Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short‐term prognosis. (9th May 2015)

• Record Type: Journal Article
• Authors: Schulman, S.; Zondag, M.; Linkins, L.; Pasca, S.; Cheung, Y. W.; de Sancho, M.; Gallus, A.; Lecumberri, R.; Molnar, S.; Ageno, W.; Le Gal, G.; Falanga, A.; Hulegårdh, E.; Ranta, S.; Kamphuisen, P.; Debourdeau, P.; Rigamonti, V.; Ortel, T. L.; Lee, A.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 13:Number 6(2015:Jun.)
• Page Start: 1010
• Page End: 1018
• Publication Date: 2015-05-09
• Subjects: Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.12955
• Languages: English
• ISSNs: 1538-7933

Abstract

<abstract abstract-type="main" id="jth12955-abs-0001"> <title>Summary</title> <sec id="jth12955-sec-0001" sec-type="section"> <title>Background</title> <p>Recommendations for management of cancer‐related venous thromboembolism (VTE) in patients already receiving anticoagulant therapy are based on low‐quality evidence. This international registry sought to provide more information on outcomes after a breakthrough VTE in relation to anticoagulation strategies.</p> </sec> <sec id="jth12955-sec-0002" sec-type="section"> <title>Methods</title> <p>Patients with cancer and VTE despite anticoagulant therapy were reported to the registry. Data on treatments, VTE events, major bleeding, residual thrombosis symptoms and death were collected for the following 3 months. Breakthrough VTE and subsequent recurrences were objectively verified. Outcomes with different treatment strategies were compared with Cox proportional hazards regression.</p> </sec> <sec id="jth12955-sec-0003" sec-type="section"> <title>Results</title> <p>We registered 212 patients with breakthrough VTE. Of those, 59% had adenocarcinoma and 73% had known metastases. At the time of the breakthrough event, 70% were on low‐molecular‐weight heparin (LMWH) and 27% on a vitamin K antagonist (VKA); 70% had a therapeutic or supratherapeutic dose. After breakthrough the regimen was: unchanged therapeutic dose in 33%, dose increased in 31%, switched to another drug in 24%; and other management in 11%. During the following 3 months 11% had another VTE, 8% had major bleeding and 27% died. Of the survivors, 74% had residual thrombosis symptoms. Additional VTE recurrence was less common with LMWH than with a VKA (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.11–0.70) but similar with unchanged or increased anticoagulant intensity (HR, 1.09; 95% CI, 0.45–2.63). The bleeding rate did not increase significantly with dose escalation.</p> </sec> <sec id="jth12955-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Morbidity and mortality are high after recurrence of cancer‐related VTE despite anticoagulation. Further treatment appears to be more effective with LMWH than with a VKA.</p> </sec> </abstract>