Treatment Patterns of Cancer-associated Thrombosis in the Netherlands: The Four Cities Study.

TH open : companion journal to thrombosis and haemostasis Pub Date : 2024-01-30 eCollection Date: 2024-01-01 DOI:10.1055/a-2214-8101
Fleur H J Kaptein, Noori A M Guman, Susan B Lohle, Frederikus A Klok, Albert T A Mairuhu, Pieter W Kamphuisen, Nick Van Es, Menno V Huisman
{"title":"Treatment Patterns of Cancer-associated Thrombosis in the Netherlands: The Four Cities Study.","authors":"Fleur H J Kaptein, Noori A M Guman, Susan B Lohle, Frederikus A Klok, Albert T A Mairuhu, Pieter W Kamphuisen, Nick Van Es, Menno V Huisman","doi":"10.1055/a-2214-8101","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background</b>  Current guidelines recommend either low-molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs) as first-line treatment in cancer-associated venous thromboembolism (VTE). <b>Aim</b>  This study aimed to investigate treatment regimens for cancer-associated VTE over the past 5 years, explore predictors for initial treatment (LMWH vs. DOAC), and to assess the risks of recurrent VTE and bleeding. <b>Methods</b>  This was a Dutch, multicenter, retrospective cohort study including consecutive patients with cancer-associated VTE between 2017 and 2021. Treatment predictors were assessed with multivariable logistic regression models. Six-month cumulative incidences for recurrent VTE and major bleeding (MB) were estimated with death as competing risk. <b>Results</b>  In total, 1,215 patients were included. The majority (1,134/1,192; 95%) started VTE treatment with anticoagulation: 561 LMWH (47%), 510 DOACs (43%), 27 vitamin K antagonist (2.3%), and 36 other/unknown type (3.0%). The proportion of patients primarily treated with DOACs increased from 18% (95% confidence interval [CI] 12-25) in 2017 to 70% (95% CI 62-78) in 2021. Poor performance status (adjusted odds ratio [aOR] 0.72, 95% CI 0.53-0.99) and distant metastases (aOR 0.61, 95% CI 0.45-0.82) were associated with primary treatment with LMWH. Total 6-month cumulative incidences were 6.0% (95% CI 4.8-7.5) for recurrent VTE and 7.0% (95% CI 5.7-8.6) for MB. During follow-up, 182 patients (15%) switched from LMWH to a DOAC, and 54 patients (4.4%) vice versa, for various reasons, including patient preference, recurrent thrombosis, and/or bleeding. <b>Conclusion</b>  DOAC use in cancer-associated VTE has increased rapidly over the past years. Changes in anticoagulation regimen were frequent over time, and were often related to recurrent thrombotic and bleeding complications, illustrating the complexity and challenges of managing cancer-associated VTE.</p>","PeriodicalId":94220,"journal":{"name":"TH open : companion journal to thrombosis and haemostasis","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10827569/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"TH open : companion journal to thrombosis and haemostasis","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/a-2214-8101","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background  Current guidelines recommend either low-molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs) as first-line treatment in cancer-associated venous thromboembolism (VTE). Aim  This study aimed to investigate treatment regimens for cancer-associated VTE over the past 5 years, explore predictors for initial treatment (LMWH vs. DOAC), and to assess the risks of recurrent VTE and bleeding. Methods  This was a Dutch, multicenter, retrospective cohort study including consecutive patients with cancer-associated VTE between 2017 and 2021. Treatment predictors were assessed with multivariable logistic regression models. Six-month cumulative incidences for recurrent VTE and major bleeding (MB) were estimated with death as competing risk. Results  In total, 1,215 patients were included. The majority (1,134/1,192; 95%) started VTE treatment with anticoagulation: 561 LMWH (47%), 510 DOACs (43%), 27 vitamin K antagonist (2.3%), and 36 other/unknown type (3.0%). The proportion of patients primarily treated with DOACs increased from 18% (95% confidence interval [CI] 12-25) in 2017 to 70% (95% CI 62-78) in 2021. Poor performance status (adjusted odds ratio [aOR] 0.72, 95% CI 0.53-0.99) and distant metastases (aOR 0.61, 95% CI 0.45-0.82) were associated with primary treatment with LMWH. Total 6-month cumulative incidences were 6.0% (95% CI 4.8-7.5) for recurrent VTE and 7.0% (95% CI 5.7-8.6) for MB. During follow-up, 182 patients (15%) switched from LMWH to a DOAC, and 54 patients (4.4%) vice versa, for various reasons, including patient preference, recurrent thrombosis, and/or bleeding. Conclusion  DOAC use in cancer-associated VTE has increased rapidly over the past years. Changes in anticoagulation regimen were frequent over time, and were often related to recurrent thrombotic and bleeding complications, illustrating the complexity and challenges of managing cancer-associated VTE.

荷兰癌症相关血栓的治疗模式:四城研究
背景 现行指南推荐低分子量肝素(LMWH)或直接口服抗凝剂(DOAC)作为癌症相关静脉血栓栓塞症(VTE)的一线治疗方案。目的 本研究旨在调查过去 5 年中癌症相关 VTE 的治疗方案,探索初始治疗(LMWH 与 DOAC)的预测因素,并评估复发性 VTE 和出血的风险。方法 这是一项荷兰多中心回顾性队列研究,研究对象包括2017年至2021年间的连续癌症相关VTE患者。采用多变量逻辑回归模型评估了治疗预测因素。以死亡作为竞争风险,估算了复发性 VTE 和大出血 (MB) 的 6 个月累积发生率。结果 共纳入 1215 名患者。大多数患者(1,134/1,192;95%)开始接受 VTE 抗凝治疗:其中 561 例为 LMWH(47%),510 例为 DOAC(43%),27 例为维生素 K 拮抗剂(2.3%),36 例为其他/未知类型(3.0%)。主要接受 DOACs 治疗的患者比例从 2017 年的 18%(95% 置信区间 [CI] 12-25)增至 2021 年的 70%(95% CI 62-78)。表现状态不佳(调整后比值比 [aOR] 0.72,95% CI 0.53-0.99)和远处转移(aOR 0.61,95% CI 0.45-0.82)与主要接受 LMWH 治疗有关。复发性 VTE 和 MB 的 6 个月累计总发病率分别为 6.0% (95% CI 4.8-7.5) 和 7.0% (95% CI 5.7-8.6)。在随访期间,182 名患者(15%)从 LMWH 转为 DOAC,54 名患者(4.4%)从 LMWH 转为 DOAC,原因多种多样,包括患者偏好、血栓复发和/或出血。结论 在过去几年中,DOAC 在癌症相关 VTE 中的使用迅速增加。随着时间的推移,抗凝治疗方案的改变很频繁,而且往往与复发性血栓和出血并发症有关,这说明了癌症相关 VTE 管理的复杂性和挑战性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
审稿时长
12 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信