Low molecular heparin for cancer-associated venous thromboembolism – still the “CATCH of the day“?

A. Matzdorff

doi:10.12687/phleb2279-5-2015

Phlebologie, Inhaltsverzeichnis

Phlebologie 2015; 44(05): 256-260
DOI: 10.12687/phleb2279-5-2015

Review article

Schattauer GmbH

Niedermolekulares Heparin bei Tumor-assoziierter venöser Thromboembolie – immer noch „CATCH of the day“?

Artikel in mehreren Sprachen: English | deutsch

A. Matzdorff

¹Asklepios Klinik Uckermark, Schwedt, Germany

› Institutsangaben

Abstract

Zusammenfassung

Im Dezember 2014 wurde auf dem Jahreskongress der American Society of Hematology die CATCH-Studie vorgestellt. Sie vergleicht die Gabe des niedermolekularen Heparins Tinzaparin mit dem Vitamin-K-Antagonisten Warfarin in der 6-monatigen Lang-zeittherapie (Sekundärprophylaxe) nach Tumor-assoziierter venöser Thrombose oder Lungenembolie (VTE). Die Studie zeigt, dass 6,9 % der mit Tinzaparin behandelten und 10 % der Warfarin-Patienten eine symptomatische und/oder asymptomatische RezidivThromboembolie entwickelten. Der Unterschied war statistisch nicht signifikant. Wenn man jedoch nur die symptomatischen Thromboembolie-Rezidive betrachtet, war Tinzaparin sogar signifikant besser. Blutungen waren mit Tinzaparin auch nicht häufiger, so genannte nicht-schwerwiegende, aber klinisch relevante Blutungen sogar signifikant seltener. Die CATCH-Studie ist die bisher größte Studie zur Frage der Langzeitantikoagulation nach Tumor-assoziierter VTE. Sie bestätigt die Empfehlung der Fachgesellschaften, dass niedermolekulare Heparine in der Sekundärprophylaxe bei Tumorpatienten mit venöser Thromboembolie den Vitamin-K-Antagonisten vorgezogen werden sollten.

