Major areas of interest in VTE

Jeffrey Weitz

In your opinion, are there any new trial results, drugs, or procedures in the field of thromboembolic disease that are worth particular attention?

Jeffrey Weitz: So you are asking me about new trials that are in the works, that are exciting in the thrombosis area. I think the first one that will become available toward the end of this year is a study in cancer-associated thrombosis. It is called the Hokusai VTE-cancer study. This study has taken patients with cancer-associated thrombosis; they have all received dalteparin for at least 5 days and then they were randomized to extended therapy with dalteparin or to treatment with oral edoxaban. They received treatment for up to a year. Recruitment finished in December of last year, by the end of this year we will have the data. That is exciting because although we have very good data comparing the direct (novel) oral anticoagulants – NOACs, if you will – with warfarin, we do not have good data comparing them with extended low-molecular-weight heparin. Because we do not have that data, right now the guidelines recommend that we continue to use extended low-molecular-weight heparin for venous thromboembolism (VTE) patients in the setting of active cancer. But if we can show that the NOACs are at least as effective and safe as extended low-molecular-weight heparin, it will simplify treatment because these poor cancer patients are taking daily injections on top of everything else. It would be nice if they could get away with a tablet.

[When it comes to] other trials that are in the works but are earlier in progress, there are some very exciting trials looking at factor XI as a target for new anticoagulant therapy. We have some phase 2 data and we are having more phase 2 studies with that as the target. But to actually see studies for the treatment of VTE… The phase 2 studies are all focusing on prevention of VTE in the orthopedic setting because that is the standard approach for assessing efficacy and safety in a phase 2 setting. We are going to see them progressing depending on how they do. That is exciting because that is a new target – potentially effective and possibly safer than what we have right now.

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