Edoxaban appears to be as effective as low-molecular-weight heparin for the treatment of cancer-associated VTE. Researchers randomized just over 1,000 cancer patients who had acute symptomatic or incidental VTE to low-molecular-weight heparin for at least five days. The researchers followed with oral edoxaban 60 mg once a day or with subcutaneous dalteparin 200 IU/kg of body weight once daily for one month followed by dalteparin 150 IU/kg once daily. Patients were treated for at least six months and up to 12 months. The primary outcome was a composite of recurrent VTE or major bleeding.
A primary outcome event occurred in 12.8% of subjects in the edoxaban group compared with 13.5% of subjects in the dalteparin group (hazard ratio [HR], 0.97; 95% CI, 0.70-1.36; P = 0.006 for noninferiority and P = 0.87 for superiority). Recurrent VTE occurred in 7.9% of subjects in the edoxaban group and 11.3% of subjects in the dalteparin group (difference in risk, -3.4%; 95% CI, -7.0 to 0.2). Major bleeding occurred in 6.9% of the edoxaban patients compared with 4.0% of the dalteparin patients (difference in risk, 2.9%; 95% CI, 0.1-5.6). The authors concluded that edoxaban was noninferior to dalteparin regarding the composite outcome of recurrent VTE or major bleeding, although recurrent VTE was lower and bleeding was higher with edoxaban (N Engl J Med 2018;378:615-624).