Abstract
An optimal duration of LMWH in cancer associated venous thromboembolism(CAT)patients is unknown.
Objective: To analyze the required duration of LMWH according clinical criteria in CAT patients.
Methods: CAT patients were referred to outpatients venous thromboembolic diseases (VTD) unit for suspection of deep venous thrombosis (DVT) or for follow-up of symptomatic or incidental Pulmonary Emobolism (PE).Demographic, related to VTD or cancer variables and events during the follow up patientswere collected.The comparison between groups was performed using Chi-squared test and Student's t-test.Bleeding risk was weighted using Cox regression.
Results: 121 patients were included.69% were in a metastatic stage.DVT of lower limbs as diagnosed in 56% of patients, of which 27% were asymptomatic;11% were diagnosed with DVT of higher limbs.Up to 87% were treated with Tinzaparin and 50% were anticoagulated more than 6 months.Anticoagulant treatment was maintained when there was active malignancy(56%),persistent residual thrombosis(31%)and use of chemotherapy 7.4%). 25% of patients died, although not related to VTD.Half of the deaths occurred in the first six months after diagnosing VTD(p=0.01).There were 12 episodes of recurrence(10%)of which 30% happened despite anticoagulation.18 patients(15%)suffered bleeding,and 5% of them were severe.The bleeding risk after the first 6 months descended significantly [HR:0.089(95% CI: 0.017 to 0.462),p=0.004].
Conclusions: Most of CAT patients needed anticoagulation with LMWH treatment for more than 6 months. There was higher incidence than expected in VTD recurrences The bleeding risk decreased after 6 months of LMWH treatment.
- Copyright ©ERS 2015