Skip to main content
Journal cover image

Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis.

Publication ,  Journal Article
Schulman, S; Zondag, M; Linkins, L; Pasca, S; Cheung, YW; de Sancho, M; Gallus, A; Lecumberri, R; Molnar, S; Ageno, W; Le Gal, G; Falanga, A ...
Published in: J Thromb Haemost
June 2015

BACKGROUND: Recommendations for management of cancer-related venous thromboembolism (VTE) in patients already receiving anticoagulant therapy are based on low-quality evidence. This international registry sought to provide more information on outcomes after a breakthrough VTE in relation to anticoagulation strategies. METHODS: Patients with cancer and VTE despite anticoagulant therapy were reported to the registry. Data on treatments, VTE events, major bleeding, residual thrombosis symptoms and death were collected for the following 3 months. Breakthrough VTE and subsequent recurrences were objectively verified. Outcomes with different treatment strategies were compared with Cox proportional hazards regression. RESULTS: We registered 212 patients with breakthrough VTE. Of those, 59% had adenocarcinoma and 73% had known metastases. At the time of the breakthrough event, 70% were on low-molecular-weight heparin (LMWH) and 27% on a vitamin K antagonist (VKA); 70% had a therapeutic or supratherapeutic dose. After breakthrough the regimen was: unchanged therapeutic dose in 33%, dose increased in 31%, switched to another drug in 24%; and other management in 11%. During the following 3 months 11% had another VTE, 8% had major bleeding and 27% died. Of the survivors, 74% had residual thrombosis symptoms. Additional VTE recurrence was less common with LMWH than with a VKA (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.11-0.70) but similar with unchanged or increased anticoagulant intensity (HR, 1.09; 95% CI, 0.45-2.63). The bleeding rate did not increase significantly with dose escalation. CONCLUSION: Morbidity and mortality are high after recurrence of cancer-related VTE despite anticoagulation. Further treatment appears to be more effective with LMWH than with a VKA.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

June 2015

Volume

13

Issue

6

Start / End Page

1010 / 1018

Location

England

Related Subject Headings

  • Warfarin
  • Vitamin K
  • Venous Thromboembolism
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Recurrence
  • Prospective Studies
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Schulman, S., Zondag, M., Linkins, L., Pasca, S., Cheung, Y. W., de Sancho, M., … Lee, A. (2015). Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis. J Thromb Haemost, 13(6), 1010–1018. https://doi.org/10.1111/jth.12955
Schulman, S., M. Zondag, L. Linkins, S. Pasca, Y. W. Cheung, M. de Sancho, A. Gallus, et al. “Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis.J Thromb Haemost 13, no. 6 (June 2015): 1010–18. https://doi.org/10.1111/jth.12955.
Schulman S, Zondag M, Linkins L, Pasca S, Cheung YW, de Sancho M, et al. Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis. J Thromb Haemost. 2015 Jun;13(6):1010–8.
Schulman, S., et al. “Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis.J Thromb Haemost, vol. 13, no. 6, June 2015, pp. 1010–18. Pubmed, doi:10.1111/jth.12955.
Schulman S, Zondag M, Linkins L, Pasca S, Cheung YW, de Sancho M, Gallus A, Lecumberri R, Molnar S, Ageno W, Le Gal G, Falanga A, Hulegårdh E, Ranta S, Kamphuisen P, Debourdeau P, Rigamonti V, Ortel TL, Lee A. Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis. J Thromb Haemost. 2015 Jun;13(6):1010–1018.
Journal cover image

Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

June 2015

Volume

13

Issue

6

Start / End Page

1010 / 1018

Location

England

Related Subject Headings

  • Warfarin
  • Vitamin K
  • Venous Thromboembolism
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Recurrence
  • Prospective Studies