Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Internal Medicine and Medical Oncology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:1076029620979575. doi: 10.1177/1076029620979575.
This study assessed epidemiologic data and clinical outcomes, including venous thromboembolism (VTE) recurrence and bleeding events, in patients with cancer-associated VTE, and assessed factors associated with clinical outcomes. Data were extracted from retrospective medical-chart review of adult patients diagnosed with cancer-associated deep vein thrombosis or pulmonary embolism who received anticoagulation treatment for ≥3 months. Patients were classified by: low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs), and other anticoagulants. First VTE recurrence and bleeding events, and factors associated with their occurrence, were assessed during the initial 6 months of treatment. Overall, 623 patients (age: 63.7 ± 11.3 years, 49.3% male) were included (119, 132, and 372 patients in LMWH, DOACs and other anticoagulants groups, respectively). The cumulative 6-month incidence of VTE recurrence was 16.6% (total), 8.3% (LMWH), 16.7% (DOACs), and 20.7% (other); respective bleeding events were 22.5%, 11.0%, 12.3%, and 30.7%). VTE recurrence and bleeding rates differed only between LMWH and other anticoagulants (HR 2.4, 95% CI: 1.2-5.0 and 3.6, 1.9-6.8, respectively). These results highlight the importance of initial VTE treatment choice for preventing VTE recurrence and bleeding events. LMWH or DOACs for ≥3 months can be considered for effective VTE management in cancer patients.
本研究评估了癌症相关静脉血栓栓塞症（VTE）患者的流行病学数据和临床结局，包括 VTE 复发和出血事件，并评估了与临床结局相关的因素。数据来自对接受抗凝治疗≥3 个月的成人癌症相关深静脉血栓形成或肺栓塞患者的回顾性病历回顾中提取。患者按低分子肝素（LMWH）、直接口服抗凝剂（DOAC）和其他抗凝剂进行分类。在治疗的最初 6 个月内评估首次 VTE 复发和出血事件及其发生的相关因素。共有 623 名患者（年龄：63.7±11.3 岁，49.3%为男性）被纳入研究（LMWH、DOAC 和其他抗凝剂组分别有 119、132 和 372 名患者）。VTE 复发的 6 个月累积发生率为 16.6%（总发生率）、8.3%（LMWH）、16.7%（DOAC）和 20.7%（其他）；相应的出血事件发生率分别为 22.5%、11.0%、12.3%和 30.7%。VTE 复发和出血率仅在 LMWH 和其他抗凝剂之间存在差异（HR 2.4，95%CI：1.2-5.0 和 3.6，1.9-6.8）。这些结果强调了初始 VTE 治疗选择对预防 VTE 复发和出血事件的重要性。对于癌症患者，LMWH 或 DOAC 治疗≥3 个月可被视为有效的 VTE 管理方法。
