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Long-term anticoagulation treatment for acute venous thromboembolism in patients with and without cancer

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: http://dx.doi.org/10.1160/TH11-01-0002
Issue: 2011: 105/6 (June) pp. 933–1123
Pages: 962-967

Long-term anticoagulation treatment for acute venous thromboembolism in patients with and without cancer

The SWIss Venous ThromboEmbolism Registry (SWIVTER) II

D. Spirk (1), J. Ugi (2), W. Korte (3), M. Husmann (4), D. Hayoz (5), T. Baldi (6), B. Frauchiger (7), M. Banyai (8), D. Aujesky (9), I. Baumgartner (2), N. Kucher (2)

(1) Medical Affairs, Sanofi-Aventis (Suisse) SA, Meyrin, Switzerland; (2) Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland; (3) Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; (4) Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland; (5) Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland; (6) Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; (7) Department of Internal Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland; (8) Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland; (9) Division of General Internal Medicine, University Hospital Bern, Bern, Switzerland

Keywords

cancer, venous thromboembolism, anticoagulation

Summary

In patients with acute cancer-associated thrombosis, current consensus guidelines recommend anticoagulation therapy for an indefinite duration or until the cancer is resolved. Among 1,247 patients with acute venous thromboembolism (VTE) enrolled in the prospective Swiss Venous Thromboembolism Registry (SWIVTER) II from 18 hospitals, 315 (25%) had cancer of whom 179 (57%) had metastatic disease, 159 (50%) ongoing or recent chemotherapy, 83 (26%) prior cancer surgery, and 63 (20%) recurrent VTE. Long-term anticoagulation treatment for >12 months was more often planned in patients with versus without cancer (47% vs. 19%; p<0.001), with recurrent cancer-associated versus first cancer-associated VTE (70% vs. 41%; p<0.001), and with metastatic versus non-metastatic cancer (59% vs. 31%; p<0.001). In patients with cancer, recurrent VTE (OR 3.46; 95%CI 1.83–6.53), metastatic disease (OR 3.04; 95%CI 1.86–4.97), and the absence of an acute infection (OR 3.55; 95%CI 1.65–7.65) were independently associated with the intention to maintain anticoagulation for >12 months. In conclusion, long-term anticoagulation treatment for more than 12 months was planned in less than half of the cancer patients with acute VTE. The low rates of long-term anticoagulation in cancer patients with a first episode of VTE and in patients with non-metastatic cancer require particular attention.

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