Low-molecular-weight heparin beyond 12 months in patients with cancer-associated thrombosis

• Published in: British journal of cancer Vol. 127; no. 12; pp. 2234 - 2240
• Main Authors: Lopez-Ruz, Sergio, Barca-Hernando, Maria, Marin-Romero, Samira, Elias-Hernandez, Teresa, Otero- Candelera, Remedios, Jara-Palomares, Luis
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 07.12.2022; Nature Publishing Group
• Subjects: 692/4028/67; 692/699/75/591; Anticoagulants; Biomedical and Life Sciences; Biomedicine; Bleeding; Cancer; Cancer Research; Drug Resistance; Epidemiology; Heparin; Heparin, Low-Molecular-Weight - adverse effects; Humans; Molecular Medicine; Neoplasms - complications; Neoplasms - drug therapy; Oncology; Patients; Risk assessment; Sensitivity analysis; Thrombosis
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-022-02007-x

Background Clinical guidelines indicate that in patients with cancer-associated thrombosis (CAT), anticoagulant treatment should be continued beyond 6 months as long as the cancer is active. We aimed to analyse the safety of low-molecular-weight heparin (LMWH) beyond 12 months in patients with CAT. Methods We performed a post hoc analysis of consecutive CAT patients from October 2008 to December 2019. The primary outcome was the rate of clinically relevant bleeding (CRB), and we compared two periods (1–12 vs. 12–24 months). Hazard ratio (HR), competing risk analysis and sensitivity analyses were performed. Results Of the 588 patients included, 30.1% ( n  = 177) received LMWH beyond 12 months. The rate of CRB in the first 12 months compared to the 12–24 month period was 3.2 per 100 patients/month (95% CI 2.5–4.1) vs. 0.9 per 100 patients/month (95% CI 0.4–1.5), ( P  < 0.0001). The competing risk analysis of CRB comparing both periods showed a lower sub-distribution hazard ratio (SHR) during the period 12–24 months (SHR: 0.5, 95% CI: 0.3–0.8, P  < 0.001). Conclusion In patients with cancer-associated thrombosis under anticoagulant treatment with LMWH, the rate of clinically relevant bleeding and major bleeding were lower beyond 12 months.