Treatment of venous thromboembolism in patients with cancer: Subgroup analysis of the Matisse clinical trials

Frederiek F. van Doormaal; Gary E. Raskob; Bruce L. Davidson; Hervé Decousus; Alexander Gallus; Anthie W. A. Lensing; Franco Piovella; Martin H. Prins; Harry R. Büller

doi:10.1160/TH08-09-0563

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2009; 101(04): 762-769
DOI: 10.1160/TH08-09-0563

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Treatment of venous thromboembolism in patients with cancer: Subgroup analysis of the Matisse clinical trials

Frederiek F. van Doormaal

¹Academic Medical Center, Amsterdam, The Netherlands

,

Gary E. Raskob

²University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA

,

Bruce L. Davidson

³University of Washington School of Medicine, Seattle, Washington, USA

,

Hervé Decousus

⁴Hospital de Bellevue, St-Etienne, France

,

Alexander Gallus

⁵Flinders Medical Center, Adelaide, South Australia, Australia

,

Anthie W. A. Lensing

⁶Academic Medical Center, Amsterdam, The Netherlands

,

Franco Piovella

⁷U.O. Malattie Tromboemboliche, IRCCS Policlinico San Matteo, Pavia, Italy

,

Martin H. Prins

⁸University Hospital of Maastricht, Maastricht, The Netherlands

,

Harry R. Büller

⁹Academic Medical Center, Amsterdam, The Netherlands

› Author Affiliations

Abstract

Summary

In the initial treatment of venous thromboembolism (VTE) fondaparinux, a pentasaccharide, is a good alternative to heparin. Whether this is also true for cancer patients is unknown. We performed two post-hoc analyses of two randomized studies to compare efficacy, safety and overall survival of fondaparinux to standard initial (low-molecular-weight) heparin (LMWH) treatment in cancer patients with venous thromboembolism. Two hundred thirty-seven cancer patients with deep venous thrombosis (DVT) were initially treated with fondaparinux or enoxaparin. Two hundred forty cancer patients with pulmonary embolism (PE) received fondaparinux or unfractionated heparin. The initial treatment was followed by vitamin K antagonists. In DVT patients, the three-month recurrence rate was 5.4% in the enoxaparin recipients compared to 12.7% in those treated with fondaparinux [absolute difference 7.3%, 95% CI 0.1, 14.5]. A recurrence was observed in 8.9% of the PE patients treated with fondaparinux compared to 17.2% in the unfractionated heparin recipients [absolute difference –8.3, 95% CI –16.7, 0.1]. In both studies no difference in bleeding and overall survival was observed. Regarding overall survival and bleeding fondaparinux is comparable to enoxaparin and unfractionated heparin in cancer patients. No significant differences in recurrent VTE were observed when comparing fondaparinux with unfractionated or LMWH. Because of study limitations these results should be considered hypothesis-generating.

Keywords

Venous thromboembolism - cancer - anticoagulants - heparin - pentasaccharides

Full Text

References

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