Anticoagulation treatment of cancer patients with deep or superficial leg vein thrombosis – a retrospective observational study of German statutory health insurance claims data (the CERTIFICAT initiative)

Schellong, Sebastian; Kretzschmar, Albrecht; Heinken, Andreas; May, Melanie; Kolbe, Karin; Schreiber, Stefan; Riess, Hanno

doi:10.1024/0301-1526/a000878

Cited by 3 publications

(5 citation statements)

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“…The results of GeCAT differ in some important aspects from those obtained in CERTIFICAT, a retrospective analysis of insurance claims data collected in Germany from 2012 to 2015 [10]. Based on this analysis, more than 80% of prescriptions for CAT patients in the outpatient setting were made by general practitioners and less than 10% by hemato-oncologists.…”

Section: Discussionmentioning

confidence: 88%

Anticoagulation Practice in Patients with Cancer-Associated Thrombosis: Insights from GeCAT, a German Prospective Registry Study

et al. 2021

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Introduction: Cancer-associated venous thrombosis (CAT) is a common and serious complication of active malignancies, increasing in frequency during systemic treatment and radiotherapy. Due to a high risk of recurrence and bleeding, the administration of anticoagulants for initial treatment and secondary prevention of CAT is challenging. We conducted a prospective registry study of patients with acute CAT to evaluate the way treatment is given to these patients in routine practice. Methods: From May 2015 to May 2017, all consecutive patients with acute venous thromboembolism (VTE) admitted to specialty or emergency departments of the participating hospitals in Berlin, Germany, were entered in the registry. Patients with cancer underwent extensive baseline evaluation including the type and location of thrombosis and use of anticoagulant therapy. Follow-up assessments were made at discharge and by telephone interviews at 3 and 6 months. Results: A total of 382 patients with acute CAT were enrolled in the study, representing 24.5% of all patients with thrombosis. 70.4% of CAT patients had deep vein thromboses (DVT), 48.2% had pulmonary embolism (PE), and 18.6% had concurrent PE and DVT. A significant proportion of VTE (27%) were asymptomatic and were diagnosed only incidentally. At baseline, 97.9% of the patients received anticoagulant therapy, predominantly with low-molecular-weight heparin (LMWH) (n=334, 87.4%). Direct oral anticoagulants (DOACs) were given to 5.8% of patients, and vitamin K antagonists (VKAs) were rarely used (<2% of patients). Changes in the prescription of antithrombotic agents were seen at discharge from hospital and during follow-up. Overall, the use of LMWH declined during follow-up, while the proportion of patients treated with DOACs increased to 32.4% at 6 months. At baseline, the most frequently used LMWH were enoxaparin and nadroparin, but many patients were switched to once daily tinzaparin prior to discharge. Initially and after discharge the majority of patients were treated by oncologists. Overall, 263 (68.8%) and 222 (58,1%) patients were still alive and could be contacted at 3 and 6 months of follow-up, respectively. Of these, 84.0% and 71.6% were still on anticoagulant therapy (58.6% and 36.5% on LMWH). Conclusion: In accordance with the guidelines, the majority of CAT patients received anticoagulation therapy for the recommended minimum duration of 3-6 months. LMWH remained the preferred option throughout the study, demonstrating good patient adherence. In deviation from guideline recommendations and available study results during the study period, more than a quarter of CAT patients were treated with DOACs. Only recently, DOACs have been established as another option for anticoagulation in CAT patients.

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Section: Discussionmentioning

confidence: 88%

Anticoagulation Practice in Patients with Cancer-Associated Thrombosis: Insights from GeCAT, a German Prospective Registry Study

et al. 2021

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“…Around 90.0% of incident thromboseswere diagnosed in the outpatient sector. The study population of 7,313 cancer patients with incident thrombosis and at least one outpatient prescription of an anticoagulant was identified using the defined criteria 17 between 2012 and 2015 ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…The bleeding prevalence during and after anticoagulation prescription was analyzed for gastrointestinal bleedings combined with inpatient stays. Further details regarding study design can be found in the publication from Schellong et al 17…”

Section: Methodsmentioning

confidence: 99%

“…The dominant substance was defined as a share of 51% or higher of the defined daily dose in accordance to the DIMDI (Deutsches Institut für Medizinische Dokumentation und Information) definition during the prescription period. 17…”

Section: Methodsmentioning

confidence: 99%

“…The methodology of our study and first results were recently reported 17 and confirmed the feasibility of the here-presented detailed analysis of anticoagulation practice in 7,313 cancer outpatients, allowing us to focus on the kind of anticoagulation drugs more deeply, the prescribing physicians, and the adherence to guideline recommendations. 17…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2021

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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.

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Urgent surgery versus anticoagulation for treatment of superficial vein thrombosis in patients with varicose veins

Casian

Bzovîi

Culiuc

et al. 2022

Vasa

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Summary: Background: We performed a prospective observational study to compare the results of surgery and anticoagulation in patients with superficial vein thrombosis (SVT). Patients and methods: A total of 190 patients (195 limbs) with varicose veins and SVT were included and treated by anticoagulation or by surgery. Patients were followed-up during 6 months. The primary outcome for treatment efficacy was the composite rate of SVT extension/recurrence; deep vein thrombosis (DVT) or symptomatic pulmonary embolism (PE). The primary outcome for safety was the rate of wound complications and rate of bleedings. Results: Surgery was performed in 85 (44.7%) patients and 105 patients (5 with bilateral SVT) were treated conservatively. In the whole study cohort the primary outcome for treatment efficacy was registered in 15 (7.6%) cases: 9/85 (10.5%) in surgical group and 6/110 (5.4%) in anticoagulation group. Nine patients treated with surgery were diagnosed with postoperative DVT. In anticoagulation group SVT extension occurred in 3 limbs; SVT recurrence in 2 and DVT in one. There were no cases of PE or death during the follow-up. Time-to-event analysis demonstrated no significant difference between groups (HR 0.48; 95% CI 0.17–1.34). The total length of the thrombus was associated with primary efficacy outcome in surgical group (HR 1.07; 95% CI 1.02–1.11); and duration of anticoagulation (HR 0.91 per day; 95% CI 0.83–0.99) and value of Caprini score (HR 1.86; 95% CI 1.1–3.14) in anticoagulation group. Six (7%) wound complications were registered after surgery and 6 (5.71%) bleedings during anticoagulation. Conclusions: Urgent surgery is not associated with reduction of venous thromboembolism compared to anticoagulation in treatment of patients with SVT and varicose veins during 6-months follow-up. However, in patients with isolated thrombosis of varicose tributaries or with limited involvement of the saphenous trunk surgery is relatively safe.

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Anticoagulation treatment of cancer patients with deep or superficial leg vein thrombosis – a retrospective observational study of German statutory health insurance claims data (the CERTIFICAT initiative)

Cited by 3 publications

References 25 publications

Anticoagulation Practice in Patients with Cancer-Associated Thrombosis: Insights from GeCAT, a German Prospective Registry Study

Anticoagulation Practice in Patients with Cancer-Associated Thrombosis: Insights from GeCAT, a German Prospective Registry Study

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

Urgent surgery versus anticoagulation for treatment of superficial vein thrombosis in patients with varicose veins

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