Anticoagulation Therapy in Cancer Patients with Thrombosis in the Outpatient Sector of Germany (The CERTIFICAT Initiative)—German Practice of Anticoagulation Therapy of Cancer Patients with Thrombosis

Abstract

Objective This article aims to investigate the reality of anticoagulation treatment for cancer patients with thrombosis in the outpatient sector of Germany. Methods For the analysis period 2012 to 2015, anonymized data from 4.1 million statutory insured patients were analyzed. Cancer patients with incident thrombosis and an outpatient prescription of anticoagulant drugs were identified and evaluated for three subsequent quarters with regard to anticoagulant use. Results A total of 7,313 cancer patients with incident thrombosis (ICD-10: I80*) were evaluated. About, 90% of patients with thromboses were diagnosed and treated in the ambulatory sector. More than 80% of the prescriptions were issued by general practitioners. And 57% of patients were anticoagulated predominantly (>50% of the time) with different low-molecular-weight heparins (LMWHs), 24% predominantly with vitamin K antagonists (VKAs), and 17% with direct oral anticoagulants (DOACs). Anticoagulants were prescribed for an average of 4.5 months. LMWH had a substantially longer prescription period (90–135 days) than VKA (53 days) or DOAC (47 days). Gastrointestinal bleeding in conjunction with hospitalization was documented in 1.76% of patients with a range of 1.3 to 3% for the different LMWHs. Conclusion The prescription practice documented by this representative and comprehensive evaluation demonstrates an anticoagulation duration in accordance with the guidelines, although the choice of the respective anticoagulant was often not in compliance with the contemporary label or guidelines.

Cancer-Associated Venous Thromboembolism—Diagnostic and Therapeutic Considerations: An Update Based on the Revised AWMF S2k Guideline

“…6 With the introduction of the direct oral anticoagulant drugs (DOACs) into VTE therapy of non-cancer patients a decade ago, the use of DOACs also became more frequent in CAT despite a lack of trial evidence or guideline recommendations to support the use of DOAC in CAT. 7,12 Five recent RCTs investigated the efficacy and safety of direct oral factor Xa inhibitors (DXI; apixaban, edoxaban, and rivaroxaban)-a specific subgroup of DOACs-in comparison to LMWH (dalteparin) in CAT. Although individual trial outcomes differed in details, an overall similar benefit-risk balance could be seen across these trials, making DXI a valid treatment alternative also in CAT.…”

“…Guidelines recommend anticoagulation therapy for at least 3 to 6 months, but most patients with CAT complete anticoagulation therapy prior to 6 months. 7 The recently updated German AWMF-S2k Guideline "Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism" 8 offers up-to-date guidance on how to diagnose and treat patients with CAT.…”

Haemostaseological pearls

“…Low-molecular-weight heparin is still considered one of the standard treatments for cancer-associated thrombosis and was shown to be more efficacious and at least as safe as vitamin K antagonists (VKAs) for this indication. In the era of direct oral anticoagulants (DOACs), Riess et al 1 aimed to elucidate the reality of anticoagulation treatment in 7,313 German patients with cancer. In terms of duration of anticoagulation treatment, prescriptions were guideline-conform and considered patient prognosis.…”

Rivaroxaban bei tumorassoziierter venöser Thromboembolie

“…Für CERTIFICAT wurden Krankenkassendaten des Zeitraums 2012–2015 ausgewertet, d. h. aus einer Zeit ohne klinische Daten zu DOAKs bei Patienten mit CAT 45 . Von 7313 Patienten erhielten die meisten (57 %) eine leitliniengerechte Therapie mit NMH über einen Zeitraum von im Mittel 3–4,5 Monaten.…”