Cohort study on the management of cancer-associated venous thromboembolism aimed at the safety of stopping anticoagulant therapy in patients cured from cancer.
Chest. 2016 Jan 13;
Authors: van der Hulle T, den Exter PL, van den Hoven P, van der Hoeven JJ, van der Meer FJ, Eikenboom J, Huisman MV, Klok FA
INTRODUCTION: After diagnosis of cancer-associated venous thromboembolism (VTE), guidelines recommend to consider continuing anticoagulant treatment until patients are cured from cancer, although the safety of stopping anticoagulant treatment after cancer is cured has never been evaluated.
METHODS: Cohort study in consecutive patients diagnosed with cancer-associated VTE at the Leiden University Medical Center between January 2001 and January 2010 followed for the effect of cancer treatment, occurrence of recurrent VTE, major haemorrhage and death.
RESULTS: Of the 358 patients diagnosed with cancer-associated VTE, anticoagulant treatment was continued until death in 207 patients. In another 12 patients anticoagulant treatment was continued because of an alternative indication despite cure from cancer. Anticoagulant treatment was stopped in 50 patients for reasons other than major haemorrhage despite active cancer, in 21 patients after major haemorrhage, and in 68 patients after cure from cancer. Among these 68 patients, 10 patients were diagnosed with symptomatic recurrent VTE during a cumulative follow-up of 311 years resulting in an incidence rate (IR) of 3.2/100 PY (95%CI 1.5-5.9). Seven out of these 10 patients with recurrent VTE were also diagnosed with a cancer relapse during follow-up. In the 50 patients who stopped anticoagulant treatment despite active cancer the recurrent VTE IR was 19 per 100 PY (11 events during 59 years of follow-up; 95%CI 9.3-33).
CONCLUSIONS: Our data support the recommendation to stop anticoagulant treatment for cancer-associated VTE in patients cured from cancer. A cancer relapse seems to be a strong risk factor for recurrent symptomatic VTE.
PMID: 26836911 [PubMed - as supplied by publisher]