Abstract 3853
Background
Even low molecular weight heparin (LMWH) for 3 to 6 months (Ms) is recommended for cancer-associated VTE, little has been known about practical treatment (Tx) pattern of anticoagulants and clinical outcome in Asia.
Methods
This retrospective cohort study was conducted from Oct 2016 to Jul 2017 at 8 university hospitals in Korea. Data was extracted from the medical chart of each individual hospital. Active cancer patients (pts), ≥19 years, with cancer-associated deep vein thrombosis or pulmonary embolism diagnosed from 2013 to 2015, and on anticoagulants, were enrolled and followed for 1 year. Demographic data will be published in abstract book of ISPOR 2018. Pts were classified by the form of anticoagulants; the group with LMWH Tx over 3 consecutive Ms allowing at most 14 days of temporary discontinuation and the non-LMWH group with other anticoagulants. The cumulative incidence of 1st recurrent VTE and bleeding for 1st 6 Ms of Tx was compared between LMWH and non-LMWH groups. LMWH group was further divided into ≤ 6 and > 6 Ms of Tx period. 3-group comparison was completed for the cumulative incidence of 1st recurrent VTE and bleeding from 6 to 12 Ms of Tx.
Results
Of total 748 pts (age: 63.8±11.5, male: 50.3%), the major cancer type was lung cancer (24.6%). 15.2% received LMWH over 3 Ms whereas 84.8% had various non-LMWH anticoagulants. The incidence of recurrent VTE was 17.5% in LMWH and 19.4% in non-LMWH. Bleeding events of LMWH and non-LMWH were 12.3% and 21.6%. Of the pts with bleeding, 28.6% in LMWH had major bleeding while 33.6% in non-LMWH. Up to 6 Ms after the 1st Tx, the cumulative incidence of first recurrent VTE in LMWH (8.4, CI: 3.09, 13.67) was lower than that of non-LMWH (9.7, CI: 7.33, 12.11) (p = 0.0048). Likewise, the cumulative incidence of 1st bleeding until 6 Ms was significantly lower in LMWH (8.9, CI: 3.28, 14.48) than non-LMWH (9.7, CI: 7.32, 12.02) (p = 0.0006). For following 6 Ms after 1st 6 Ms of Tx, the group with LMWH > 6 Ms (6.7, CI: 0.00, 19.29) had the lowest cumulative incidence of VTE recurrence among 3 groups (p = 0.0024).
Conclusions
Our data suggest that LMWH be used for 3 to 6 Ms and be maintained even afterwards to minimize the incidence of recurrence and bleeding in the cancer patients with VTE.
Clinical trial identification
Legal entity responsible for the study
Pfizer Pharmaceuticals Korea Ltd.
Funding
Pfizer Pharmaceuticals Korea Ltd.
Editorial Acknowledgement
Disclosure
Y-J. Kim, J-H. Cha: Pfizer Pharmaceuticals Korea Ltd. All other authors have declared no conflicts of interest.