Low-molecular-weight-heparin versus a coumarin for the prevention of recurrent venous thromboembolism in high- and low-risk patients with active cancer: a post hoc analysis of the CLOT Study
| Autor: | Agnes Y.Y. Lee, Guillaume Feugère, Joseph Heissler, Seth Woodruff, Paula Abreu, Marc Carrier |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Dalteparin
Male medicine.medical_specialty medicine.drug_class Low molecular weight heparin Active cancer Hemorrhage 030204 cardiovascular system & hematology Gastroenterology Article Disease-Free Survival 03 medical and health sciences Anticoagulation 0302 clinical medicine Recurrent thromboembolism Coumarins Internal medicine Neoplasms Post-hoc analysis Medicine Humans 030212 general & internal medicine Aged business.industry Mortality rate Hazard ratio Bleeding Cancer Thrombosis Hematology Venous Thromboembolism Vitamin K antagonist Middle Aged medicine.disease Survival Rate Risk factors Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Thrombosis and Thrombolysis |
| ISSN: | 1573-742X 0929-5305 |
| Popis: | In patients with active cancer and acute venous thromboembolism (VTE), the low-molecular-weight-heparin (LMWH) dalteparin is more effective than vitamin K antagonist (VKA) in reducing the risk of recurrent venous thromboembolism (rVTE) without increasing the risk of bleeding. However, the relative benefit of LMWH versus VKA in patients with active cancer at high or low risk of rVTE and bleeding is unclear. This post hoc analysis used data from the CLOT study to explore the efficacy and safety of LMWH versus VKA in preventing recurrent thrombosis in high- and low-risk patients with active cancer. High-risk patients were defined by metastatic disease and/or antineoplastic treatment at baseline; low-risk patients presented with neither. Among high-risk patients, rVTE occurred in 25/318 (8%) (LMWH) versus 53/314 (17%) (VKA) (hazard ratio, 0.44; p = 0.001). No significant difference was detected in the rate of major or any bleeding. The 6-month mortality rate was 40% (LMWH) versus 41% (VKA). In low-risk patients, 2/20 (10%) (LMWH) had rVTE versus 0/24 (0%) (VKA) (hazard ratio, not estimable; p = 0.998). No significant difference was detected in the rate of major or any bleeding. The 6-month mortality rate was 20% (LMWH) versus 29% (VKA). In patients with cancer-associated thrombosis at high risk of rVTE and bleeding, the LMWH dalteparin was more effective than VKA in reducing the risk of rVTE without increasing the risk of bleeding. No difference in rate of rVTE or bleeding was observed between LMWH and VKA among low-risk patients. |
| Databáze: | OpenAIRE |
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