1818MO - Can thromboprophylaxis build a link for cancer patients undergoing surgical and/or chemotherapy treatment? Intermediate results from the MeTHOS study

Background

Cancer is implicated in multiple pathways increasing thrombogenicity. Cance associated thrombosis can delay cancer treatment and results in increased mortality, morbidity, and surcharge on healthcare resources. An effective antithrombotic strategy in high-risk patients (pts) in postoperative and chemotherapy periods may improve outcome.

Methods

The Metaxas’s Hospital THromboprophylaxis program in Oncological & Surgical Patients (MeTHOS), is a prospective observational study aiming to record our thromboprophylaxis program in high-risk active cancer pts undergoing surgical and/or chemotherapy treatment. According to our program, patients receiving tinzaparin (fixed dose of 0,5 ml, 10.000 Anti-Xa IU, OD) were enrolled after signing informed consent.

Results

We report intermediate results of the MeTHOS study for 237 enrolled ambulatory pts receiving chemotherapy. There were 55% males and 45% females, with median age 67.0 years (interquartile range (IQR): 59-74 years). Primary cancers included GI 35%, lung 20%, gynecological 16%, urinary 9% and others 20%; 67% of patients had metastatic disease; 90% were receiving Highly Thrombogenic Agents (HTAs) e.g. platinum, taxanes, 5-FU and antiangiogenics; 20% had undergone surgery; 62% had a history of cardiovascular disease, 32% diabetes, 31% respiratory disease, 38% dyslipidemia and 19% prior thrombosis; 22% had central venous catheter; 27% were smokers and 40% ex-smokers. Median duration of tinzaparin administration was 6.9mo (IQR: 3.7-12.0 mo). Four pts experienced thrombotic events (1.7%, 95%CI: 0.5-4.3%, 3 DVT, 1 PE). Seven bleeding events were recorded (3.0%, 95%CI: 1.2-6.0%); 5 of them were graded as minor. Thrombotic risk was higher in patients with thrombosis history (OR: 4.2), metastatic disease (OR: 2.8) and diabetes (OR: 2.2).

Conclusions

Thromboprophylaxis with tinzaparin in active cancer pts receiving chemotherapy was safe and effective. Cancer pts may tolerate higher doses of LMWH without increasing bleeding events. A high-thrombotic burden-adapted strategy with more effective LMWH doses, could benefit high risk pts without compromising safety. Further research is needed.

Clinical trial identification

NCT04248348.

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.