Renal Impairment, Recurrent Venous Thromboembolism and Bleeding in Cancer Patients with Acute Venous Thromboembolism—Analysis of the CATCH Study

Rupert Bauersachs; Agnes Y. Y. Lee; Pieter W. Kamphuisen; Guy Meyer; Mette S. Janas; Mikala F. Jarner; Alok A. Khorana; on behalf of the CATCH Investigators

doi:10.1055/s-0038-1641150

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2018; 118(05): 914-921
DOI: 10.1055/s-0038-1641150

Stroke, Systemic or Venous Thromboembolism

Schattauer GmbH Stuttgart

Renal Impairment, Recurrent Venous Thromboembolism and Bleeding in Cancer Patients with Acute Venous Thromboembolism—Analysis of the CATCH Study

Rupert Bauersachs

¹Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany

²Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany

,

Agnes Y. Y. Lee

³Division of Hematology, University of British Columbia and British Columbia Cancer Agency, Vancouver, Canada

,

Pieter W. Kamphuisen

⁴Department of Internal Medicine, Tergooi, Hilversum, and Vascular Medicine, University Medical Center Groningen, Groningen, The Netherlands

,

Guy Meyer

⁵Respiratory Unit, Hospital European Georges Pompidou, Assistance Publique-Hopitaux de Paris, and Université Paris Descartes, Sorbonne Paris Cité, Paris, France

,

Mette S. Janas

⁶LEO Pharma, Ballerup, Denmark

,

Mikala F. Jarner

⁶LEO Pharma, Ballerup, Denmark

,

Alok A. Khorana

⁷Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States

,

on behalf of the CATCH Investigators

› Author Affiliations

Abstract

Objective This article assesses the impact of renal impairment (RI) on the efficacy and safety of anticoagulation in patients with cancer-associated thrombosis from the Comparison of Acute Treatments in Cancer Hemostasis (CATCH) study (NCT01130025).

Materials and Methods Renal function was assessed using the Modification of Diet in Renal Disease equation in patients with cancer-associated thrombosis who received either tinzaparin (175 IU/kg) once daily or warfarin for 6 months, in an open-label, randomized, multi-centre trial with blinded adjudication of outcomes. Associations between baseline RI (glomerular filtration rate [GFR] <60 mL/min/1.73m²) and recurrent symptomatic or incidental venous thromboembolism (VTE), clinically relevant bleeding (CRB), major bleeding and death were assessed using Fisher's exact test.

Results Baseline-centralized GFR data were available for 864 patients (96% of study population). RI was found in 131 patients (15%; n = 69 tinzaparin). Recurrent VTE occurred in 14% of patients with and 8% of patients without RI (relative risk [RR] 1.74; 95% confidence interval [CI] 1.06, 2.85), CRB in 19% and 14%, respectively (RR 1.33; 95% CI 0.90, 1.98), major bleeding in 6.1% and 2.0%, respectively (RR 2.98; 95% CI 1.29, 6.90) and mortality rate was 40% and 34%, respectively (RR 1.20; 95% CI 0.94, 1.53). Patients with RI on tinzaparin showed no difference in recurrent VTE, CRB, major bleeding or mortality rates versus those on warfarin.

Conclusion RI in patients with cancer-associated thrombosis on anticoagulation was associated with a statistically significant increase in recurrent VTE and major bleeding, but no significant increase in CRB or mortality. No differences were observed between long-term tinzaparin therapy and warfarin.

Keywords

cancer-associated thrombosis - recurrent venous thromboembolism - renal impairment - anticoagulation - tinzaparin

Full Text

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Supplementary Material