Clinical Pharmacy Research Scientist, Pharmacy Department, Kaiser Permanente Colorado, 16601 E. Centretech Parkway, Aurora, Colorado 80011, USA.
Oncologist. 2012;17(3):419-27. doi: 10.1634/theoncologist.2011-0323. Epub 2012 Feb 14.
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.
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.
Overall, 25% of the 1,089 eligible patients received LMWH monotherapy as primary VTE treatment. The percentage increased steadily over time from 18% among patients diagnosed in 2000 to 31% among those diagnosed in 2007. Factors associated with LMWH monotherapy included VTE diagnosis year, chemotherapy within 60 days prior to VTE diagnosis, history of VTE prior to cancer diagnosis, and invasive surgery in the 90 days following VTE diagnosis. Colorectal and prostate cancer patients versus lung cancer patients and stage III versus stage IV patients were less likely to be treated with LMWH monotherapy.
Adoption of LMWH monotherapy as initial treatment for cancer-associated VTE was low but increased steadily over the study period. Future studies should explore reasons underlying the underutilization of this preferred evidence-based treatment as well as the comparative effectiveness of LMWH versus warfarin-based anticoagulation in real-world cancer patients with VTE.
循证治疗指南建议将低分子肝素（LMWH）单药治疗用于癌症相关静脉血栓栓塞症（VTE）。本分析评估了晚期实体瘤患者 VTE 的一线治疗策略。
使用来自四个具有综合交付系统的 HMO 的 2000 年 1 月至 2007 年 12 月期间诊断为晚期肺癌、前列腺癌、结肠癌或乳腺癌的患者的行政数据，这些患者在癌症诊断后 2 年内有门诊或住院 VTE 诊断，并且在 VTE 诊断后 7 天内有门诊购买华法林、LMWH 和/或磺达肝素抗凝剂。评估了一线门诊 VTE 药物治疗和与接受/未接受 LMWH 单药治疗独立相关的因素。
总体而言，1089 名合格患者中有 25%接受 LMWH 单药治疗作为 VTE 的主要治疗方法。该比例从 2000 年诊断的患者的 18%稳步上升至 2007 年诊断的患者的 31%。与 LMWH 单药治疗相关的因素包括 VTE 诊断年份、VTE 诊断前 60 天内的化疗、癌症诊断前的 VTE 史以及 VTE 诊断后 90 天内的侵袭性手术。与肺癌患者相比，结直肠癌和前列腺癌患者以及 III 期与 IV 期患者更不可能接受 LMWH 单药治疗。
将 LMWH 单药治疗作为癌症相关 VTE 的初始治疗方法的采用率较低，但在研究期间稳步上升。未来的研究应探讨这种首选循证治疗方法利用不足的原因，以及 LMWH 与华法林为基础的抗凝剂在真实世界中 VTE 癌症患者中的比较效果。
