Clinically relevant bleeding in cancer patients treated for venous thromboembolism from the CATCH study

Autor:	P.W. Kamphuisen, A.Y.Y. Lee, G. Meyer, R. Bauersachs, M.S. Janas, M.F. Jarner, A.A. Khorana, R. Bella Santiago, S. Cerana, J.J. Zarbá, J. Andel, C.H. Barrios, A. Borba Reiriz, F. Cesario, S. de Azevedo, A.F. Ferreira Filho, F.A. Franke, S. Padilha, R. Paiva Queiroz, A. Pimenta, J. Rerin, R. Rigo, S.B. van Eyll Rocha, G. Santos Borges, G. Vacaro, V. Anastasov, T. Dragneva, G. Georgiev, P. Champion, P. Kuruvilla, C. Gonzalez, P. Ditl, J. Förster, B. Lubomir, J. Vydra, R.A. El Hassan, S. Sabri, N. Allahloubi, A. Elzawawy, S.S. Ezzat, M.S. El Kady, L. Bacchus, J. Beyer‐Westendorf, U. Kamphausen, D. Niederwieser, H. Ostermann, M. Sosada, N. Anagnostopoulos, G. Fountzilas, C. Ioannou, C. Liapis, J.F.B. Schaeffer, S. Atilli, S. Balsubramanian, S. Bondarde, S.C. Desai, C. Deshmukh, D.P. Singh, F. Gharami, L. Goyal, S. Gupta, S. Gupte, K.K. Mukherjee, S. Krishnan, K. Kumar, A. Mehta, K. Mishra, R. Naik, S. Pawar, R.V. Nagarkar, N. Warrier, B. Brenner, I. Gavish, G. Lugassy, M. Kolin, B. Enrico, M.G. Mazzucconi, G. Visani, A. Awidi, N. Novikovs, J. Miscuks, D. Abigerges, F. Farhat, P. Khoueiry, J. Makarem, O. Alvarez Ordorica, E. Anaya Santacruz, G. Calderillo Ruiz, J.H. de la Concha Ureta, W.S.R. Pantigoso, M. Philco, A.R. Pineda, E.A.V. Queszada, K. Gawrychowski, W. Witkiewicz, E. Macias, E. Teixeira, T.‐E. Ciuleanu, C.C. Ligia, D. Lungulescu, I.G. Manolescu, A. Rodica, C. Volovat, Y. Burov, I. Katelnitsky, D. Svistov, K. Ahmad, F. Algahtani, H. Al‐Zahrani, M. Qari, D. Jovanovic, N. Milanovic, B. Perin, V. Stojanovic, L. Tomasic, J. Chovanec, O. Herman, V. Kissova, F. Sasvary, S. Špánik, M. Szentivanyi, F. Barón, E. Gallardo, D. Jiménez, O. Remedios, A. Sanchez, J. Engelbrecht, N. Jonas, G. McAdam, M. Patel, B. Rapoport, B. Robertson, D. Oh, H. Kim, H.‐K. Kim, H.J. Kim, H.S. Kim, J.S. Ahn, J. Chung, J. Jang, K.U. Park, S.‐W. Shin, S.H. Kim, S‐S. Yoon, Y.‐K. Kim, C.‐F. Chiu, C.‐S. Chang, J.‐H. Liu, K.‐M. Rau, S.‐W. Chen, S. Chittima, T. Ekkapong, K. Nonglak, A. Pantep, M. Pramook, S. Thanakrit, S. Patrapim, T. Sumitra, C. Udomluck, I. Kobza, O. Nykonenko, V. Prasol, I. Vladychuk
Přispěvatelé:	Cardiovascular Centre (CVC)
Jazyk:	angličtina
Rok vydání:	2018
Předmět:	Male medicine.medical_specialty anticoagulants Time Factors INTRACRANIAL HEMORRHAGE venous thromboembolism neoplasms BRAIN METASTASES Hemorrhage 030204 cardiovascular system & hematology Malignancy Risk Assessment ANTICOAGULANT TREATMENT 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Medicine Humans Prospective Studies THERAPEUTIC RANGE Aged COMPLICATIONS tinzaparin business.industry Incidence Hazard ratio RIETE REGISTRY Warfarin Cancer Hematology Tinzaparin MOLECULAR-WEIGHT HEPARIN Middle Aged medicine.disease bleeding Thrombosis Confidence interval Exact test WARFARIN PATIENTS Treatment Outcome 030220 oncology & carcinogenesis INTERNATIONAL NORMALIZED RATIO ATRIAL-FIBRILLATION Female Drug Monitoring business medicine.drug
Zdroj:	Journal of Thrombosis and Haemostasis, 16(6), 1069-1077. Wiley
ISSN:	1538-7933
Popis:	Essentials Cancer patients receiving anticoagulants for venous thromboembolism have an elevated bleeding risk. This secondary analysis of CATCH assessed characteristics of clinically relevant bleeding (CRB). CRB occurs in 15% of cancer patients with thrombosis using therapeutic doses of anticoagulation. After multivariate analysis, risk factors for CRB were age >75 years and intracranial malignancy. Summary Background Cancer patients with acute venous thromboembolism (VTE) receiving anticoagulant treatment have an increased bleeding risk. Objectives We performed a prespecified secondary analysis of the randomized, open-label, Phase III CATCH trial (NCT01130025) to assess the rate and sites of and the risk factors for clinically relevant bleeding (CRB). Patients/Methods Patients with active cancer and acute, symptomatic VTE received either tinzaparin 175 IU kg-1 once daily or warfarin (target International Normalized Ratio [INR] of 2.0-3.0) for 6 months. Fisher's exact test was used to screen prespecified clinical risk factors; those identified as being significantly associated with an increased risk of CRB then underwent competing risk regression analysis of time to first CRB. Results Among 900 randomized patients, 138 (15.3%) had 180 CRB events. CRB occurred in 60 patients (81 events) in the tinzaparin group and in 78 patients (99 events) in the warfarin group (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.45-0.89). Common bleeding sites were gastrointestinal (36.7%; n = 66), genitourinary (22.8%; n = 41), and nasal (10.0%; n = 18). In multivariate analysis, the risk of CRB increased with age > 75 years (HR 1.83, 95% CI 1.14-2.94) and intracranial malignancy (HR 1.97, 95% CI 1.07-3.62). In the warfarin group, 40.4% of CRB events occurred in patients with with an INR of 75 years and intracranial malignancy.
Databáze:	OpenAIRE
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