Enzalutamide & Management of Anticoagulation.

[pjoshea13]

New paper below.

"Enzalutamide interacts with several anticoagulants through various mechanisms, making their concurrent use clinically challenging. As such, complex decisions about anticoagulation in these patients are frequently encountered by treating physicians. In this review, we describe the potential interactions between enzalutamide and various anticoagulants, and suggest management paradigms based on the current body of knowledge for patients with atrial fibrillation, venous thromboembolism, and mechanical heart valves."

-Patrick

ncbi.nlm.nih.gov/pubmed/291...

J Oncol Pract. 2017 Nov;13(11):720-727. doi: 10.1200/JOP.2017.022004.

Management of Anticoagulation in Patients With Prostate Cancer Receiving Enzalutamide.

Shatzel JJ1, Daughety MM1, Olson SR1, Beer TM1, DeLoughery TG1.

Author information

Abstract

Enzalutamide, a novel, oral androgen receptor antagonist used for the treatment of metastatic, castration-resistant prostate cancer, has been shown to improve overall and progression-free survival, prolong time to initiation of chemotherapy, reduce skeletal-related events, and carry a favorable adverse effect profile. Metastatic prostate cancer is a disease of older men, a population with an increased incidence of medical comorbidities warranting anticoagulation. Prostate cancer itself, along with some of its therapies, is also prothrombotic. Enzalutamide interacts with several anticoagulants through various mechanisms, making their concurrent use clinically challenging. As such, complex decisions about anticoagulation in these patients are frequently encountered by treating physicians. In this review, we describe the potential interactions between enzalutamide and various anticoagulants, and suggest management paradigms based on the current body of knowledge for patients with atrial fibrillation, venous thromboembolism, and mechanical heart valves.

PMID: 29125921 DOI: 10.1200/JOP.2017.022004

[cesanon]

"Prostate cancer itself... is... prothrombotic. "

I never knew that. So I guess it is good that I take aspirin and fish oil.

[pjoshea13 in reply to cesanon]

I suppose so, but it wouldn't hurt to get a D-dimer test periodically.

-Patrick

[joeoconnell]

i have PC + AFib and take 81 mg aspirin, is that a threat to me?

[pjoshea13 in reply to joeoconnell]

Joe,

Aberrant coagulation is a threat to everyone with PCa. 81mg aspirin is enough to inhibit the aggregation of platelets, which is the first step of clotting.

-Patrick

[Hidden]

too bad the abstract doesn't say if it includes the newer factor 10 drugs - rivaoxiban and the other x's.

or is it primarily lmw heparin and warfarin?

[middlejoel]

OK Patrick, so if one has A-Fib and PCa, and is ready to move on to second tier ADT drugs, the choices are Zytiga which raises blood pressure or Xtandi that might react with the anticoagulant medicines of choice. Is it a matter of pick your poison and hope for the best?

Jal

[pjoshea13 in reply to middlejoel]

Joel,

Hopefully, one's oncologist is competent enough to take comorbidities & meds prescribed elsewhere into account, before introducing a new PCa drug.

But the patient shouldn't assume anything, IMO, & should discuss concerns, & perhaps cite papers such as the one above.

Unfortunately, as you say, there might be a downside to every option for some men.

-Patrick

[BigRich in reply to pjoshea13]

"Hopefully, one's oncologist is competent enough to take comorbidities & meds prescribed elsewhere into account, before introducing a new PCa drug." I have to do this myself, with my own research.

Rich