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2) Reasons for switching to rivaroxaban
week 4.
follow-up. Anti-Clot Treatment Scale (ACTS)
treatment option for patients with CAT, because
9
The common reasons for shifting to rivaroxaban
it can be administered to patients as a fixed oral
questionnaires were performed at baseline, week
were mainly patient-related that were dependent
dose and without any requirement of routine
4, and months 3 and 6 for pairwise comparison
on their preferences and desires, as summarized
to mean scores at baseline (Figure 1).
Following a shift to rivaroxaban, there was a
anticoagulation monitoring.
8
8
in table 1.
significant improvement in patient treatment
8
Study outcome:
Cancer-associated thrOmboSIs –
satisfaction on the ACTS Burdens subscale at
patient-reported outcoMes with rivarOx-
week 4 and maintained at months 3 and 6.
aban (COSIMO) study:
1) Percentage of patients who switched to
The immediate increase in treatment
Rivaroxaban from other therapies
The COSIMO study was designed to evaluate
satisfaction at week 4 is strongly supportive
Majority of patients changed to Rivaroxaban
patient satisfaction after planned change from
of treatment dependent nature of the change
from LMWH therapy (96.65%), while few patients
traditional anticoagulant therapy to rivaroxaban
in satisfaction.
changed from VKA and Fondaparinux as well
therapy for cancer associated thrombosis
(Figure 2).
8
(CAT).
8, 9
treatment of CAT owing to superior efficacy and
Factors underlying cancer associated
The COSIMO study demonstrates that CAT
safety. The major drawbacks associated with
4, 5
thrombosis (CAT)
patients who changed their VTE treatment to
VKA include strict requirement of monitoring of
Study plan:
Cancer promotes hypercoagulability in patients
Rivaroxaban experienced :
8
international normalized ratio (INR) to track
A prospective, non-interventional, single-arm
in
improved
due to some or all of the following factors :
3
anticoagulation status and interactions with food
cohort study enrolled patients from 55 sites
everyday clinical practice.
Long-term chemotherapy
and drugs.
4,5
across Australia, Canada and Europe. 505
8,9
reduced anticoagulation burden (patient
Endothelial damage
cancer patients who received rivaroxaban were
reported).
However, patients’ adherence towards LMWH
included in the study. During analysis, ratings
6
Obstruction to blood flow by tumor masses
3) Patient-reported treatment satisfaction on
This can improve long term persistence and
over oral anticoagulants is low thereby affecting
were reverse coded; as a result, higher scores
Procoagulant microparticles released from
the ACTS Burdens subscale after switching to
clinical outcomes.
patient outcomes. Major reasons are as follows :
4
reflected greater patient treatment satisfaction.
8
cancer cells
Rivaroxaban :
8
Observations lasted for 6 months or until the
Comorbid conditions
References
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a) At Baseline:
Advanced age
recurrent hospital visits and clinical care
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Haemost. 2021;5(8):e12604. doi:10.1002/rth2.12604
Intraoperative characteristics Postoperative complications
OSR cEVAR OSR cEVAR
(N=258; 57%) (N=197; 43%) (N=258; 57%) (N=197; 43%)
Tube Prosthesis Fenestrated grafts Intensive care 2 [1-3] 0 [0-1]
(54%) or FEVAR (69%) admission, days
1
Bifurcated Chimney EVAR or (P < 0.001)
Prosthesis (45%) CHEVAR (31%)
Aortic Clamp: Above both renal Hospital 8 [6-12] 4 [3-7]
arteries (55%) admission, days
7
Above one of the (P < 0.001)
renal arteries
(37%)
Similar 7% 8% Patients with a 127 (49) 65 (33)
intraoperative complication
complication (P within 30 days
=0.088)
Blood Loss Reintervention More often Shorter ICU
or hospital stay reintervention and/or hospital
101-500 mL 9% 42% (P<0.01) (higher stay
re-laparotomies)
>1000 mL 67% 14%