Phlebologie 2015; 44(05): 256-260
DOI: 10.12687/phleb2279-5-2015
Review article
Schattauer GmbH

Low molecular heparin for cancer-associated venous thromboembolism – still the “CATCH of the day“?

Article in several languages: English | deutsch
A. Matzdorff
1   Asklepios Klinik Uckermark, Schwedt, Germany
› Author Affiliations
Further Information

Publication History

Received: 04 August 2015

Accepted: 07 August 2015

Publication Date:
04 January 2018 (online)

Summary

In December 2014 the CATCH study was presented at the annual meeting of the American Society of Hematology. CATCH is a randomized controlled trial comparing the low molecular weight heparin tinzaparin with warfarin for 6 months extended treatment (=secondary prophylaxis) of cancer-associated venous thromboembolism (VTE). 6.9 % of patients in the tanzaparin arm experienced recurrent symptomatic and asymptomatic VTE compared with 10 % in the warfarin arm, this difference was statistically not significant. The difference became significant when only symptomatic VTEs were compared. There was no difference in the incidence of major bleeding events, but significantly fewer patients experienced clinically relevant non-major bleeding with tinzaparin than warfarin. The CATCH study is so far the largest study on extended treatment of cancer-associated VTE. It supports the guideline recommendation that low molecular weight heparins should be preferred to vitamin K antagonists for anticoagulation of cancer-associated VTE.

