C W Francis1, C M Kessler2, S Z Goldhaber3, M J Kovacs4, M Monreal5, M V Huisman6, D Bergqvist7, A G Turpie8, T L Ortel9, A C Spyropoulos1, I Pabinger10, A K Kakkar11. 1. University of Rochester Medical Center, Rochester, NY, USA. 2. Georgetown University Hospital, Washington, DC, USA. 3. Brigham and Women's Hospital, Boston, MA, USA. 4. London Health Sciences Centre, London, Ontario, Canada. 5. Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, Barcelona, Spain. 6. Leiden University Medical Center, Leiden, the Netherlands. 7. University Hospital, Uppsala, Sweden. 8. Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada. 9. Duke University Medical Center, Durham, NC, USA. 10. Medical University of Vienna, Wien, Austria. 11. Barts and The London Queen Mary's School of Medicine and Dentistry, London, UK.
Abstract
BACKGROUND: Treatment of venous thromboembolism (VTE) in patients with cancer has a high rate of recurrence and bleeding complications. Guidelines recommend low-molecular-weight heparin (LMWH) for at least 3-6 months and possibly indefinitely for patients with active malignancy. There are, however, few data supporting treatment with LMWH beyond 6 months. The primary aim of the DALTECAN study (NCT00942968) was to determine the safety of dalteparin between 6 and 12 months in cancer-associated VTE. METHODS: Patients with active cancer and newly diagnosed VTE were enrolled in a prospective, multicenter study and received subcutaneous dalteparin for 12 months. The rates of bleeding and recurrent VTE were evaluated at months 1, 2-6 and 7-12. FINDINGS: Of 334 patients enrolled, 185 and 109 completed 6 and 12 months of therapy; 49.1% had deep vein thrombosis (DVT); 38.9% had pulmonary embolism (PE); and 12.0% had both on presentation. The overall frequency of major bleeding was 10.2% (34/334). Major bleeding occurred in 3.6% (12/334) in the first month, and 1.1% (14/1237) and 0.7% (8/1086) per patient-month during months 2-6 and 7-12, respectively. Recurrent VTE occurred in 11.1% (37/334); the incidence rate was 5.7% (19/334) for month 1, 3.4% (10/296) during months 2-6, and 4.1% (8/194) during months 7-12. One hundred and sixteen patients died, four due to recurrent VTE and two due to bleeding. CONCLUSION: Major bleeding was less frequent during dalteparin therapy beyond 6 months. The risk of developing major bleeding complications or VTE recurrence was greatest in the first month of therapy and lower over the subsequent 11 months.
BACKGROUND: Treatment of venous thromboembolism (VTE) in patients with cancer has a high rate of recurrence and bleeding complications. Guidelines recommend low-molecular-weight heparin (LMWH) for at least 3-6 months and possibly indefinitely for patients with active malignancy. There are, however, few data supporting treatment with LMWH beyond 6 months. The primary aim of the DALTECAN study (NCT00942968) was to determine the safety of dalteparin between 6 and 12 months in cancer-associated VTE. METHODS:Patients with active cancer and newly diagnosed VTE were enrolled in a prospective, multicenter study and received subcutaneous dalteparin for 12 months. The rates of bleeding and recurrent VTE were evaluated at months 1, 2-6 and 7-12. FINDINGS: Of 334 patients enrolled, 185 and 109 completed 6 and 12 months of therapy; 49.1% had deep vein thrombosis (DVT); 38.9% had pulmonary embolism (PE); and 12.0% had both on presentation. The overall frequency of major bleeding was 10.2% (34/334). Major bleeding occurred in 3.6% (12/334) in the first month, and 1.1% (14/1237) and 0.7% (8/1086) per patient-month during months 2-6 and 7-12, respectively. Recurrent VTE occurred in 11.1% (37/334); the incidence rate was 5.7% (19/334) for month 1, 3.4% (10/296) during months 2-6, and 4.1% (8/194) during months 7-12. One hundred and sixteen patients died, four due to recurrent VTE and two due to bleeding. CONCLUSION: Major bleeding was less frequent during dalteparin therapy beyond 6 months. The risk of developing major bleeding complications or VTE recurrence was greatest in the first month of therapy and lower over the subsequent 11 months.
Authors: M Carrier; N Blais; M Crowther; P Kavan; G Le Gal; O Moodley; S Shivakumar; V Tagalakis; C Wu; A Y Y Lee Journal: Curr Oncol Date: 2018-10-31 Impact factor: 3.677
Authors: Renato D Lopes; Patricia O Guimarães; Mark Crowther; Elaine Hylek; Gilson S Feitosa-Filho; Luiz E Ritt; Nivaldo Filgueiras; David A Garcia Journal: J Thromb Thrombolysis Date: 2018-05 Impact factor: 2.300