Comparative Effectiveness of Venous Thromboembolism (VTE) Prophylaxis in Patients with Cancer

Objective: To evaluate the safety and effectiveness of anticoagulants used for thromboprophylaxis in cancer patients Background: Cancer patients account for 20% of all VTE cases in the United States, and VTE has a more substantial effect on cancer patients than on non-cancer patients. Despite many clinical practice guidelines, the anticoagulant’s effectiveness still remains controversial in cancer patients. Methods: A retrospective comparative effectiveness cohort study was conducted using data from the Medical Expenditure Panel Survey. The incidence of VTE, bleeding, and all-cause death events; and health-related quality of life were used as outcomes to evaluate the two cohorts (prophylactic and matching-control). The effects of age, gender, race, and comorbidities on the clinical outcomes were controlled in logistic regression. Results: The incidence of VTE was higher in the prophylactic cohort than the matching-control (5.6% vs. 2.1%, respectively, with a relative risk (RR) of 2.66, 95%CI 2.64-2.68). Furthermore, there were more bleeding (29% vs. 24%, RR 1.21, 95%CI 1.21-1.22) and all-cause death events (10.13% vs. 6.86%, RR 1.47, 95%CI 1.46-1.48) in the prophylactic cohort than in the matching-control cohort. However, after controlling for the effect of age, gender, race, and comorbidities these differences between the two cohorts became statistically insignificant. The use of thromboprophylaxis was associated with a significant decline in physical quality of life, with no significant impact on mental quality of life. Conclusion: The present study findings support the current guidelines’ recommendation pertaining to VTE prophylaxis in cancer patients by providing evidence on the anticoagulants’ effectiveness for thromboprophylaxis in real-world practice