for the diagnosis and management of acute pulmonary embolism, developed in collaboration with the European Respiratory Society (ERS), can be found here: https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehz405
The American College of Chest Physicians (ACCP) guidelines for antithrombotic therapy for VTE disease can be found here: https://journal.chestnet.org/article/S0012-3692(15)00335-9/fulltext
The summary of product characteristics for rivaroxaban can be found here: https://www.medicines.org.uk/emc/product/2793/smpc#gref
The summary of product characteristics for apixaban can be found here: https://www.medicines.org.uk/emc/product/2878/smpc#gref

NOACs for the treatment of VTE: How can we improve the patient experience?

In this episode, Professor Stavros Konstantinides and Professor Ander Cohen discuss contemporary guidance on how the patient experience can be improved for those receiving non-vitamin K antagonist oral anticoagulants (NOACs) for venous thromboembolism (VTE) without concurrent cancer.

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The 2019 European Society of Cardiology (ESC) guidelines for the diagnosis and management of acute pulmonary embolism, developed in collaboration with the European Respiratory Society (ERS), can be found here: https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehz405
The American College of Chest Physicians (ACCP) guidelines for antithrombotic therapy for VTE disease can be found here: https://journal.chestnet.org/article/S0012-3692(15)00335-9/fulltext
The summary of product characteristics for rivaroxaban can be found here: https://www.medicines.org.uk/emc/product/2793/smpc#gref
The summary of product characteristics for apixaban can be found here: https://www.medicines.org.uk/emc/product/2878/smpc#gref
The summary of product characteristics for dabigatran can be found here: https://www.medicines.org.uk/emc/product/4703/smpc#gref
The summary of product characteristics for edoxaban can be found here: https://www.medicines.org.uk/emc/product/6905#gref

Treatment of cancer-associated thrombosis: What’s the priority for patients?

In this episode, Dr Mari Thomas and Professor Jan Beyer-Westendorf discuss practical considerations for how physicians should take patient preference into account when deciding on an anticoagulant for the treatment of cancer-associated thrombosis.

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Information on patient persistence with oral anticoagulant treatment compared with parenteral can be found here: https://onlinelibrary.wiley.com/doi/full/10.1002/rth2.12002
Details on the COSIMO study can be found here: https://thrombosisjournal.biomedcentral.com/articles/10.1186/s12959-018-0176-2 and https://ashpublications.org/blood/article/134/Supplement_1/2161/427953/Baseline-Characteristics-and-Clinical-Outcomes
The American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer guidelines can be found here: https://ashpublications.org/bloodadvances/article/5/4/927/475194/American-Society-of-Hematology-2021-guidelines-for
The American Society of Clinical Oncology venous thromboembolism prophylaxis and treatment in patients with cancer clinical practice guideline update can be found here: https://ascopubs.org/doi/10.1200/JCO.19.01461?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
The 2019 International Initiative on Thrombosis and Cancer clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer can be found here: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30336-5/fulltext
The International Society on Thrombosis and Haemostasis guidelines on the role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism can be found here: https://onlinelibrary.wiley.com/doi/10.1111/jth.14219
The 2019 European Society of Cardiology guidelines for the diagnosis and management of acute pulmonary embolism, developed in collaboration with the European Respiratory Society can be found here: https://academic.oup.com/eurheartj/article/41/4/543/5556136

Seeing the Bigger Picture in Cancer-Associated Thrombosis

In this episode, Dr Alok Khorana talks about the evolution of treatment for patients with cancer-associated thrombosis, Dr Ander Cohen discusses the importance of treatment satisfaction in these patients and Dr Jeff Weitz and Dr Jan Beyer-Westendorf discuss the management of a patient with colorectal cancer and incidental pulmonary embolism.

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Data showing the increased risk of VTE recurrence in patients with cancer-associated thrombosis is available here: https://ashpublications.org/blood/article/100/10/3484/106282/Recurrent-venous-thromboembolism-and-bleeding
The dedicated trials on NOACs in cancer-associated thrombosis can be accessed here for edoxaban (pubmed.ncbi.nlm.nih.gov/31733403/), rivaroxaban (pubmed.ncbi.nlm.nih.gov/31995662/) and apixaban (pubmed.ncbi.nlm.nih.gov/28837207/, pubmed.ncbi.nlm.nih.gov/32223112/)
More details on the patient reported outcomes in COSIMO can be found here: pubmed.ncbi.nlm.nih.gov/32877956/
COSIMO baseline characteristics and clinical outcomes are described here:https://ashpublications.org/blood/article/134/Supplement_1/2161/427953/Baseline-Characteristics-and-Clinical-Outcomes
The ISTH 2018 guidelines on cancer-associated thrombosis can be found here: onlinelibrary.wiley.com/doi/full/10.1111/jth.14219
The ASCO 2019 guidelines on cancer-associated thrombosis can be found here: ascopubs.org/doi/10.1200/JCO.19.01461
The ITAC 2019 guidelines on cancer-associated thrombosis can be found here: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30336-5/fulltext
The NCCN 2020 guidelines on cancer-associated thrombosis can be found here: https://www.nccn.org/professionals/physician_gls/pdf/vte.pdf
The ESC 2019 guidelines on the diagnosis and management of acute pulmonary embolism can be found here: https://academic.oup.com/eurheartj/article/41/4/543/5556136
For anticoagulant dosing information, see the European labels for apixaban (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf), dabigatran (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf), edoxaban (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002629/WC500189045.pdf), rivaroxaban (https://www.ema.europa.eu/documents/product-information/xarelto-epar-product-information_en.pdf) and low molecular weight heparin (https://www.ema.europa.eu/documents/product-information/inhixa-epar-product-information_en.pdf) (https://www.ema.europa.eu/documents/product-information/arixtra-epar-product-information_en-0.pdf) (www.medicines.org.uk/emc/product/4247/smpc#gref) (www.medicines.org.uk/emc/product/1695#gref)

