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. Methods: 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. Results: 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. Conclusion: 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.
Schulman, S., Zondag, M., Linkins, L., Pasca, S., Cheung, Y., de Sancho, M., et al. (2015). Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis. JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 13(6), 1010-1018 [10.1111/jth.12955].
|Citazione:||Schulman, S., Zondag, M., Linkins, L., Pasca, S., Cheung, Y., de Sancho, M., et al. (2015). Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis. JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 13(6), 1010-1018 [10.1111/jth.12955].|
|Tipo:||Articolo in rivista - Articolo scientifico|
|Carattere della pubblicazione:||Scientifica|
|Presenza di un coautore afferente ad Istituzioni straniere:||Si|
|Titolo:||Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis|
|Autori:||Schulman, S; Zondag, M; Linkins, L; Pasca, S; Cheung, Y; 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; Lee, A|
|Data di pubblicazione:||2015|
|Rivista:||JOURNAL OF THROMBOSIS AND HAEMOSTASIS|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1111/jth.12955|
|Appare nelle tipologie:||01 - Articolo su rivista|