Long-term therapy with low-molecular-weight heparin in cancer patients with venous thromboembolism

Pablo Javier Marchena; José Antonio Nieto; María Guil; Ferrán García-Bragado; Ramón Rabuñal; Henri Boccalon; Javier Trujillo-Santos; Manuel Monreal; RIETE Investigators

doi:10.1160/TH11-06-0423

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2012; 107(01): 37-43
DOI: 10.1160/TH11-06-0423

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Long-term therapy with low-molecular-weight heparin in cancer patients with venous thromboembolism

Pablo Javier Marchena

¹Departamento de Medicina Interna y Urgencias, Parc Sanitari Sant Joan de Deu, Hospital General de Sant Boi, Spain

,

José Antonio Nieto

²Servicio de Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain

,

María Guil

³Servicio de Medicina Interna, Hospital de la Axarquía, Vélez, Málaga, Spain

,

Ferrán García-Bragado

⁴Servicio de Medicina Interna, Hospital de Girona Dr. Josep Trueta, Girona, Spain

,

Ramón Rabuñal

⁵Servicio de Medicina Interna, Complexo Hospitalario Xeral-Calde, Lugo, Spain

,

Henri Boccalon

⁶Department of Vascular Medicine, Hospital de Rangueil, Toulouse, France

,

Javier Trujillo-Santos

⁷Servicio de Medicina Interna, Hospital Santa Maria del Rosell, Cartagena, Spain

,

Manuel Monreal

⁸Servicio de Medicina Interna Hospital Universitari Germans Trias i Pujol, Badalona, Spain

,

RIETE Investigators

› Author Affiliations

Abstract

Summary

Long-term therapy with low-molecular-weight heparin (LMWH) is the treatment of choice for cancer patients with venous thromboembolism (VTE). However, the ideal doses of LMWH have not been thoroughly studied. We used the RIETE Registry data to assess the influence of the daily LMWH dosage on outcome during the first three months after VTE. We used propensity score-matching to compare patients who received <150 vs. those receiving ≥150 UI/kg/day LMWH. Up to July 2010, 3,222 cancer patients with VTE received long-term therapy with fixed doses of LMWH. Of these, 1,472 (46%) received <150 IU/kg/day (mean, 112 ± 28), and 1,750 received ≥150 IU/kg/day (mean, 184 ± 32). Results of the propensity score matching involved 1269 matched pairs. During follow-up, the incidence of pulmonary embolism (PE) recurrences was similar (1.2% vs. 1.9%), but patients receiving <150 IU/kg/day LMWH had a lower incidence of fatal PE than those treated with ≥150 IU/kg/day (0.2% vs. 1.0%; p=0.004). Multivariate analysis confirmed that patients receiving <150 IU/kg/day LMWH had a lower risk for fatal PE (odds ratio [OR]: 0.2; 95% confidence interval [CI]: 0.06–0.8) and for major bleeding (OR: 0.6; 95% CI: 0.3–1.0) than those treated with ≥150 IU/kg/day. In real life, one in every two cancer patients with VTE received lower doses of LMWH than those used in randomised trials, with large variations from patient to patient. Unexpectedly, patients treated with <150 IU/kg/day LMWH had fewer fatal PE cases and fewer major bleeding events than those receiving ≥150 IU/kg/day LMWH. This finding, however, should be validated in prospective clinical trials.

Keywords

Cancer - heparins - venous thrombosis - pulmonary embolism

Full Text

References

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