Anticoagulation practice of cancer-associated thrombosis in the outpatient sector of Germany

Objective Venous thromboses involving deep or superficial veins are bothrelevant complications in cancer patients with serious consequences on quality of life and prognosis. In difference to common venous thromboses, low molecular weight heparins (LMWH) until very recently were the recommended treatment for at least 3 to 6 months in cancer patients. But little is known about the reality of care for these patients in the outpatient sector of Germany with regard to compliance with contemporary guidelines and drug label.

Material and Methods We analysed anonymized data from 4.1 million statutory insured patients during a four year period (2012-2015). Cancer patients with newly diagnosed thrombosis and anticoagulation in the outpatient sector were identified and descriptively evaluated in the course of the three following quarters with the main focus on anticoagulant drug use.

Results 7,313 cancer patients with newly coded thrombosis (ICD-10:I80*) and an outpatient prescription of an anticoagulant were evaluated. More than 80 % of the anticoagulant prescriptions were made by general practitioners, close to 10 % by oncologists and less than 5 % by other physicians. 57 % of patients were anticoagulated dominantly (> 50 % of the time) with different LMWH, 24 % with vitamin K antagonists (VKA) and 17 % with direct oral anticoagulants (DOAC). Within the LMWHs the relative frequency of the different brands reflects the overall market distribution of that time, with less than 3 % of patients treated dominantly with dalteparin, the only LMWH explicitly approved for longterm use in cancer patients during that period. Anticoagulant drugs were prescribed for an average of 4.5 months. LMWH had a significantly longer prescription period (90 - 135 days) than VKA (53 days) or DOAK (47 days). Gastrointestinal bleeding in conjunction with hospitalization as an indicator of bleeding frequency durung anticoagulation therapy was documented in 1.76 % of patients with a range of 1.3%-3 % for the different LMWHs.

Conclusion The prescription practice documented with this representative and comprehensive evaluation demonstrates an anticoagulation duration in adherence to the guidelines. But more than 40 % of the patients were dominantly treated with oral anticoagulant drugs. Thus the prescription choice of the respective anticoagulant drug was largely not in compliance with the approved label or contemporary guidelines.

Publication History

Article published online:
18 June 2021