Long-Term Treatment of Cancer-Associated Thrombosis (CAT) Beyond 6 Months in the Medical Practice: USCAT, a 432-Patient Retrospective Non-Interventional Study

Abstract

Background: extended anticoagulant therapy beyond the initial 6 months is suggested in patients with cancer-associated thrombosis (CAT) and active cancer. Few data are available on patient management and outcomes on the period between 6 and 12 months after the venous thromboembolism (VTE) event. Objectives: our objective was to document patient management and outcomes beyond 6 months and up to 12 months in CAT patients initially treated for 6 months with tinzaparin. Methods: adult CAT patients with a cancer still alive at the end of an initial 6-month treatment period were eligible to participate in this retrospective non-interventional French multicenter study. Results: a total of 432 patients aged 66.5 ± 12.7 years were available to participate in this study. Out of the patients included in the study, the anticoagulant treatment was maintained in 348 of 422 documented patients (82.5%) while it was discontinued in 74 (17.5%) patients (before the end or at the end of the initial 6-month treatment period). Between 6 and 12 months, 24 patients (5.7%) experienced VTE recurrence, while 21 (5.1%) patients had clinically relevant bleeding, 11 patients (2.7%) had major bleeding and 96 patients (22.3%) died, mostly from cancer. VTE recurrence was more frequent in patients with lung (14.3%) and colorectal cancer (6.0%) while major bleeding was more frequent in patients with colorectal cancer (6.0%). Conclusion: clinical outcomes were consistent with previous observations and variable according to the type of cancer. Further clinical research is required to orient the management of patients with CAT beyond 6 months based on cancer-specific treatment strategies.

Adult breast, lung, pancreatic, upper and lower gastrointestinal cancer patients with venous thromboembolism in the nationalFrench hospital discharge database

“…Cancer-associated thrombosis (CAT) represents a signi cant challenge since they are at higher risk of both VTE recurrence and major bleeding compared to patients without cancer (15,16). Guidelines have considerably changed over the recent years and currently rely upon low-molecular weight heparin (LMWH) and direct oral anticoagulants such as apixaban, rivaroxaban or edoxaban (17)(18)(19).…”

“…In women, higher rates of VTE are also found in ovarian and breast cancer patients (9,10). Furthermore, active cancer is also a predictor of VTE recurrence (12-14).Cancer-associated thrombosis (CAT) represents a signi cant challenge since they are at higher risk of both VTE recurrence and major bleeding compared to patients without cancer (15,16). Guidelines have considerably changed over the recent years and currently rely upon low-molecular weight heparin (LMWH) and direct oral anticoagulants such as apixaban, rivaroxaban or edoxaban (17)(18)(19).The aims of our study were to ll the evidence gap regarding CAT in France and to provide up-to-date data on the number of VTE events among cancer patients, the patient characteristics, and their hospital management.…”

Incidence, risk factors, and management of bleeding in patients receiving anticoagulants for the treatment of cancer-associated thrombosis

“…In the TiCAT study (n = 247) [30], the CRB rate was 0.9% per patient-month during months 1-6 and 0.6% per patient-month during months 7-12 (p = 0.5) while the rate of VTE recurrence was 4.5% during months 1-6 and 1.1% during months 7-12. Finally, in the USCAT study (n = 432) [31], the CRB, MB, and VTE recurrence rates during months 6-12 were 5.1%, 2.7%, and 5.7%, respectively.…”

Extended Anticoagulant Treatment with Full- or Reduced-Dose Apixaban in Patients with Cancer-Associated Venous Thromboembolism: Rationale and Design of the API-CAT Study

“…2,[4][5][6][7][8][9] Consequently, up to 60% of patients with cancer are still alive 6 months after the index VTE event. 10,11 The optimal treatment beyond the first 6 months of treatment for CAT− a disease with considerable economic impact 12,13 − is unknown, but lies in the prevention of recurrent VTE while avoiding excess bleeding. 12,13 After 6 months of anticoagulant treatment, the risk of VTE recurrence is lower than during the first 6 months, but is still considerable in patients with CAT.…”

“… 2 4 5 6 7 8 9 Consequently, up to 60% of patients with cancer are still alive 6 months after the index VTE event. 10 11 The optimal treatment beyond the first 6 months of treatment for CT—a disease with considerable economic impact 12 13 —is unknown, but lies in the prevention of recurrent VTE while avoiding excess bleeding. 12 13 …”