Use of direct oral anticoagulants and low molecular weight heparin in venous thromboembolism associated with cancer: real-world evidence in Argentina

ABSTRACT

Background

Venous thromboembolism (VTE) and major bleeding (MB) are common in cancer patients. Reduced-doses of antithrombotics as secondary prophylaxis have limited data. This work aims to describe and to compare treatments and outcomes for cancer-associated VTE.

Research design and methods

Retrospective study. Adults with cancer-associated VTE were included. After 3–6 months of full-doses of anticoagulants, three strategies were considered: A) lowering the doses; B) maintaining full-doses; C) stopping treatment. The strategy and medication used were shown in a descriptive analysis and the rate of bleeding and VTE-recurrence between those in a comparative analysis.

Results

A total of 420 patients were included, 56.2% received DOACs, 43.8% enoxaparin. Strategy was defined in 257 patients: A (50.2%), B (46.3%), and C (3.5%). Forty-one (9.8%) had VTE-recurrence and 15 (3.6%) had MB or clinically relevant non-major bleeding (CRNMB).

According to strategy, recurrent-VTE was 8.5% (A), 4.2% (B), and 11.1 (C) (p = 0.22), MB or CRNMB was 0.8% (A), 1.7% (B), and 0% (C) (p = 0.64).

Conclusions

DOACs and strategy A were the most frequently used agent and strategy, respectively. There were no differences between medications or strategies used. The results must be interpreted with caution, and it is a retrospective single-center study, probably with information and selection bias.

Keywords:

• Thrombosis
• cancer
• cancer associated thrombosis
• anticoagulation
• direct oral anticoagulant
• enoxaparin thromboembolism
• venous thromboembolism
• deep vein thrombosis
• pulmonary thromboembolism

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Acknowledgments

The authors would like to thank Juan Cicco and María Victoria Ortuño for their contributions in analysis and interpretation of data, and Mariana Fabiano for her assistance in English.

Author contributions

Conception and design: Clavijo MM, Ruiz JI. Analysis and interpretation of the data: Clavijo MM, Ruiz JI. Drafting of the paper: Clavijo MM, Ruiz JI. Revising it critically for intellectual content: Clavijo MM, Ruiz JI, Muñoz C, Vicente Reparaz M de los A, Acuña MA, Casali CE, Aizpurua MF, Mahuad CV, Zerga ME, Ventura A, Garate GM. Final approval of the version to be published: Clavijo MM, Ruiz JI, Garate GM. All authors agree to be accountable for all aspects of the work.

Additional information

Funding

This study was supported by Pfizer through an Investigator Sponsored Research grant (grant number ID: 63970407).