 
  • References

  • 1 http://www.krebsdaten.de/Krebs/DE/Content/Kreb/sarten/Krebs_gesamt/krebs_gesamt_node.html (abgefragt 1.8.15)
  • 2 Krebs in Deutschland 2009/2010. 9. Ausgabe. Robert Koch-Institut (Hrsg) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg). Berlin, 2013
  • 3 Ahmad AS, Ormiston-Smith N, Sasieni PD. Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960. Br J Cancer 2015; 112: 943-947.
  • 4 Khorana AA, Kuderer NM, Culakova E. et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008; 111: 4902-4907.
  • 5 Carrier M, Khorana AA, Moretto P. et al. Lack of evidence to support thromboprophylaxis in hospitalized medical patients with cancer. Am J Med 2014; 127: 82-86.
  • 6 Falanga A, Zacharski L. Deep vein thrombosis in cancer: the scale of the problem and approaches to management. Ann Oncol 2005; 16: 696-701.
  • 7 Heit JA, Silverstein MD, Mohr DN. et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160: 809-815.
  • 8 Gil-Bernabé A, Lucotti S, Muschel RJ. Coagulation and metastasis: what does the experimental literature tell us?. Br J Haematol 2013; 162: 433-441.
  • 9 Lin RJ, Afshar-Kharghan V, Schafer AI. Paraneo-plastic thrombocytosis: the secrets of tumor self-promotion. Blood 2014; 124: 184-187.
  • 10 Kroll MH, Pemmaraju N, Oo TH. et al. Mortality from Cancer-Associated Venous Thromboembolism. Blood 2014; 124: Abstr. #4829.
  • 11 Khorana AA, Francis CW, Culakova E. et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5: 632-634.
  • 12 Kuderer NM, Dale DC, Crawford J. et al. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006; 106: 2258-2266.
  • 13 Farge D, Debourdeau P, Beckers M. et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost 2013; 11: 56-70.
  • 14 Lyman GH, Khorana AA, Kuderer NM. et al; American Society of Clinical Oncology Clinical Practice Guideline.. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2013; 31: 2189-2204.
  • 15 Lyman GH, Bohlke K, Khorana AA. et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014. J Clin Oncol 2015; 33: 654-656.
  • 16 NCCN Clinical Practice Guidelines in Oncology.. Cancer-associated venous thromboembolic disease. Version 1/2014 www.nccn.org (abgefragt 1.8.15)
  • 17 Hull RD, Pineo GF, Brant RF. et al; LITE Trial Investigators.. Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. Am J Med 2006; 119: 1062-1072.
  • 18 Meyer G, Marjanovic Z, Valcke J. et al. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 2002; 162: 1729-1735.
  • 19 Lee AY, Levine MN, Baker RI. et al. Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators: Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349: 146-153.
  • 20 Deitcher SR, Kessler CM, Merli G. et al; ONCE-NOX Investigators.. Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost 2006; 12: 389-396.
  • 21 Kakkar AK, Levine M, Pinedo HM. et al. Venous thrombosis in cancer patients: insights from the FRONTLINE survey. Oncologist 2003; 8: 381-388.
  • 22 Wittkowsky AK. Barriers to the long-term use of low-molecular weight heparins for treatment of cancer-associated thrombosis. J Thromb Haemost 2006; 4: 2090-2091.
  • 23 Imberti D, Agnelli G, Ageno W. et al.; MASTER Investigators.. Clinical characteristics and management of cancer-associated acute venous thromboembolism: findings from the MASTER Registry. Haematologica 2008; 93: 273-278.
  • 24 Spirk D, Ugi J, Korte W. et al. Long-term anticoagulation treatment for acute venous thromboembolism in patients with and without cancer. The SWIss Venous ThromboEmbolism Registry (SWIVTER) II. Thromb Haemost 2011; 105: 962-967.
  • 25 Delate T, Witt DM, Ritzwoller D. et al. Outpatient use of low molecular weight heparin monotherapy for first-line treatment of venous thromboembolism in advanced cancer. Oncologist 2012; 17: 419-427.
  • 26 Marchena PJ, Nieto JA, Guil M. et al. RIETE Investigators.. Long-term therapy with low-molecular-weight heparin in cancer patients with venous thromboembolism. Thromb Haemost 2012; 107: 37-43.
  • 27 Belhadj Chaidi R, Thollot C. et al. Adherence to guidelines for the treatment of venous thromboembolism in cancer patients: a retrospective analysis of 145 cases. [Article in French]. J Mal Vasc 2013; 38: 185-192.
  • 28 Kleinjan A, Hutten B, Di Nisio M. et al. Anticoagulant treatment of cancer patients with pulmonary embolism in the real world. Actual use of low-molecular-weight heparin in cancer. Neth J Med 2014; 72: 467-472.
  • 29 Rahme E, Feugère G, Sirois C. et al. Anticoagulant use in patients with cancer-associated venous thromboembolism: a retrospective cohort study. Thromb Res 2013; 131: 210-217.
  • 30 Sevestre MA, Belizna C, Durant C. et al.; Carmen Investigators for the Groupe Francophone Thrombose et Cancer (GFTC).. Compliance with recommendations of clinical practice in the management of venous thromboembolism in cancer: the CARMEN study. J Mal Vasc 2014; 39: 161-168.
  • 31 Caprini JA, Tapson VF, Hyers TM. et al.; NABOR Steering Committee.. Treatment of venous thromboembolism: adherence to guidelines and impact of physician knowledge, attitudes, and beliefs. J Vasc Surg 2005; 42: 726-733.
  • 32 Schellong SM, Gerlach H, Hach-Wunderle V. et al. Diagnosis of deep-vein thrombosis: adherence to guidelines and outcomes in real-world health care. Thromb Haemost 2009; 102: 1234-1240.
  • 33 Kakkar AK, Levine M, Pinedo HM. et al. Venous thrombosis in cancer patients: insights from the FRONTLINE survey. Oncologist 2003; 8: 381-388.
  • 34 Francis CW, Kessler CM, Goldhaber SZ. et al. Treatment of venous thromboembolism in cancer patients with dalteparin for up to 12 months: the DALTECAN Study. J Thromb Haemost 2105 13: 1028-1035.
  • 35 Farge D, Debourdeau P, Gorin NC. et al. Long-Term Use of Low-Molecular-Weight Heparins (LMWH) for Cancer-Associated Venous Thromboembolism (VTE): Patients’ Perception in Tro-pique, a Prospective, Multicenter, Observational Study. Blood 2014; 124: Abstr. #4272.
  • 36 Lee AYY, Kamphuisen PW, Meyer G. et al.; for the CATCH–Investigators.. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer. A randomized clinical trial. JAMA 2015; 314: 677-686.
  • 37 Kamphuisen PW, Lee AYY, Meyer G. et al. on behalf of the CATCH Investigators.. Characteristics and risk factors of major and clinically relevant non-major bleeding in cancer patients receiving anticoagulant treatment for acute venous thromboembolism – the CATCH study. J Thromb Haemost 2015; 13 (Suppl. 02) 182 Abstr.#OR228.A