In a study of adults with\u00a0advanced prostate\u00a0cancer\u00a0taking androgen-receptor pathway inhibitors\u00a0and\u00a0different types\u00a0of\u00a0anticoagulants,\u00a0investigators found no\u00a0evidence of an\u00a0increase\u00a0in\u00a0patients’ bleeding or clotting risks, despite\u00a0previous\u00a0lab results that raised alarms.\u00a0The findings are published\u00a0by\u00a0Wiley\u00a0online in\u00a0CANCER, a peer-reviewed journal of the American Cancer Society.<\/p>\n
Thromboembolism,\u00a0caused by a circulating\u00a0blood clot\u00a0that gets stuck and causes an obstruction,\u00a0is the second leading cause of death in\u00a0people with\u00a0cancer, surpassed only by progression of the cancer itself.\u00a0Anticoagulants (blood thinners) are\u00a0standard\u00a0therapy to treat or prevent\u00a0thromboembolism.\u00a0For\u00a0individuals with advanced prostate cancer, thromboembolism\u00a0can be especially worrisome because\u00a0lab experiments have\u00a0indicated\u00a0that\u00a0androgen-receptor pathway inhibitors, which\u00a0are\u00a0recommended for\u00a0nearly all\u00a0patients with advanced prostate cancer, can\u00a0interact\u00a0with\u00a0certain\u00a0anticoagulants-specifically, direct oral anticoagulants (DOACs).<\/p>\n
To investigate whether these lab-based findings correlate to real concerns in patients, researchers evaluated\u00a0outcomes in patients taking\u00a0both\u00a0anticoagulants\u00a0and\u00a0androgen-receptor pathway inhibitors, including\u00a0enzalutamide, apalutamide, and abiraterone.<\/p>\n
In the\u00a0retrospective\u00a0population-based\u00a0analysis of 2,997 Canadian adults with prostate cancer\u00a0who were prescribed\u00a0anticoagulants\u00a0(DOACs or non-DOACs)\u00a0and enzalutamide\u00a0or\u00a0apalutamide between 2012 and 2023, investigators found no increased risks of clotting in the DOAC versus non-DOAC groups.\u00a0Similarly, investigators compared DOAC and non-DOAC groups\u00a0combined\u00a0with abiraterone\u00a0and did not find an increased risk of bleeding.<\/p>\n
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As clinicians, we are\u00a0faced with\u00a0the\u00a0question of\u00a0choosing the\u00a0best anticoagulant\u00a0option\u00a0for patients\u00a0on a daily basis,\u00a0and the\u00a0complexity\u00a0further increases\u00a0in patients\u00a0with cancer\u00a0taking many other medications including\u00a0anticancer therapies\u00a0that could cause\u00a0concerning drug\u2013drug\u00a0interactions. Our findings suggest that pharmacokinetic drug\u2013drug interaction concerns may not translate into adverse clinical outcomes in\u00a0the\u00a0real\u00a0world.\u00a0These results can help clinicians and patients feel more confident when managing anticoagulation alongside modern prostate cancer treatments.”\u00a0<\/p>\n
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Tzu-Fei Wang, MD, lead author,\u00a0University of Ottawa at The Ottawa Hospital and the Ottawa Hospital Research Institute<\/p>\n
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