Prophylaxis of cancer‑associated venous thromboembolism with low‑molecular‑weight heparin‑tinzaparin: Real world evidence

Abstract

Thromboprophylaxis, as a preventive measure for cancer-associated thrombosis (CAT), may be beneficial for patients with active cancer and high-risk for thrombosis. The present post hoc analysis include a total of 407 patients enrolled in the Greek Management of Thrombosis study, who received thromboprophylaxis with tinzaparin. The objectives of the present analysis were: i) To obtain sufficient evidence for the administration of prophylaxis in patients with active cancer, irrespective of Khorana risk assessment model score; ii) to identify the selection criteria for both dose and duration of tinzaparin; and iii) to evaluate the efficacy and safety of tinzaparin administered for CAT prophylaxis. The main tumor types for the patients included in the present study were as follows: Lung (25.1%), pancreatic (14.3%), breast (9.1%), stomach (8.4%), colorectal (7.9%) and ovarian (7.6%). Furthermore, metastatic disease was observed in 69.5% of the patients. High thrombotic burden agents (HTBAs) were administered to 66.3% of the patients, and 17.4% received erythropoietin. A total of 43.7% of the patients exhibited a Khorana score <2. The results of the present study demonstrated that both the presence of metastatic disease and the use of HTBAs seemed to influence oncologists' decisions for the use of thromboprophylaxis in patients with active cancer, regardless of Khorana score. Tinzaparin, in dose expressed in the standard notation for heparins, i.e., anti-Xa factor international units (Anti-Xa IU), was administered at an intermediate dose (InterD; 8,000-12,000 Anti-Xa IU; once daily) to 52.4% of patients, while the remaining patients received a prophylactic dose (ProD; ≤4,500 Anti-Xa IU; once daily). The average duration of thromoprophylaxis was 5 months. Furthermore, a total of 14 (3.4%) thrombotic events and 6 (1.5%) minor bleeding events were recorded. A total of four thrombotic events were observed following an InterD treatment of tinzaparin, while 10 thrombotic events were observed following ProD treatment. The present study also demonstrated that an InterD of tinzaparin was administered more frequently to patients

Efficacy and Safety of Tinzaparin Thromboprophylaxis in Lung Cancer Patients with High Thromboembolic Risk: A Prospective, Observational, Single-Center Cohort Study

“…Furthermore, they did not differ at 10 days and 3 months, suggesting that the daily intermediate dose of Tinzaparin suffices to achieve stable concentrations. This aligns with recent data suggesting that the use of intermediate doses of Tinzaparin may be more effective than prophylactic doses without safety concerns [36].…”

Can thromboprophylaxis build a link for cancer patients undergoing surgical and/or chemotherapy treatment? The MeTHOS cohort study

“…Since LMWHs express “pleiotropic effects” in a dose-dependent manner, a “high thrombotic burden (HTB)”-adapted strategy could help high-risk patients who may benefit beyond anticoagulation from use of higher than conventional prophylactic LMWH dose. Notably, in recently published data, intermediate-dose tinzaparin (8000–12,000 Anti‑Xa IU, once daily) was found to be more efficacious for the prevention of VTE, without compromising safety [ 54 ]. Tinzaparin sodium possesses important pharmacokinetic properties, with the consecutive involvement of cellular and renal route of elimination, exhibiting no bioaccumulation even in patients with severe renal impairment, maintaining a special stand among other LMWHs [ 55 ] [ 56 ].…”

Gynecological Cancer and Venous Thromboembolism: A Narrative Review to Increase Awareness and Improve Risk Assessment and Prevention

“…Cancer patients receiving systemic treatment are among the higher-risk populations for thromboembolic complications. High-prothrombotic agents include platinum compounds, 5-fluorouracil, capecitabine, gemcitabine, hormonal therapy, and anti-angiogenesis treatments, such as bevacizumab [108]. All the above-mentioned guidelines suggest medical prophylaxis in ambulatory outpatients under systemic therapy if considered at a high risk based on Khorana (>2 score) or other venous thromboembolism risk scores (Table 2) [15][16][17]91,92].…”

“…However, it must be considered that gynecological cancer patients who are more likely to receive platinum-based therapies or anti-angiogenesis treatment have a higher risk of venous thromboembolism complications (Table 1) [110,111]. Accordingly, real-life evidence suggests considering the overall patient profile instead of solely the Khorana risk score in the risk assessment of venous thromboembolism [108].…”