Vichaidit Kawin, Chantrathammachart Pichika, Niparuck Pimjai, Puawilai Teeraya, Angchaisuksiri Pantep, Boonyawat Kochawan
Department of Internal medicine, Ramathibodi Hospital, Mahidol University, Thailand.
Res Pract Thromb Haemost. 2024 Nov 26;9(1):102643. doi: 10.1016/j.rpth.2024.102643. eCollection 2025 Jan.
Reduced-dose anticoagulant therapy for extended treatment of cancer-associated venous thromboembolism (VTE) has been used to avoid bleeding. However, it may increase the risk of recurrent VTE.
To study the rate of recurrent VTE and bleeding complications in Thai patients with cancer-associated VTE who were treated with full-dos/e or reduced-dose anticoagulants.
A retrospective cohort study was conducted in a single-center academic hospital. Electronic medical records were reviewed from 2016-2023. Patients with cancer-associated VTE who received anticoagulants for at least 3 months were evaluated. Reduced-dose anticoagulant was defined as a dose that was lower than the recommended standard dosage. The primary outcome was recurrent VTE. The secondary outcomes were major bleeding and clinically relevant nonmajor bleeding.
A total of 229 patients were included. The median age was 65 years (IQR, 54-72). In the reduced-dose group, age and history of previous bleeding were higher than in the full-dose group. There were 169 (74%) patients and 60 (26%) patients who received full- and reduced-dose anticoagulants. The median time to reduce the dose was 3.6 months (IQR, 0.7-5.5). Of a total of 7 (3.1%) recurrent VTEs, 4 (2.4%) occurred in the full-dose and 3 (5.0%) in the reduced-dose groups ( = .4), respectively. The median time to recurrent VTE was 7.2 months (IQR, 3.5-12.4). There were 8 (3.5%) bleeding events, 7 (4.1%) and 1 (1.7%) in the full and reduced-dose anticoagulant groups ( = .35), respectively. The median follow-up time was 1.5 years (IQR, 1-3.1).
Older age and a history of previous bleeding were associated with the use of reduced-dose anticoagulants. Patients with cancer-associated VTE receiving reduced-dose anticoagulants had a numerically higher risk of recurrent VTE and lower bleeding outcomes compared with those receiving full-dose anticoagulants.
降低剂量的抗凝治疗用于癌症相关静脉血栓栓塞（VTE）的延长治疗，以避免出血。然而，这可能会增加VTE复发的风险。
研究接受全剂量或降低剂量抗凝剂治疗的泰国癌症相关VTE患者的VTE复发率和出血并发症。
在一家单中心学术医院进行了一项回顾性队列研究。回顾了2016年至2023年的电子病历。对接受抗凝剂治疗至少3个月的癌症相关VTE患者进行评估。降低剂量的抗凝剂定义为低于推荐标准剂量的剂量。主要结局是VTE复发。次要结局是大出血和临床相关非大出血。
共纳入229例患者。中位年龄为65岁（四分位间距，54 - 72岁）。在降低剂量组中，年龄和既往出血史高于全剂量组。分别有169例（74%）和60例（26%）患者接受了全剂量和降低剂量的抗凝剂。降低剂量的中位时间为3.6个月（四分位间距，0.7 - 5.5个月）。在总共7例（3.1%）VTE复发中，全剂量组有4例（2.4%），降低剂量组有3例（5.0%）（P = 0.4）。VTE复发的中位时间为7.2个月（四分位间距，3.5 - 12.4个月）。有8例（3.5%）出血事件，全剂量和降低剂量抗凝剂组分别为7例（4.1%）和1例（1.7%）（P = 0.35）。中位随访时间为1.5年（四分位间距，1 - 3.1年）。
年龄较大和既往有出血史与使用降低剂量的抗凝剂有关。与接受全剂量抗凝剂的患者相比，接受降低剂量抗凝剂的癌症相关VTE患者VTE复发的风险在数值上更高，出血结局更低。
