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Longo de Oliveira ALM, de Oliveira Pereira RF, Agati LB, Ribeiro CM, Kawamura Suguiura GY, Cioni CH, Bermudez M, Pirani MB, Caffaro RA, Castelli V, Resende Aguiar VC, Volpiani GG, Paschoa A, Scarlatelli Macedo AV, de Barros e Silva PGM, de Campos Guerra JC, Fareed J, Lopes RD, Ramacciotti E. Rivaroxaban Versus Enoxaparin for Thromboprophylaxis After major Gynecological Cancer Surgery: The VALERIA Trial : Venous thromboembolism prophyl Axis after gyneco Logical p Elvic cancer surgery with RIvaroxaban versus enox Aparin (VALERIA trial). Clin Appl Thromb Hemost 2022; 28:10760296221132556. [PMID: 36474344 PMCID: PMC9732794 DOI: 10.1177/10760296221132556] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Direct oral anticoagulants (DOACs) for venous thromboembolism (VTE) prevention after major gynecological cancer surgery might be an alternative to parenteral low-molecular-weight heparin (LMWH). Patients undergoing major gynecological cancer surgery were randomized at hospital discharge to receive rivaroxaban 10 mg once daily or enoxaparin 40 mg once daily for 30 days. The primary efficacy outcome was a combination of symptomatic VTE and VTE-related death or asymptomatic VTE at day 30. The primary safety outcome was the incidence of major or clinically relevant nonmajor bleeding. Two hundred and twenty-eight patients were enrolled and randomly assigned to receive rivaroxaban (n = 114)or enoxaparin (n = 114). The trial was stopped due to a lower-than-expected event rate. The primary efficacy outcome occurred in 3.51% of patients assigned to rivaroxaban and in 4.39% of patients assigned to enoxaparin (relative risk 0.80, 95% CI 0.22 to 2.90; p = 0.7344). Patients assigned to rivaroxaban had no primary bleeding event, and 3 patients (2.63%) in the enoxaparin group had a major or CRNM bleeding event (hazard ratio, 0.14; 95% CI, 0.007 to 2.73; P = 0.1963). In patients undergoing major gynecological cancer surgery, thromboprophylaxis with rivaroxaban 10 mg daily for 30 days had similar rates of thrombotic and bleeding events compared to parenteral enoxaparin 40 mg daily. While the power is limited due to not reaching the intended sample size, our results support the hypothesis that DOACs might be an attractive alternative strategy to LMWH to prevent VTE in this high-risk population.
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Affiliation(s)
| | | | | | | | | | | | - Marilsa Bermudez
- São Paulo State Public Women's Health Reference Center, São Paulo,
Brazil
| | | | | | - Valter Castelli
- Santa Casa de São Paulo School of Medical Sciences, São Paulo,
Brazil
| | | | - Giuliano Giova Volpiani
- Santa Casa de São Paulo School of Medical Sciences, São Paulo,
Brazil,Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André,
SP, Brazil
| | | | | | | | | | - Jawed Fareed
- Hemostasis & Thrombosis Research Laboratories at Loyola
University Medical Center, Maywood, IL, USA
| | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, USA
| | - Eduardo Ramacciotti
- Science
Valley Research Institute, Santo André, São
Paulo, Brazil,Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André,
SP, Brazil,Hemostasis & Thrombosis Research Laboratories at Loyola
University Medical Center, Maywood, IL, USA,Eduardo Ramacciotti, Science Valley
Research Institute, Santo André, São Paulo, Brazil.
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