Schlüsselwörter

Tumor-assoziierte Thromboembolie - CATCH - Tinzaparin - NMH

Volltext

Referenzen

References
1 http://www.krebsdaten.de/Krebs/DE/Content/Kreb/sarten/Krebs_gesamt/krebs_gesamt_node.html (abgefragt 1.8.15)
2 Krebs in Deutschland 2009/2010. 9. Ausgabe. Robert Koch-Institut (Hrsg) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg). Berlin, 2013
3 Ahmad AS, Ormiston-Smith N, Sasieni PD. Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960. Br J Cancer 2015; 112: 943-947.
4 Khorana AA, Kuderer NM, Culakova E. et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008; 111: 4902-4907.
5 Carrier M, Khorana AA, Moretto P. et al. Lack of evidence to support thromboprophylaxis in hospitalized medical patients with cancer. Am J Med 2014; 127: 82-86.
6 Falanga A, Zacharski L. Deep vein thrombosis in cancer: the scale of the problem and approaches to management. Ann Oncol 2005; 16: 696-701.
7 Heit JA, Silverstein MD, Mohr DN. et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160: 809-815.
8 Gil-Bernabé A, Lucotti S, Muschel RJ. Coagulation and metastasis: what does the experimental literature tell us?. Br J Haematol 2013; 162: 433-441.
9 Lin RJ, Afshar-Kharghan V, Schafer AI. Paraneo-plastic thrombocytosis: the secrets of tumor self-promotion. Blood 2014; 124: 184-187.
10 Kroll MH, Pemmaraju N, Oo TH. et al. Mortality from Cancer-Associated Venous Thromboembolism. Blood 2014; 124: Abstr. #4829.
11 Khorana AA, Francis CW, Culakova E. et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5: 632-634.
12 Kuderer NM, Dale DC, Crawford J. et al. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006; 106: 2258-2266.
13 Farge D, Debourdeau P, Beckers M. et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost 2013; 11: 56-70.
14 Lyman GH, Khorana AA, Kuderer NM. et al; American Society of Clinical Oncology Clinical Practice Guideline.. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2013; 31: 2189-2204.
15 Lyman GH, Bohlke K, Khorana AA. et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014. J Clin Oncol 2015; 33: 654-656.
16 NCCN Clinical Practice Guidelines in Oncology.. Cancer-associated venous thromboembolic disease. Version 1/2014 www.nccn.org (abgefragt 1.8.15)
17 Hull RD, Pineo GF, Brant RF. et al; LITE Trial Investigators.. Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. Am J Med 2006; 119: 1062-1072.
18 Meyer G, Marjanovic Z, Valcke J. et al. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 2002; 162: 1729-1735.
19 Lee AY, Levine MN, Baker RI. et al. Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators: Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349: 146-153.
20 Deitcher SR, Kessler CM, Merli G. et al; ONCE-NOX Investigators.. Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost 2006; 12: 389-396.
21 Kakkar AK, Levine M, Pinedo HM. et al. Venous thrombosis in cancer patients: insights from the FRONTLINE survey. Oncologist 2003; 8: 381-388.
22 Wittkowsky AK. Barriers to the long-term use of low-molecular weight heparins for treatment of cancer-associated thrombosis. J Thromb Haemost 2006; 4: 2090-2091.
23 Imberti D, Agnelli G, Ageno W. et al.; MASTER Investigators.. Clinical characteristics and management of cancer-associated acute venous thromboembolism: findings from the MASTER Registry. Haematologica 2008; 93: 273-278.
24 Spirk D, Ugi J, Korte W. et al. Long-term anticoagulation treatment for acute venous thromboembolism in patients with and without cancer. The SWIss Venous ThromboEmbolism Registry (SWIVTER) II. Thromb Haemost 2011; 105: 962-967.
25 Delate T, Witt DM, Ritzwoller D. et al. Outpatient use of low molecular weight heparin monotherapy for first-line treatment of venous thromboembolism in advanced cancer. Oncologist 2012; 17: 419-427.
26 Marchena PJ, Nieto JA, Guil M. et al. RIETE Investigators.. Long-term therapy with low-molecular-weight heparin in cancer patients with venous thromboembolism. Thromb Haemost 2012; 107: 37-43.
27 Belhadj Chaidi R, Thollot C. et al. Adherence to guidelines for the treatment of venous thromboembolism in cancer patients: a retrospective analysis of 145 cases. [Article in French]. J Mal Vasc 2013; 38: 185-192.
28 Kleinjan A, Hutten B, Di Nisio M. et al. Anticoagulant treatment of cancer patients with pulmonary embolism in the real world. Actual use of low-molecular-weight heparin in cancer. Neth J Med 2014; 72: 467-472.
29 Rahme E, Feugère G, Sirois C. et al. Anticoagulant use in patients with cancer-associated venous thromboembolism: a retrospective cohort study. Thromb Res 2013; 131: 210-217.
30 Sevestre MA, Belizna C, Durant C. et al.; Carmen Investigators for the Groupe Francophone Thrombose et Cancer (GFTC).. Compliance with recommendations of clinical practice in the management of venous thromboembolism in cancer: the CARMEN study. J Mal Vasc 2014; 39: 161-168.
31 Caprini JA, Tapson VF, Hyers TM. et al.; NABOR Steering Committee.. Treatment of venous thromboembolism: adherence to guidelines and impact of physician knowledge, attitudes, and beliefs. J Vasc Surg 2005; 42: 726-733.
32 Schellong SM, Gerlach H, Hach-Wunderle V. et al. Diagnosis of deep-vein thrombosis: adherence to guidelines and outcomes in real-world health care. Thromb Haemost 2009; 102: 1234-1240.
33 Kakkar AK, Levine M, Pinedo HM. et al. Venous thrombosis in cancer patients: insights from the FRONTLINE survey. Oncologist 2003; 8: 381-388.
34 Francis CW, Kessler CM, Goldhaber SZ. et al. Treatment of venous thromboembolism in cancer patients with dalteparin for up to 12 months: the DALTECAN Study. J Thromb Haemost 2105 13: 1028-1035.
35 Farge D, Debourdeau P, Gorin NC. et al. Long-Term Use of Low-Molecular-Weight Heparins (LMWH) for Cancer-Associated Venous Thromboembolism (VTE): Patients’ Perception in Tro-pique, a Prospective, Multicenter, Observational Study. Blood 2014; 124: Abstr. #4272.
36 Lee AYY, Kamphuisen PW, Meyer G. et al.; for the CATCH–Investigators.. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer. A randomized clinical trial. JAMA 2015; 314: 677-686.
37 Kamphuisen PW, Lee AYY, Meyer G. et al. on behalf of the CATCH Investigators.. Characteristics and risk factors of major and clinically relevant non-major bleeding in cancer patients receiving anticoagulant treatment for acute venous thromboembolism – the CATCH study. J Thromb Haemost 2015; 13 (Suppl. 02) 182 Abstr.#OR228.A