Optimal Duration of Low Molecular Weight Heparin for the Treatment of Cancer-Related Deep Vein Thrombosis: The Cancer-DACUS Study

Napolitano, Mariasanta; Saccullo, Giorgia; Malato, Alessandra; Sprini, Delia; Ageno, Walter; Imberti, Davide; Mascheroni, Doris; Bucherini, Eugenio; Gallucci, Pina; D’Alessio, Andrea; Prantera, T.; Spadaro, P.; Rotondo, Stefano; Micco, Pierpaolo Di; Oriana, Vincenzo; Urbano, O; Recchia, F.; Ghirarduzzi, Angelo; Coco, Lucio Lo; Mancuso, Salvatrice; Casuccio, Alessandra; Rini, Giovam Battista; Siragusa, Sergio

doi:10.1200/jco.2013.51.7433

Cited by 102 publications

(69 citation statements)

References 25 publications

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“…The updated search identifi ed one study 47 that assessed extended LMWH treatment in patients with cancer and residual VTE after an initial 6 months of nadroparin (97 IU/kg twice a day). Patients with residual VTE were randomly assigned to either 6-month anticoagulation continuation (119 patients) or immediate anticoagulant discontinuation (123 patients).…”

Section: Early Maintenance (10 Days To 3 Months) and Long-term (Beyonmentioning

confidence: 99%

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Farge

Bounameaux

Brenner

et al. 2016

The Lancet Oncology

391

434

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Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at an increased risk of developing VTE and are more likely to have a recurrence of VTE and bleeding while taking anticoagulants. Management of VTE in patients with cancer is a major therapeutic challenge and remains suboptimal worldwide. In 2013, the International Initiative on Thrombosis and Cancer (ITAC-CME), established to reduce the global burden of VTE in patients with cancer, published international guidelines for the treatment and prophylaxis of VTE and central venous catheter-associated thrombosis. The rapid global adoption of direct oral anticoagulants for management of VTE in patients with cancer is an emerging treatment trend that needs to be addressed based on the current level of evidence. In this Review, we provide an update of the ITAC-CME consensus recommendations based on a systematic review of the literature ranked according to the Grading of Recommendations Assessment, Development, and Evaluation scale. These guidelines aim to address in-hospital and outpatient cancer-associated VTE in specifi c subgroups of patients with cancer.

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Section: Early Maintenance (10 Days To 3 Months) and Long-term (Beyonmentioning

confidence: 99%

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Farge

Bounameaux

Brenner

et al. 2016

The Lancet Oncology

391

434

View full text Add to dashboard Cite

show abstract

“…3,26 The recurrence rate at 5 years has not been estimated given the high cancer mortality by 5 years. In the DACUS study, 27 an additional 6 months of anticoagulation was found to reduce the risk of DVT recurrence in patients who had residual DVT on ultrasound imaging following their initial 6 months of anticoagulation. However, this reduction in recurrent VTE risk was lost once anticoagulation had been stopped.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Deep Vein Thrombosis Interventions in Cancer Patients

Charalel

Vedantham

2017

Semin intervent Radiol

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The presence of cancer increases the risk of deep vein thrombosis (DVT), DVT recurrence, and treatment-related bleeding, and therefore offers distinctive clinical considerations when planning treatment. Anticoagulation with a low-molecular-weight heparin is the preferred initial and long-term therapy in cancer patients. Inferior vena cava filters may be used judiciously for patients with cancer-related DVT who have contraindications to anticoagulation or who exhibit breakthrough pulmonary embolism (PE) despite anticoagulation, but should be removed when the PE risk is felt to subside. Because moderate-quality evidence suggests that the use of catheter-directed thrombolysis (CDT) can prevent the postthrombotic syndrome, cancer patients with acute iliofemoral DVT, low expected bleeding risk, and good functional status may reasonably be considered for CDT if DVT-related sequelae are likely to be a dominant contributor to the patient's clinical condition, functional status, and quality of life. In selected patients who have chronic venous symptoms from mass/nodal compression of the pelvic veins, endovascular stent placement may provide symptom relief. As current recommendations are based on very limited data, further studies would be welcome to better delineate the most appropriate use of endovascular therapies in patients with cancer.

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“…The adoption of an algorithm incorporating both RVT and serial D-Dimer was found to identify a substantial proportion of patients with unprovoked DVT in who anticoagulation can be safely discontinued (annual rate of recurrent VTE, 3.0%). According to recent findings, RVT can be of help for predicting the risk of recurrent VTE also in patients with cancer [19].…”

Section: Issn: 2380-6842mentioning

confidence: 96%

Residual Clot in Patients with Deep Vein Thrombosis and Pulmonary Embolism: Prognostic Implications

2015

J Hematol Thromb

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In order to assess whether there is discordance in the timing of thrombus resolution between deep vein thrombosis (DVT) and pulmonary embolism (PE), we analyzed current evidence from recent major literature, and evaluated its prognostic implications. After an episode of proximal DVT, residual vein thrombosis (RVT), as shown with ultrasonography, is still detectable in approximately 50% of patients after three months, and in lower proportions afterwards. RVT is likely to represent a marker of hypercoagulability, and is associated with an approximately doubled risk for recurrent thromboembolism, post-thrombotic syndrome, arterial thrombotic events and cancer. Males, individuals with extensive thrombosis and those with previous thromboembolism have the highest likelihood of developing RVT. Conversely, based on recent findings in 85% of patients with PE a full recanalization, as shown by CT scanning, is achieved, and in the remaining patients the thrombotic mass decreases by 80%. No association exists between residual embolism and the risk for recurrent thromboembolism or chronic thromboembolic pulmonary hypertension. Accordingly, repeating CT scanning for prognostic implications does not seem justified. These findings add to the growing perception that DVT and PE are to be regarded as separate pathophysiological entities.

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Optimal Duration of Low Molecular Weight Heparin for the Treatment of Cancer-Related Deep Vein Thrombosis: The Cancer-DACUS Study

Abstract: In patients with cancer with a first DVT, treated for 6 months with LMWH, absence of RVT identifies a population at low risk for recurrent thrombotic events. Continuation of LMWH in patients with RVT up to 1 year did not reduce recurrent VTE.

Cited by 102 publications

References 25 publications

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Deep Vein Thrombosis Interventions in Cancer Patients

Residual Clot in Patients with Deep Vein Thrombosis and Pulmonary Embolism: Prognostic Implications

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