CAT is a common complication of cancer with impact on overall prognosis. After 2003 low molecular weight heparin (LMWH) instead of vitamin K antagonists (VKA) became guideline recommended treatment. Direct oral anticoagulant drugs (DOAC) were investigated in CAT only recently. Little data is available concerning incidence and current treatment situation in Germany.
Data on drugs and coding of diagnosis for all continuously insured members of SHI were available. An anonymized health claims database (2011-2016) of German SHI was used for a retrospective analysis. With a wash out period of one year patients with preexisting conditions were eliminated. According to our definition pts with CAT had a new a cancer diagnosis and a new VTE diagnosis and a prescrition of any type of anticoagulant. Anticoagulant drug type and duration in CAT pts during the next year was analyzed and then classified according to their dominant (> 51 % of time) anticoagulant drug. Any coded bleeding diagnosis was captured as well. The study has descriptive character.
Out of a sample of > 4 million MSHI which is 5,5 % of the German SHI population 322,600 tumor pts and 13,131 (4%) pts with initial VTE diagnosis were identified. 25% of them had no prescription of any anticoagulant. According to the definition 7,313 were CAT. Dominant anticoagulant was LMWH in 58% VKA in 24%, and DOAC in 18%, respectively. During prescription of anticoagulation approx. 20% of all pts with CAT suffered from bleedings with no significant differences between agents (LMWH, DOAC, VKA). The individual LMWH type (approved for secondary prophylaxis or not) and switch of therapy were analyzed as well.
Out of 7,313 pts with CAT more than half received secondary prophylaxis of VTE with LMWH in accordance with the German guideline. VKA (probably suboptimal choice) as well as DOAC (no data publised before 2017) were used in a clinically relevant subset. Bleeding was comparable in different agents of anticoagulation. As compared to available small market research studies our data set offers more reliable information due to its comprehensive character. This has impact on future guidelines and education.
Clinical trial identification
Legal entity responsible for the study
HGC Healthcare Consultants GmbH.
Aspen Germany GmbH.
A. Kretzschmar: Travel cost compensation: Aspen Pharma. M. May: Research funding: Aspen Pharma GmbH, Germany; Compensation for travel, Employee: HGC. A. Heinken: Employee: Aspen Pharma, Germany. H. Riess: Travel compensation, Honoraria, Advisory board: Aspen Pharma, Bayer Schering, Daiichi Sankyo, Boehringer Ingelheim, Leo-Pharma.