Treatment and outcomes after on-treatment recurrent venous thromboembolism in patients with cancer: a post hoc analysis of the Hokusai venous thromboembolism cancer study.

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2025-03-04 DOI:10.1016/j.jtha.2025.02.022

Vincent R Lanting, Kika van Bergen En Henegouwen, Floris T M Bosch, Michael A Grosso, Annelise Segers, Gary E Raskob, T Pieter Willem Kamphuisen, Harry R Büller, Peter Verhamme, Jeffrey I Weitz, Marcello Di Nisio, Marc Carrier, Nick van Es, Tzu-Fei Wang

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引用次数: 0

Abstract

Background: The management of recurrent venous thromboembolism (VTE) despite anticoagulant treatment in patients with cancer is uncertain. To address this, we used data from the Hokusai VTE Cancer trial, which compared edoxaban with dalteparin to treat cancer-associated VTE.

Objectives: To characterize and evaluate anticoagulant treatment strategies during and after on-treatment recurrent VTE, including the type and dose of anticoagulant.

Methods: In this post hoc analysis, all patients with adjudicated on-treatment recurrent VTE within 12 months after randomization were included. Outcomes were second recurrent VTE and major bleeding within 3 months after the first recurrent VTE.

Results: A total of 67 patients developed on-treatment recurrent VTE while receiving therapeutic-dose edoxaban (31%), therapeutic-dose low-molecular-weight heparin (LMWH) (34%), maintenance-dose LMWH (21%), or other therapies (14%). After the recurrent event, 28 patients (42%) received an increased dose, 35 (52%) a comparable dose, and 4 (6%) a reduced dose or stopped anticoagulants. Common treatment regimens included supratherapeutic-dose LMWH (21%), therapeutic-dose LMWH (51%), direct oral anticoagulants (16%), or another treatment strategy (12%). In the 3 months after recurrent VTE, 6 (9%) patients had a second recurrence and 7 (10%) had major bleeding.

Conclusion: Treatment strategies for recurrent VTE in patients with cancer are heterogeneous. The risk of a second recurrence and major bleeding are considerable. More studies are needed to determine the optimal treatment strategy for recurrent cancer-associated thrombosis.

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癌症患者复发性静脉血栓栓塞治疗后的治疗和结果：Hokusai静脉血栓栓塞癌症研究的事后分析。

背景：癌症患者在抗凝治疗后复发性静脉血栓栓塞（VTE）的处理尚不确定。为了解决这个问题，我们使用了来自Hokusai静脉血栓栓塞癌症试验的数据，该试验比较了依多沙班和达特帕林治疗癌症相关静脉血栓栓塞的效果。方法：在这项事后分析中，我们描述并评估了复发性静脉血栓栓塞治疗期间和治疗后的抗凝治疗策略，包括抗凝药物的类型和剂量。在随机分组后的12个月内，所有经治疗的复发性静脉血栓栓塞患者均被纳入研究。结果为第二次静脉血栓栓塞复发，第一次静脉血栓栓塞复发后3个月内大出血。结果：共有67例患者在接受治疗剂量依多沙班（31%）、治疗剂量低分子肝素（34%）、维持剂量低分子肝素（21%）或其他治疗（14%）时发生复发性静脉血栓栓塞。复发事件发生后，28例患者（42%）接受了增加剂量，35例（52%）接受了相当剂量，4例（6%）接受了减少剂量或停止使用抗凝药物。常见的治疗方案包括超治疗剂量低分子肝素（21%）、治疗剂量低分子肝素（51%）、DOAC（16%）或其他治疗策略（12%）。静脉血栓栓塞复发后3个月内，6例（9%）患者再次复发，7例（10%）发生大出血。结论：癌症患者复发性静脉血栓栓塞的治疗策略存在差异。二次复发和大出血的风险是相当大的。需要更多的研究来确定复发性癌症相关血栓的最佳治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.