Recurrent venous thromboembolism in anticoagulated patients with cancer – management and short-term prognosis.

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Recurrent venous thromboembolism in anticoagulated patients with cancer - management and short-term prognosis.

J Thromb Haemost. 2015 Apr 7;

Authors: Schulman S, Zondag M, Linkins L, Pasca S, Cheung YW, 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 TL, Lee A

BACKGROUND: 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), 27% on a vitamin K antagonist (VKA); 70% had a therapeutic or supratherapeutic dose. After breakthrough the regimen was unchanged therapeutic in 33%, dose increased in 31%, switched to another drug in 24% and other management in 11%. During the 3 following 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 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). Bleeding rate did not increase significantly with dose escalation.
CONCLUSION: Morbidity and mortality is high after cancer-related VTE recurrence despite anticoagulation. Further treatment appears more effective with LMWH than with VKA. This article is protected by copyright. All rights reserved.

PMID: 25851122 [PubMed - as supplied by publisher]

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