低分子肝素治疗的癌症相关血栓患者血栓复发和出血的发生和管理：一项法国全国队列研究

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-01-01 DOI:10.1016/j.rpth.2024.102642

Isabelle Mahé , Gaelle Gusto , Nadia Quignot , Artak Khachatryan , Jose Chaves , Audrey Moniot , Lucas Andre , Sylvain Van Roy , Ruth Mokgokong , Laurent Bertoletti

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引用次数: 0

摘要

背景：静脉血栓栓塞（VTE）复发和出血的比率仍然很高的癌症患者处方抗凝剂（ACs），如低分子肝素（LMWH）后，初始VTE事件。目的：确定接受低分子肝素治疗癌症相关性静脉血栓栓塞的患者与静脉血栓栓塞复发和出血相关的患者特征，并探讨这些患者的继发性AC治疗和临床结果。方法：利用法国全国范围内的数据，对2013-2018年因静脉血栓栓塞住院、出院后≤30天获得低分子肝素报销的活动性癌症患者进行了一项观察性研究。主要结局为静脉血栓栓塞复发和出血。对于这两种结果，根据不同的患者特征计算了经历该结果的患者比例。使用解剖治疗化学代码跟踪静脉血栓栓塞复发和出血后的交流开关。结果：共31771例患者接受低分子肝素治疗，其中静脉血栓栓塞复发1925例（6.1%），出血1804例（5.7%）。大多数复发性静脉血栓栓塞和出血事件发生在初始静脉血栓栓塞事件后6个月内。静脉血栓栓塞复发和出血的比例在不同癌症类型之间存在差异。大多数静脉血栓栓塞复发或出血的患者继续接受低分子肝素治疗。11%的静脉血栓栓塞复发患者在3个月内再次发生静脉血栓栓塞。结论：超过10%的接受低分子肝素治疗癌症相关性静脉血栓栓塞的患者发生静脉血栓栓塞复发或出血。该患者群体的AC管理方案应在临床试验中进行前瞻性评估。

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Occurrence and management of thrombosis recurrence and bleeding in low-molecular-weight heparin-treated patients with cancer-associated thrombosis: a French nationwide cohort study

Background

Rates of venous thromboembolism (VTE) recurrence and bleeding remain high in patients with cancer who are prescribed anticoagulants (ACs) such as low-molecular-weight heparin (LMWH) after an initial VTE event.

Objectives

To identify patient characteristics associated with VTE recurrence and bleeding in patients receiving LMWH for cancer-associated VTE and to explore secondary AC management and clinical outcomes in these patients.

Methods

An observational study was conducted using nationwide French data for adults with active cancer who were hospitalized with VTE in 2013-2018 and were reimbursed for LMWH ≤ 30 days after hospital discharge. The main outcomes were VTE recurrence and bleeding. For both outcomes, the proportions of patients who experienced the outcome were calculated for different patient characteristics. AC switching following VTE recurrence and bleeding was tracked using Anatomical Therapeutic Chemical codes.

Results

A total of 31,771 patients received LMWH, of whom 1925 (6.1%) experienced VTE recurrence and 1804 (5.7%) bleeding. Most recurrent VTE and bleeding events occurred within 6 months after the initial VTE event. The proportion of patients with VTE recurrence and bleeding varied between cancer types. Most patients who experienced VTE recurrence or bleeding continued to receive LMWH. Eleven percent of patients with VTE recurrence experienced a further recurrent VTE event within 3 months.

Conclusion

More than 10% of patients who received LMWH for cancer-associated VTE experienced VTE recurrence or bleeding. AC management options in this patient population should be prospectively assessed in clinical trials.

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