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Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in Cancer Patients with Venous Thromboembolism

2017; Elsevier BV; Volume: 131; Issue: 4 Linguagem: Inglês

10.1016/j.amjmed.2017.11.042

1555-7162

Chatree Chai‐Adisaksopha, Alfonso Iorio, Mark Crowther, Javier de Miguel‐Díez, E. Salgado, Marija Zdraveska, Carmen Fernández‐Capitán, José Antonio Nieto, Giovanni Barillari, Laurent Bertoletti, Manuel Monréal, M.A. Aibar, J.I. Arcelus, Aitor Ballaz, Raquel Barba, M. Barrón, B. Barrón‐Andrés, José Bascuñana, Á. Blanco-Molina, Tulio Bueso, Begoña Calvo, G. Cañada, I. Cañas, I. Casado, Alex Culla, Javier de Miguel‐Díez, J. del Toro, J.A. Díaz‐Peromingo, C. Falgá, Carmen Fernández‐Capitán, Carme Font, Llorenç Font, P. Gallego, F García‐Bragado, Vicente Gómez del Olmo, J. González, E Grau, María J. Guil, L. Guirado, Juan Mata, Giselle Riquelme Hernández, Luis Blasco, V. Isern, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, B. Lacruz, Ramón Lecumberri, J.L. Lobo, Luciano López-Jiménez, Raquel López-Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, Olga Madridano, Ana M. Maestre, I. Manrique-Abos, P.J. Marchena, J.M. Martín‐Antorán, F. Martín‐Martos, Manuel Monréal, M.V. Morales, Raquel Morillo, D. Nauffal, José Antonio Nieto, Santiago Nieto, M.J. Núñez, M. Odriozola, S. Otálora, Remedios Otero, B. Pagán, José María Pedrajas, Cecilia E González Pérez, M.L. Peris, I. Pons, José Antonio Porras, Luz Margarita Ramirez, Antoni Riéra, A. Rivas, C. Rodríguez, M.A. Rodríguez‐Dávila, V. Rosa, N. Ruiz‐Giménez, A. Sampériz, Rosario Sánchez‐Martínez, M.C. Sala, Joan Carles Sahuquillo, O. Sanz, S. Soler, I. Suárez-González, J.M. Suriñach, G Tiberio, Carles Tolosa, J. Trujillo-Santos, Fernando Uresandi, B. Valero, R. Valle, J. Vela, M.P. Vicente, G. Vidal, V. Vilella-Tomás, J Villalta, Pablo Malfante, Thomas Vanassche, Peter Verhamme, Philip Wells, Jana Hirmerová, Radován Malý, T. Tomko, Geert Celis, E. Salgado, G.T. Sánchez, Laurent Bertoletti, A. Bura-Rivière, Dominique Farge, A. Hij, I. Mahé, A. Merah, I. Quéré, Marios Papadakis, Andrei Braester, Benjamin Brenner, Inna Tzoran, A. Apollonio, Giovanni Barillari, A. Bertone, Franca Bilora, Eugenio Bucherini, G Candelero, Maurizio Ciammaichella, P. Di Micco, Paola Ferrazzi, Elvira Grandone, Gianfranco Lessiani, Corrado Lodigiani, Daniela Mastroiacovo, F. Pace, Raffaele Pesavento, Massimiliano Pinelli, Paolo Prandoni, M. Rosa, L. Rota, Eros Tiraferri, D. Tonello, Antonella Tufano, U. Venturelli, A. Visonà, Beniamino Zalunardo, Eva Dručka, Dana Kigitoviča, Andris Skride, Mariana S. Sousa, Marijan Bosevski, Marija Zdraveska, Henri Bounameaux, Lucia Mazzolai, Juan Carlos Serrano,

Central Venous Catheters and Hemodialysis

Low-molecular-weight heparin (LMWH) is the treatment of choice in cancer patients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty.We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry to compare the rate of venous thromboembolism recurrences and major bleeding appearing beyond the first 6 months of anticoagulant therapy in cancer patients with venous thromboembolism, according to therapy with LMWH or vitamin K antagonists (VKA). We performed a propensity score-matched cohort study.After propensity matching, 482 cancer patients continued to receive LMWH and 482 switched to VKA. During the course of anticoagulant therapy (mean 275.5 days), 57 patients developed venous thrombosis recurrences (recurrent pulmonary embolism 26, recurrent deep vein thrombosis 29, both 2), 28 had major bleeding, 38 had nonmajor bleeding, and 129 died. No patient died of recurrent venous thrombosis, and 5 patients died of bleeding (2 were on LMWH, 3 on VKA). Patients who continued with LMWH had a similar rate of deep vein thrombosis recurrences (relative risk [RR] 1.41; 95% confidence interval [CI], 0.68-2.93), pulmonary embolism recurrences (RR 0.73; 95% CI, 0.34-1.58), major bleeding (RR 0.96; 95% CI, 0.51-1.79), or nonmajor bleeding (RR 1.15; 95% CI, 0.55-2.40), compared with those who switched to VKA, but a higher mortality rate (RR 1.58; 95% CI, 1.13-2.20).In cancer patients with venous thromboembolism who completed 6 months of LMWH therapy, switching to VKA was associated with a similar risk of venous thrombosis recurrences or bleeding when compared with patients who continued LMWH.