Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.
Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
J Thromb Haemost. 2022 Mar;20(3):619-634. doi: 10.1111/jth.15599. Epub 2021 Dec 8.
Patients with cancer-associated venous thromboembolism (VTE) are recommended to receive treatment with therapeutic anticoagulation for at least 3-6 months. Little data exist on extended treatment beyond 6 months.
To comprehensively summarize the best available evidence on incidence of recurrent VTE and major bleeding 6-12 months after the index event in patients with cancer-associated VTE.
PATIENTS/METHODS: We systematically screened biomedical databases (MEDLINE, Embase, CENTRAL) to identify studies reporting recurrent VTE and/or bleeding events between 6 and 12 months after a diagnosis of cancer-associated VTE. Based on the observed heterogeneity in study design, setting, patient cohort characteristics, anticoagulation strategies, and outcome rates, no overall quantitative estimate of outcome rates was calculated.
We screened 2597 publications and identified 11 eligible studies matching predefined in-/exclusion criteria, reporting on 3019 patients specifically during the 6- to 12-month period post-index VTE. Overall rates of recurrent VTE in this timeframe varied substantially (1%-12%), with the highest risk observed in the patient subgroup with residual vein thrombosis present at 6 months randomized to receive no anticoagulation (13%-15%). Reported rates of major bleeding between 6 and 12 months were between 2% and 5%.
In this systematic review, we provide a comprehensive and structured summary of the best available evidence on recurrence and bleeding risk between 6 and 12 months after cancer-associated VTE. VTE recurrence remains common beyond 6 months and continuation of different anticoagulation strategies has an acceptable safety profile indicated by lower bleeding rates. These findings support guideline recommendations to continue anticoagulation treatment beyond 6 months in patients with active cancer.
患有癌症相关静脉血栓栓塞症（VTE）的患者建议接受至少 3-6 个月的治疗性抗凝治疗。关于 6 个月后延长治疗的资料很少。
全面总结癌症相关 VTE 患者在指数事件后 6-12 个月时复发性 VTE 和主要出血的最佳现有证据。
患者/方法：我们系统地筛选了生物医学数据库（MEDLINE、Embase、CENTRAL），以确定报告癌症相关 VTE 诊断后 6-12 个月时复发性 VTE 和/或出血事件的研究。基于研究设计、设置、患者队列特征、抗凝策略和结局发生率的观察到的异质性，未计算结局发生率的总体定量估计值。
我们筛选了 2597 篇文献，确定了 11 项符合预定义纳入/排除标准的合格研究，这些研究专门报告了 3019 例患者在指数 VTE 后 6-12 个月期间的情况。在该时间范围内，复发性 VTE 的总体发生率差异很大（1%-12%），在随机接受无抗凝治疗且 6 个月时存在残留静脉血栓形成的患者亚组中观察到最高风险（13%-15%）。报告的 6-12 个月期间大出血发生率在 2%-5%之间。
在这项系统评价中，我们全面、系统地总结了癌症相关 VTE 后 6-12 个月时复发和出血风险的最佳现有证据。VTE 复发在 6 个月后仍很常见，不同抗凝策略的继续使用具有可接受的安全性，表现为较低的出血率。这些发现支持指南建议在有活动性癌症的患者中继续抗凝治疗超过 6 个月。
