LMWH or DOACs for cancer associated thrombosis (CAT) in daily clinical practice ? – Insights from the GECAT registry

Objective National and international guidelines for the diagnosis and treatment of venous thromboembolism (VTE) recommend anticoagulation treatment for 3 to 6 months with preference for direct oral anticoagulants DOACs and a re-evaluation for resumption depending on the individual risk of every patient. In cancer associated VTE (CAT) however, low molecular weight heparin (LMWH) was the guideline recommended treatment until recently. The prospective German Evaluation of CAT (GECAT) registry investigated the anticoagulation practice within the Berlin region.

Material and Methods The GECAT registry was set up for Berlin´s two main hospital companies Charité-Universitaetsmedizin Berlin and Vivantes (covering about 50 % of the hospital beds in Berlin) to document prospectively in-hospital newly diagnosed VTE in patients (pts) with active cancer. A follow-up of these pts was scheduled after 3 and 6 months per telephone interview. Major points of interest were the kind of initial and follow-up anticoagulation as well as the treatment-leading physicians.

Results Between May 2015 and May 2017, 382 pts with active cancer and newly diagnosed VTE were identified. Initially, the majority of pts,n = 334 (87,4 %) was treated with LMWH and 22 pts (5,8 %) with DOACs. Close to discharge from hospital data were available from 364 pts, 281 pts (77.2 %) remained on LMWH and 47 pts (12,9 %) received DOACs. After 3 months out of 251 evaluable pts, 154 pts (61.4 %) received LMWH and 60 pts (23.9 %) DOACs, 29 pts (11.6 %) stopped anticoagulation. From 208 evaluable pts after 6 months 81 pts (38.9 %) received LMWH, 72 pts (34.6 %) DOACs and 48 pts (23.1 %) were without anticoagulation.

LMWH administered once daily was prescribed more often than LMWH administered twice daily in the ambulant setting (at discharge 28.8 % of LMWH-prescriptions,after 6 months 51.9 %). In most cases (71.1 %) the oncologist was responsible for the treatment followed by the general practitioner (32 %) and other physicians (3.5 %). Oncologists more often prescribed LMWH.

Conclusion In compliance with the guidelines most pts with CAT were anticoagulated for 3 to 6 months. They were mainly followed by oncologists who determined the kind and length of anticoagulation treatment without strict adherence to guideline recommendations. LMWH was prescribed more often by oncologists in comparison to general practitioners and the once daily administration was preferred.

Publication History

Article published online:
18 June 2021