Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

Abstract

Background. Evidence-based treatment guidelines recommend low molecular weight heparin (LMWH) monotherapy for cancer-associated venous thromboembolism (VTE). This analysis assessed the first-line treatment strategies for VTE in patients with advanced solid tumors.Methods. Using administrative data from advanced lung, prostate, colon, or breast cancer patients diagnosed between January 2000 and December 2007 at four HMOs with integrated delivery systems, patients with an inpatient or outpatient VTE diagnosed within 2 years after cancer diagnosis and an outpatient purchase of warfarin, LMWH, and/or fondaparinux anticoagulant within 7 days of the VTE diagnosis were identified. First-line outpatient VTE pharmacological treatment and factors independently associated with receipt/non-receipt of LMWH monotherapy were assessed.Results. Overall, 25% of the 1,089 eligible patients received LMWH monotherapy as primary VTE treatment.

Compliance with recommendations of clinical practice in the management of venous thromboembolism in cancer: The CARMEN study

“…Similar observations were made from a previous retrospective, longitudinal cohort study in 1089 cancer patients with diagnosed VTE showing that the proportion of cancer patients receiving LMWH as a first-line therapy for the prevention of VTE recurrence had increased from 8% in 2000 to 31% in 2008 even though this remains insufficient [17]. Furthermore, another study in Switzerland has shown that only 39% of cancer patients with VTE were planned for long-term treatment with LMWH [18].…”

Low-molecular-weight heparins for cancer-associated thrombosis: Adherence to clinical practice guidelines and patient perception in TROPIQUE, a 409-patient prospective observational study

“…More recently a trend towards a superior efficacy in reducing the relative risk of VTE recurrence was shown with the LMWH tinzaparin compared to VKA [19]. Despite the evidence [20][21][22], there are substantial reports from observational studies of insufficient adherence to established clinical practice guidelines [23][24][25][26][27]. Thrombosis Research 144 (2016) [85][86][87][88][89][90][91][92] Recent studies have shown that long-term LMWH were well accepted by patients and physicians tended to underestimate patients' ability to accept long-term treatment with LMWH [28].…”

Practice Patterns for Prophylaxis and Treatment of Venous Thromboembolism in German Cancer Patients

“…This is particularly true for the use of LMWHs in the long-term treatment of cancer-associated VTE. Many patients receive VKAs instead, and if LMWHs are given, they are often underdosed or terminated prematurely [18,19,20,21,22,23,24,25,26,27,28,29]. With the advent of NOACs, the preference of the guidelines for LMWHs over any of these newer agents will be further challenged.…”