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Am J Med. 2018 Apr;131(4):430-437. doi: 10.1016/j.amjmed.2017.11.042. Epub 2017 Dec 20.

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

Collaborators (146)

Aibar MA11, Arcelus JI11, Ballaz A11, Barba R11, Barrón M11, Barrón-Andrés B11, Bascuñana J11, Blanco-Molina A11, Bueso T11, Calvo B11, Cañada G11, Cañas I11, Casado I11, Culla A11, de Miguel J11, Del Toro J11, Díaz-Peromingo JA11, Falgá C11, Fernández-Capitán C11, Font C11, Font L11, Gallego P11, García-Bragado F11, Gómez V11, González J11, Grau E11, Guil M11, Guirado L11, Gutiérrez J11, Hernández G11, Hernández-Blasco L11, Isern V11, Jara-Palomares L11, Jaras MJ11, Jiménez D11, Lacruz B11, Lecumberri R11, Lobo JL11, López-Jiménez L11, López-Reyes R11, López-Sáez JB11, Lorente MA11, Lorenzo A11, Madridano O11, Maestre A11, Manrique-Abos I11, Marchena PJ11, Martín-Antorán JM11, Martín-Martos F11, Monreal M11, Morales MV11, Morillo R11, Nauffal D11, Nieto JA11, Nieto S11, Núñez MJ11, Odriozola M11, Otalora S11, Otero R11, Pagán B11, Pedrajas JM11, Pérez C11, Peris ML11, Pons I11, Porras JA11, Ramirez L11, Riera A11, Rivas A11, Rodríguez C11, Rodríguez-Dávila MA11, Rosa V11, Ruiz-Giménez N11, Sampériz A11, Sánchez R11, Sala MC11, Sahuquillo JC11, Sanz O11, Soler S11, Suárez-González I11, Suriñach JM11, Tiberio G11, Tolosa C11, Trujillo-Santos J11, Uresandi F11, Valero B11, Valle R11, Vela J11, Vicente MP11, Vidal G11, Vilella-Tomás V11, Villalta J11, Malfante PC12, Vanassche T13, Verhamme P13, Wells P14, Hirmerova J15, Malý R15, Tomko T15, Celis G16, Salgado E16, Sánchez GT16, Bertoletti L17, Bura-Riviere A17, Farge-Bancel D17, Hij A17, Mahé I17, Merah A17, Quere I17, Papadakis M18, Braester A19, Brenner B19, Tzoran I19, Apollonio A20, Barillari G20, Bertone A20, Bilora F20, Bucherini E20, Candelero G20, Ciammaichella M20, Di Micco P20, Ferrazzi P20, Grandone E20, Lessiani G20, Lodigiani C20, Mastroiacovo D20, Pace F20, Pesavento R20, Pinelli M20, Prandoni P20, Rosa M20, Rota L20, Tiraferri E20, Tonello D20, Tufano A20, Venturelli U20, Visonà A20, Zalunardo B20, Drucka E21, Kigitovica D21, Skride A21, Sousa MS22, Bosevski M23, Zdraveska M23, Bounameaux H24, Mazzolai L24, Serrano JC25.

Author information

1
Department of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: chatree.chai-adisaksopha@medportal.ca.
2
Department of Medicine, McMaster University, Hamilton, ON, Canada.
3
Department of Pneumonology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
4
Intensive Care Unit, Hospital Clínica La Merced, Quito, Ecuador.
5
PHI University Clinic of Pulmology and Allergy Skopje, University Clinic of Pulmonology and Allergy, Skopje, Macedonia.
6
Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain.
7
Department of Internal Medicine, Hospital General Virgen de la Luz, Cuenca, Spain.
8
Department of Internal Medicine, Ospedale S. Maria della Misericordia, Udine, Italy.
9
Department of Médecine et Thérapeutique, Hôpital Nord-CHU St-Etienne, Saint-Etienne, France.
10
Department of Internal Medicine, Hospital Universitari Germans Trias I Pujol, Universidad Católica de Murcia, Barcelona, Spain.
11
Spain.
12
Argentina.
13
Belgium.
14
Canada.
15
Czech Republic.
16
Ecuador.
17
France.
18
Greece.
19
Israel.
20
Italy.
21
Latvia.
22
Portugal.
23
Macedonia.
24
Switzerland.
25
Venezuela.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.

KEYWORDS:

Anticoagulants; Cancer; Low-molecular-weight heparin; Thromboembolism; Warfarin

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