Efficacy and adherence comparison of rivaroxaban versus low-molecular-weight heparin for venous thromboembolism prophylaxis in cancer patients
10.3969/j.issn.1671-8348.2025.10.010
- VernacularTitle:利伐沙班与低分子肝素预防恶性肿瘤患者发生VTE的效果及其依从性比较
- Author:
Zhi CHEN
1
;
Dan TANG
;
Jin YUAN
;
Lihua LIU
;
Zhengjun GUO
;
Zhenzhou YANG
Author Information
1. 四川大学华西医院龙泉医院/成都市龙泉驿区第一人民医院肿瘤血液科,成都 610100;重庆医科大学附属第二医院肿瘤中心,重庆 400010
- Keywords:
venous thromboembolism;
rivaroxaban;
low-molecular-weight heparin;
prophylaxis;
malig-nant tumor
- From:
Chongqing Medicine
2025;54(10):2296-2301
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the efficacy and adherence of rivaroxaban versus low-molecular-weight heparin for prophylactic anticoagulation in cancer patients with venous thromboembolism(VTE).Methods A total of 120 intermediate-to-high VTE risk patients with malignant tumors admitted to Depart-ment of Hematology and Oncology,West China Longquan Hospital of Sichuan University between September 2021 and December 2022,were randomly assigned to the rivaroxaban group(n=60)and the low-molecular-weight heparin group(n=60)using the random number table.The rivaroxaban group received oral Rivaroxa-ban,while the low-molecular-weight heparin group received subcutaneous injections of low-molecular-weight heparin sodium for prophylactic anticoagulation.All patients were followed up for 180 days.The primary end-point was medication adherence.The secondary endpoints included the incidence of VTE,bleeding events,and changes in coagulation parameters.Results The rate of good medication adherence was significantly higher in the rivaroxaban group than in the low-molecular-weight heparin group(95.00％vs.88.33％,P＜0.05).However,there were no statistically significant differences in the incidence of VTE or overall bleeding events between the two groups(P＜0.05).Following treatment,parameters including fibrinogen,prothrombin time(PT),and D-dimer levels showed significant improvement from baseline in both groups.Compared to the low-molecular-weight heparin group,the Rivaroxaban group demonstrated significantly higher fibrinogen levels,shorter PT,and lower D-dimer levels(P＜0.05).Stepwise logistic regression analysis identified the post-treatment platelet(PLT)count as a significant factor influencing bleeding events during prophylactic antico-agulation(P＜0.05).Khorana score≥3(high risk)was identified as a risk factor for bleeding events(P＜0.05).The incidence of clinically relevant non-major bleeding(CRNMB)was higher in the rivaroxaban group[11.67％(7/60)]compared to the low-molecular-weight heparin group[8.33％(5/60)],although the differ-ence was not statistically significant(P＜0.05).Kaplan-Meier curve analysis revealed no significant difference in the cumulative incidence of bleeding-free events between the two groups(P＜0.05).Conclusion Oral ri-varoxaban and subcutaneous low-molecular-weight heparin demonstrate comparable efficacy and safety for VTE prevention in cancer patients,but rivaroxaban significantly improves patient's adherence.
