Chatree Chai-Adisaksopha1, Alfonso Iorio2, Mark A Crowther2, Javier de Miguel3, Estuardo Salgado4, Marija Zdraveska5, Carmen Fernández-Capitán6, José Antonio Nieto7, Giovanni Barillari8, Laurent Bertoletti9, Manuel Monreal10. 1. Department of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: chatree.chai-adisaksopha@medportal.ca. 2. Department of Medicine, McMaster University, Hamilton, ON, Canada. 3. Department of Pneumonology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 4. Intensive Care Unit, Hospital Clínica La Merced, Quito, Ecuador. 5. PHI University Clinic of Pulmology and Allergy Skopje, University Clinic of Pulmonology and Allergy, Skopje, Macedonia. 6. Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain. 7. Department of Internal Medicine, Hospital General Virgen de la Luz, Cuenca, Spain. 8. Department of Internal Medicine, Ospedale S. Maria della Misericordia, Udine, Italy. 9. Department of Médecine et Thérapeutique, Hôpital Nord-CHU St-Etienne, Saint-Etienne, France. 10. Department of Internal Medicine, Hospital Universitari Germans Trias I Pujol, Universidad Católica de Murcia, Barcelona, Spain.
Abstract
BACKGROUND: Low-molecular-weight heparin (LMWH) is the treatment of choice in cancer patients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty. METHODS: We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to compare the rate of venous thromboembolism recurrences and major bleeding appearing beyond the first 6 months of anticoagulant therapy in cancer patients with venous thromboembolism, according to therapy with LMWH or vitamin K antagonists (VKA). We performed a propensity score-matched cohort study. RESULTS: After propensity matching, 482 cancer patients continued to receive LMWH and 482 switched to VKA. During the course of anticoagulant therapy (mean 275.5 days), 57 patients developed venous thrombosis recurrences (recurrent pulmonary embolism 26, recurrent deep vein thrombosis 29, both 2), 28 had major bleeding, 38 had nonmajor bleeding, and 129 died. No patient died of recurrent venous thrombosis, and 5 patients died of bleeding (2 were on LMWH, 3 on VKA). Patients who continued with LMWH had a similar rate of deep vein thrombosis recurrences (relative risk [RR] 1.41; 95% confidence interval [CI], 0.68-2.93), pulmonary embolism recurrences (RR 0.73; 95% CI, 0.34-1.58), major bleeding (RR 0.96; 95% CI, 0.51-1.79), or nonmajor bleeding (RR 1.15; 95% CI, 0.55-2.40), compared with those who switched to VKA, but a higher mortality rate (RR 1.58; 95% CI, 1.13-2.20). CONCLUSIONS: In cancer patients with venous thromboembolism who completed 6 months of LMWH therapy, switching to VKA was associated with a similar risk of venous thrombosis recurrences or bleeding when compared with patients who continued LMWH.
BACKGROUND: Low-molecular-weight heparin (LMWH) is the treatment of choice in cancerpatients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty. METHODS: We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to compare the rate of venous thromboembolism recurrences and major bleeding appearing beyond the first 6 months of anticoagulant therapy in cancerpatients with venous thromboembolism, according to therapy with LMWH or vitamin K antagonists (VKA). We performed a propensity score-matched cohort study. RESULTS: After propensity matching, 482 cancerpatients continued to receive LMWH and 482 switched to VKA. During the course of anticoagulant therapy (mean 275.5 days), 57 patients developed venous thrombosis recurrences (recurrent pulmonary embolism 26, recurrent deep vein thrombosis 29, both 2), 28 had major bleeding, 38 had nonmajor bleeding, and 129 died. No patient died of recurrent venous thrombosis, and 5 patients died of bleeding (2 were on LMWH, 3 on VKA). Patients who continued with LMWH had a similar rate of deep vein thrombosis recurrences (relative risk [RR] 1.41; 95% confidence interval [CI], 0.68-2.93), pulmonary embolism recurrences (RR 0.73; 95% CI, 0.34-1.58), major bleeding (RR 0.96; 95% CI, 0.51-1.79), or nonmajor bleeding (RR 1.15; 95% CI, 0.55-2.40), compared with those who switched to VKA, but a higher mortality rate (RR 1.58; 95% CI, 1.13-2.20). CONCLUSIONS: In cancerpatients with venous thromboembolism who completed 6 months of LMWH therapy, switching to VKA was associated with a similar risk of venous thrombosis recurrences or bleeding when compared with patients who continued LMWH.
Authors: Claudia Coscia; Ana Jaureguizar; Carlos Andres Quezada; Alfonso Muriel; Manuel Monreal; Tomas Villén; Esther Barbero; Diana Chiluiza; Roger D Yusen; David Jimenez Journal: Chest Date: 2018-10-25 Impact factor: 9.410
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