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treatment option for patients with CAT, because follow-up. Anti-Clot Treatment Scale (ACTS) 2) Reasons for switching to rivaroxaban week 4.
9
it can be administered to patients as a ﬁxed oral questionnaires were performed at baseline, week The common reasons for shifting to rivaroxaban
dose and without any requirement of routine 4, and months 3 and 6 for pairwise comparison were mainly patient-related that were dependent Conclusion

anticoagulation monitoring. 8 to mean scores at baseline (Figure 1). 8 on their preferences and desires, as summarized Following a shift to rivaroxaban, there was a
in table 1. 8 signiﬁcant improvement in patient treatment

Cancer-associated thrOmboSIs – Study outcome: satisfaction on the ACTS Burdens subscale at
patient-reported outcoMes with rivarOx- week 4 and maintained at months 3 and 6. 8

aban (COSIMO) study: 1) Percentage of patients who switched to

The COSIMO study was designed to evaluate Rivaroxaban from other therapies The immediate increase in treatment
patient satisfaction after planned change from Majority of patients changed to Rivaroxaban satisfaction at week 4 is strongly supportive

traditional anticoagulant therapy to rivaroxaban from LMWH therapy (96.65%), while few patients of treatment dependent nature of the change
therapy for cancer associated thrombosis changed from VKA and Fondaparinux as well in satisfaction. 8

Factors underlying cancer associated treatment of CAT owing to superior efﬁcacy and (CAT). 8, 9 (Figure 2). 8 The COSIMO study demonstrates that CAT
4, 5
thrombosis (CAT) safety. The major drawbacks associated with LMWH VKA Fondaparinux
VKA include strict requirement of monitoring of Study plan: patients who changed their VTE treatment to
Cancer promotes hypercoagulability in patients Rivaroxaban experienced :
8
international normalized ratio (INR) to track A prospective, non-interventional, single-arm
due to some or all of the following factors : anticoagulation status and interactions with food cohort study enrolled patients from 55 sites improved treatment satisfaction in
3
Long-term chemotherapy and drugs. 4,5 across Australia, Canada and Europe. 505 96.6% 1.6% 1.8% everyday clinical practice.
8,9
Endothelial damage cancer patients who received rivaroxaban were reduced anticoagulation burden (patient

Obstruction to blood flow by tumor masses However, patients’ adherence towards LMWH included in the study. During analysis, ratings reported).
6
over oral anticoagulants is low thereby affecting were reverse coded; as a result, higher scores 3) Patient-reported treatment satisfaction on This can improve long term persistence and
Procoagulant microparticles released from the ACTS Burdens subscale after switching to
patient outcomes. Major reasons are as follows : reflected greater patient treatment satisfaction. Rivaroxaban (Total study population) clinical outcomes.
4
8
cancer cells Rivaroxaban :
8
Observations lasted for 6 months or until the Figure 2: Percentage of patients in the study population
Comorbid conditions switched to rivaroxaban from other anticoagulant therapy. 8 References
Inconvenient intravenous infusion requires participant withdrew consent, died, or was lost to
Advanced age recurrent hospital visits and clinical care a) At Baseline: 1) Agnelli G, Verso M. Management of venous
Restricted mobility High treatment cost DCE ACTS burden score was 51.8 out of 60 thromboembolism in patients with cancer. J Thromb
Haemost. 2011;9:316-324.
4-12 weeks after start with doi:10.1111/j.1538-7836.2011.04346.x
rivaroxaban (telephone interview)
Patients with active Primary outcome: b) At Week 4:
Management of VTE in cancer patients Recently the international guidelines have been cancer and PE/DVT Decision to change to Treatment satisfaction 2) Blom JW, Vanderschoot JP, Oostindi r MJ, Osanto S,
rivaroxaban
and/or recurrent ( N=505 ) ACTS Burden Patients who remained in the study:
Due to high VTE recurrence risk in patients with updated to include recommendations for DOACs PE/DVT Treatment Rivaroxaban score at 4 weeks van der Meer FJ, Rosendaal FR. Incidence of venous
with SOC Observation period: 6 months ACTS Burden score was signiﬁcantly higher thrombosis in a large cohort of 66,329 cancer patients:
CAT, especially in the ﬁrst 6 months, extended in patients with cancer and VTE. The American anticoagulation results of a record linkage study. J Thromb Haemost.
4,5
(LMWH/VKA) for (55.6 out of 60). 2006;4(3):529-535.
anticoagulation therapy has been recommended Society of hematology (ASH) 2021 guidelines > _ 4 weeks prior to doi:10.1111/j.1538-7836.2006.01804.x
inclusion
ACTS
ACTS
ACTS
ACTS
if the bleeding risk is low. 4,5 recommend the use of direct oral anticoagulants baseline ~4 weeks ~3 months ~6 months Signiﬁcant increase in treatment
(primary endpoint) satisfaction. 3) Campello E, Henderson MW, Noubouossie DF, Simioni
(DOACs) for the short term treatment of VTE in P, Key NS. Contact system activation and cancer: new
The previous guidelines included active cancer over low molecular weight heparin Short design: International, prospective, Indication: VTE treatment and/or insights in the pathophysiology of cancer-associated
thrombosis. Thromb Haemost. 2018;118 (2):251-265.
prevention of recurrent VTE in
non-interventional cohort study
low-molecular-weight heparin (LMWH) based (LMWH). 6 patients with active cancer c) At 3 months and 6 months: doi:10.1160/TH17-08-05962014.59.7351
anticoagulation therapy over vitamin K Abbreviations The ACTS Burden score was 56.2 and 56.5 out 4) Key NS, Khorana AA, Kuderer NM, et al. Venous
ACTS, Anti-Clot Treatment Scale; DCE, discrete choice experiment; DVT, deep vein thrombosis; ﬁrst patient ﬁrst visit; LMWH, low molecular weight heparin;
LPLV, last patient last visit; PE, pulmonary embolism; SOC, standard of care; VKA, vitamin K antagonist: VTE, venous thromboembolism of 60 at 3 and 6 months, respectively. thromboembolism prophylaxis and treatment in patients
antagonists (VKAs) for the initial and long-term Rivaroxaban is a promising and convenient with cancer: ASCO clinical practice guideline update. J
Figure 1: Study design and outcome measurements. 8 The results were statistically signiﬁcant as in Clin Oncol. 2020;38:496-520.

5) National Comprehensive Cancer Network.
Cancer-associated venous thromboembolic disease,
Version 1.2020. National Comprehensive Cancer Network,
Inc.; 2020. Available at: https://www.nccn.org/profession
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6) Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK,
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7) Yeh CH, Hogg K, Weitz JI. Overview of the new oral
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8) Cohen AT, Maraveyas A, Beyer-Westendorf J, Lee AY,
Folkerts K, Abdelgawwad K, De Sanctis Y, Fatoba S,
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9) Maraveyas A, Beyer-Westendorf J, Lee AY, et al.
Cancer-Associated ThrOmboSIs - Patient-Reported
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