Long-term anticoagulation treatment for acute venous thromboembolism in patients with and without cancer

David Spirk; Jörg Ugi; Wolfgang Korte; Marc Husmann; Daniel Hayoz; Thomas Baldi; Beat Frauchiger; Martin Banyai; Drahomir Aujesky; Iris Baumgartner; Nils Kucher

doi:10.1160/TH11-01-0002

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 105(06): 962-967
DOI: 10.1160/TH11-01-0002

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Long-term anticoagulation treatment for acute venous thromboembolism in patients with and without cancer

The SWIss Venous ThromboEmbolism Registry (SWIVTER) II

Authors

David Spirk

¹Medical Affairs, Sanofi-Aventis (Suisse) SA, Meyrin, Switzerland
Jörg Ugi

²Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland
Wolfgang Korte

³Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
Marc Husmann

⁴Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
Daniel Hayoz

⁵Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
Thomas Baldi

⁶Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
Beat Frauchiger

⁷Department of Internal Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
Martin Banyai

⁸Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
Drahomir Aujesky

⁹Division of General Internal Medicine, University Hospital Bern, Bern, Switzerland
Iris Baumgartner

²Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland
Nils Kucher

²Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland

Abstract

Summary

In patients with acute cancer-associated thrombosis, current consensus guidelines recommend anticoagulation therapy for an indefinite duration or until the cancer is resolved. Among 1,247 patients with acute venous thromboembolism (VTE) enrolled in the prospective Swiss Venous Thromboembolism Registry (SWIVTER) II from 18 hospitals, 315 (25%) had cancer of whom 179 (57%) had metastatic disease, 159 (50%) ongoing or recent chemotherapy, 83 (26%) prior cancer surgery, and 63 (20%) recurrent VTE. Long-term anticoagulation treatment for >12 months was more often planned in patients with versus without cancer (47% vs. 19%; p<0.001), with recurrent cancer-associated versus first cancer-associated VTE (70% vs. 41%; p<0.001), and with metastatic versus non-metastatic cancer (59% vs. 31%; p<0.001). In patients with cancer, recurrent VTE (OR 3.46; 95%CI 1.83–6.53), metastatic disease (OR 3.04; 95%CI 1.86–4.97), and the absence of an acute infection (OR 3.55; 95%CI 1.65–7.65) were independently associated with the intention to maintain anticoagulation for >12 months. In conclusion, long-term anticoagulation treatment for more than 12 months was planned in less than half of the cancer patients with acute VTE. The low rates of long-term anticoagulation in cancer patients with a first episode of VTE and in patients with non-metastatic cancer require particular attention.

Keywords

Anticoagulation - cancer - venous thromboembolism

Full Text

References

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