Enoxaparin for Long-Term Therapy of Venous Thromboembolism in Patients with Cancer and Renal Insufficiency

Patricia Sigüenza; Juan J. López-Núñez; Conxita Falgá; Covadonga Gómez-Cuervo; Antoni Riera-Mestre; Aída Gil-Díaz; Peter Verhamme; Ana Cristina Montenegro; Cristina Barbagelata; Egidio Imbalzano; Manuel Monreal; the RIETE Investigators

doi:10.1055/a-2191-7510

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2024; 124(04): 363-373
DOI: 10.1055/a-2191-7510

Stroke, Systemic or Venous Thromboembolism

Enoxaparin for Long-Term Therapy of Venous Thromboembolism in Patients with Cancer and Renal Insufficiency

Patricia Sigüenza

¹Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

²Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

,

Juan J. López-Núñez

¹Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

²Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

³Fundació Institut Germans Trias i Pujol, Badalona, Barcelona, Spain

,

Conxita Falgá

⁴Department of Internal Medicine, Hospital de Mataró, Spain

,

Covadonga Gómez-Cuervo

⁵Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain

,

Antoni Riera-Mestre

⁶Department of Internal Medicine, Hospital Universitari de Bellvitge, IDIBELL.L'Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, Spain

,

Aída Gil-Díaz

⁷Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain

⁸Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

,

Peter Verhamme

⁹Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium

,

Ana Cristina Montenegro

¹⁰Department of Vascular Medicine, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia

,

Cristina Barbagelata

¹¹Department of Internal Medicine, Hospital Universitario A Coruña, Coruña, Spain

,

Egidio Imbalzano

¹²Division of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

,

Manuel Monreal

¹³Faculty of Health Sciences, Universidad Católica San Antonio de Murcia, CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain

,

the RIETE Investigators

› Author Affiliations

Abstract

Background The optimal therapy of venous thromboembolism (VTE) in cancer patients with renal insufficiency (RI) is unknown. Current guidelines recommend to use low-molecular-weight heparin over direct oral anticoagulants to treat VTE in cancer patients at high risk of bleeding.

Methods We used the Registro Informatizado Enfermedad Tromboemb00F3lica (RIETE) registry to compare the 6-month incidence rates of (1) VTE recurrences versus major bleeding and (2) fatal pulmonary embolism (PE) versus fatal bleeding in three subgroups (those with mild, moderate, or severe RI) of cancer patients receiving enoxaparin monotherapy.

Results From January 2009 through June 2022, 2,844 patients with RI received enoxaparin for ≥6 months: 1,432 (50%) had mild RI, 1,168 (41%) moderate RI, and 244 (8.6%) had severe RI. Overall, 68, 62, and 12%, respectively, received the recommended doses. Among patients with mild RI, the rates of VTE recurrences versus major bleeding (4.6 vs. 5.4%) and fatal PE versus fatal bleeding (1.3 vs. 1.2%) were similar. Among patients with moderate RI, VTE recurrences were half as common as major bleeding (3.1 vs. 6.3%), but fatal PE and fatal bleeding were close (1.8 vs. 1.2%). Among patients with severe RI, VTE recurrences were threefold less common than major bleeding (4.1 vs. 13%), but fatal PE was threefold more frequent than fatal bleeding (2.5 vs. 0.8%). During the first 10 days, fatal PE was fivefold more common than fatal bleeding (2.1 vs. 0.4%).

Conclusion Among cancer patients with severe RI, fatal PE was fivefold more common than fatal bleeding. The recommended doses of enoxaparin in these patients should be revisited.

Keywords

venous thromboembolism - cancer - renal insufficiency - enoxaparin - pulmonary embolism

Full Text

References

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Supplementary Material

Supplementary Material