Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Ingrid Pabinger, Medical University of Vienna,
- Second opponent: Professor Marc Carrier, University of Ottawa,
- Third member and chair of the evaluation committee: Associate professor Magnus Lyngbakken, University of Oslo
Chair of the Defence
Associate Professor Carola Elisabeth Henriksson, University of Oslo
Principal Supervisor
Anders Erik Astrup Dahm, University of Oslo
Summary
Patients with cancer have increased risk of venous thrombosis, which are often treated with expensive anticoagulants administered as injections. Patients without cancer are mostly treated with cheaper oral anticoagulants called direct oral anticoagulants, or DOACs. Several studies, including the current thesis, have found these anticoagulants to also be effective and safe for patients with cancer. This thesis is based on the Norwegian CAP-study, which was a single-armed interventional trial. The aim was to assess treatment and secondary prophylaxis of venous thrombosis with the DOAC, apixaban, in an unselected cancer population. The trial included 298 patients with any type of cancer, at the time of venous thrombosis diagnosis. All patients received full-dose apixaban for up to six months. Patients who still had active cancer after six months, were offered secondary prophylaxis with low-dose apixaban for up to 30 months. Outcomes were recurrent venous thrombosis and bleeding. The CAP-study registered a frequency of 4.0 % (95 % confidence interval: 2.1–6.9) recurrent venous thrombosis, and 5.4% (95% confidence interval: 2.8–7.9) major bleeding during the first 6 months. This was comparable to the DOAC arm of the large randomized trials published some time before the CAP-study. Secondary prophylaxis up to 30 months showed low incidence of both recurrent venous thrombosis and bleeding. We observed similar frequency of arterial thrombosis and recurrent venous thrombosis during the first six months. Factors associated with arterial thrombosis were pancreatic cancer, ovarian cancer, previous VT, low body mass index, high leukocyte count at inclusion, and the use of non-steroidal anti –inflammatory drugs.
The CAP-study supports current randomized data on apixaban as safe and efficient for treating venous thrombosis in cancer patients.
Additional information
Contact the research support staff.