Extended Treatment for VTE: Tailoring Anticoagulation to your Patient’s Needs

In this episode, Professor Stavros Konstantinides talks about the prevention of recurrent events in patients with venous thromboembolism, Dr Phil Wells explains the pooled analysis of EINSTEIN EXT and EINSTEIN CHOICE and what it tells us about which patients are suitable for extended anticoagulation and Dr Jeff Weitz and Dr Jan Beyer-Westendorf discuss whether a patient treated for pulmonary embolism would be a candidate for extended anticoagulation.

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Data on the risk of recurrent VTE after the discontinuation of anticoagulation therapy can be accessed here: haematologica.org/article/view/4325
The 2019 ESC guidelines on the diagnosis and management of acute pulmonary embolism developed in collaboration with the ERS can be found here: https://academic.oup.com/eurheartj/article/41/4/543/5556136
The pooled analysis of EINSTEIN CHOICE and EINSTEIN EXTENSION is available here: www.ncbi.nlm.nih.gov/pmc/articles/PMC5894264/
The EINSTEIN CHOICE paper can be found here: www.nejm.org/doi/full/10.1056/NEJMoa1700518
The EINSTEIN EXTENSION paper can be accessed here: https://www.nejm.org/doi/10.1056/NEJMoa1007903?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Data showing the increased case fatality rate of PE compared with DVT can be found in this publication: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1538-7836.2007.02450.x
Data on the increased risk of VTE recurrence in males versus females can be found here: https://www.bmj.com/content/342/bmj.d813#:~:text=Conclusions-,In%20patients%20with%20a%20first%20unprovoked%20venous%20thromboembolism%2C%20men%20have,had%20hormone%20associated%20venous%20thromboembolism
Data supporting the increased risk of PE versus DVT recurrence in a patient with a previous PE can be found in this publication: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544622/#:~:text=However%2C%20PE%20patients%20are%20three,be%20low%20in%20these%20patients
For anticoagulant dosing information, see the European labels for apixaban (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf), dabigatran (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf), edoxaban (http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002629/WC500189045.pdf), rivaroxaban (https://www.ema.europa.eu/documents/product-information/xarelto-epar-product-information_en.pdf) and warfarin (https://www.medicines.org.uk/emc/product/3064/smpc)

Pulmonary Embolism: When Is it Safe to Treat Patients at Home?

In this episode, Professor Stavros Konstantinides talks about identifying patients with pulmonary embolism who may be candidates for home treatment, Dr David Jimenez explains the results of the HoT-PE study, and Dr Jeff Weitz and Dr Jan Beyer-Westendorf discuss whether a patient with pulmonary embolism could be treated as an outpatient.

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Data on the number of patients with PE who may be suitable for home treatment can be accessed here: onlinelibrary.wiley.com/doi/full/10.1111/jth.14423
Data on the proportion of patients treated as outpatients are available here: https://journals.sagepub.com/doi/10.1177/1076029616674827?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
The 2019 ESC guidelines on the diagnosis and management of acute PE, developed in collaboration with the ERS, can be found here: https://academic.oup.com/eurheartj/article/41/4/543/5556136
The 2016 CHEST guidelines on antithrombotic therapy for VTE can be accessed here: https://journal.chestnet.org/article/S0012-3692(15)00335-9/fulltext
The EINSTEIN CHOICE publication can be found here: www.nejm.org/doi/full/10.1056/NEJMoa1700518
The HoT-PE publication is available here: https://academic.oup.com/eurheartj/article/41/4/509/5497670
The study details of the HOME-PE trial can be found here: clinicaltrials.gov/ct2/show/NCT02811237
The HOME-PE presentation at the 2020 ESC annual meeting can be accessed here by ESC members: https://esc365.escardio.org/Congress/ESC-CONGRESS-2020-The-Digital-Experience/Hot-Line-HOME-PE/224194-home-pe-hospitalisation-or-outpatient-management-of-pe-patients-hestia-vs-simplified-pesi
The meta-analysis by Stefano Barco et al. is available here: https://academic.oup.com/eurheartj/article/40/11/902/5263773
For anticoagulant dosing information, see the European labels for apixaban (https://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf), dabigatran (https://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf), edoxaban (https://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002629/WC500189045.pdf), rivaroxaban (https://www.ema.europa.eu/documents/product-information/xarelto-epar-product-information_en.pdf), warfarin (https://www.medicines.org.uk/emc/product/3064/smpc) and low molecular weight heparin (https://www.ema.europa.eu/documents/product-information/inhixa-epar-product-information_en.pdf) (https://www.ema.europa.eu/documents/product-information/arixtra-epar-product-information_en-0.pdf) (https://www.medicines.org.uk/emc/product/4247/smpc#gref) (https://www.medicines.org.uk/emc/product/1695#gref)

Thrombosis Adviser