Recurrence of Venous Thromboembolism in Patients With Cancer Treated With Warfarin

Marshall, Ariela L.; Campigotto, Federico; Neuberg, Donna; Rowe, Betty; Connors, Jean M.

doi:10.1177/1076029615579099

Cited by 14 publications

(14 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Anticoagulant therapy may be difficult to manage in patients with active cancer , and the physician choice for oral anticoagulant therapy may depend on type of cancer and time since cancer diagnosis. Patients with active cancer treated with VKA therapy may not meet the desired international normalized ratio (INR) interval due to hypercoagulation, interaction with oncology drugs, or concurrent conditions , but the frequencies of comorbidities did not vary substantial among cancer patients with VKA versus NOAC prescriptions in our study.…”

Section: Discussionmentioning

confidence: 99%

Thromboembolic and bleeding complications during oral anticoagulation therapy in cancer patients with atrial fibrillation: a Danish nationwide population‐based cohort study

et al. 2017

View full text Add to dashboard Cite

Coexisting cancer in patients with atrial fibrillation (AF) has been associated with thromboembolism and bleeding. We used Danish population‐based medical databases to conduct a population‐based cohort study that included all AF patients who redeemed a prescription for vitamin K antagonists (VKA) or non‐VKA oral anticoagulant (NOAC) between July 2004 and December 2013. We characterized these patients according to the presence (N = 11,855) or absence (N = 56,264) of a cancer diagnosis before redemption of their oral anticoagulant prescription, and then examined their 1‐year risk of thromboembolic or bleeding complications or death. We next used Cox regression to compare the hazard ratios for complications among VKA‐ or NOAC‐treated AF patients with versus without a cancer diagnosis, after adjusting for sex, age, and CHA2DS2 VASc score. One‐year risks of thromboembolic complications in AF patients who redeemed a VKA prescription were similar in those with (6.5%) and without (5.8%) cancer [hazard ratio (HR) 1.0 (95% confidence interval (CI): 0.93, 1.1)]. This also was found for bleeding complications (5.4% vs. 4.3%, HR 1.1 [95% CI: 1.0, 1.2]). For AF patients with cancer who redeemed a NOAC prescription, risks were also similar for thromboembolic complications (4.9% of cancer patients vs. 5.1% of noncancer patients, HR 0.80 [95% CI: 0.61, 1.1]), and for bleeding complications (4.4% vs. 3.1%, HR 1.2 [95% CI: 0.92, 1.7]). The absolute risks of thromboembolic or bleeding complications were nearly the same in patients with and without cancer who redeemed prescription for VKAs or NOACs.

show abstract

Section: Discussionmentioning

confidence: 99%

Thromboembolic and bleeding complications during oral anticoagulation therapy in cancer patients with atrial fibrillation: a Danish nationwide population‐based cohort study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…40 A small retrospective study of cancer patients with VTE also noted favorable results with warfarin therapy compared with LMWH. 41 These studies suggest that VKAs may be as effective as LMWH in some cancer patients with VTE. Further research is warranted to confirm these findings.…”

Section: What Is the Risk Of Venous Thromboembolism (Vte) In Cancer Pmentioning

confidence: 94%

Thrombosis in the setting of cancer

Streiff

2016

Hematology

View full text Add to dashboard Cite

Venous thromboembolism (VTE) is a common cause of adverse outcomes in patients with cancer. The risk of VTE varies with cancer type, stage and grade, cancer therapy, and supportive care, as well as patient characteristics including age, ethnicity, and inherited and acquired comorbid conditions. VTE prophylaxis should be provided to all hospitalized cancer patients and high-risk outpatients. Low-molecular-weight heparin (LMWH) remains the first-line therapy for VTE in patients with active cancer. Anticoagulation should be continued as long as there is evidence of active disease or patients are receiving cancer treatment. The efficacy of direct oral anticoagulants in the treatment of cancer-associated thrombosis remains incompletely defined. Central venous catheter (CVC)–associated VTE should be treated with anticoagulation alone, unless the CVC is no longer required. Recent studies indicate that anticoagulation may be appropriate for patients with persistent thrombocytopenia or solid tumor brain metastases. Management of recurrent VTE includes the identification of the cause(s) of the recurrence and solutions targeted at addressing the potential precipitants.

show abstract

“…The differences in severity of cancer stage and associated complications also led to a lower event rate in the VKA arm in CATCH, resulting in an underpowered study. Improved VKA management or the use of VKAs in a population more like the CATCH trial could potentially overcome these issues, as demonstrated by a published retrospective study demonstrating the equivalence of warfarin and LMWH for prevention of VTE recurrence in cancer patients cared for in a dedicated anticoagulation clinic providing support for oncologic clinicians [ 26 ]. The TTR was 59.5% for patients treated with warfarin, and bleeding rates were similar between warfarin and LMWH-treated patients.…”

Section: Vitamin K Antagonists and Low Molecular Weight Heparins Fmentioning

confidence: 99%

The Role of Direct Oral Anticoagulants in Treatment of Cancer-Associated Thrombosis

Al‐Samkari

Connors

2018

Cancers

View full text Add to dashboard Cite

Venous thromboembolism (VTE) complicates the clinical course of approximately 5–10% of all cancer patients. Anticoagulation of the cancer patient often presents unique challenges as these patients have both a higher risk of recurrent VTE and a higher risk of bleeding than patients without cancer. Although low molecular weight heparins (LMWH) are the standard of care for the management of cancer-associated VTE, their use requires once or twice daily subcutaneous injections, which can be a significant burden for many cancer patients who often require a long duration of anticoagulation. The direct oral anticoagulants (DOACs) are attractive options for patients with malignancy. DOACs offer immediate onset of action and short half-lives, properties similar to LMWH, but the oral route of administration is a significant advantage. Given the higher risks of recurrent VTE and bleeding, there has been concern about the efficacy and safety of DOACs in this patient population. Data are now emerging for the use of DOACs in the cancer patient population from dedicated clinical trials. While recently published data suggest that DOACs hold promise for the treatment of cancer associated VTE, additional studies are needed to establish DOACs as the standard-of-care treatment. Many such studies are currently underway. The available data for the use of DOACs in the treatment of cancer-associated VTE will be reviewed, focusing on efficacy, safety, and other considerations relevant to the cancer patient.

show abstract

Recurrence of Venous Thromboembolism in Patients With Cancer Treated With Warfarin

Cited by 14 publications

References 28 publications

Thromboembolic and bleeding complications during oral anticoagulation therapy in cancer patients with atrial fibrillation: a Danish nationwide population‐based cohort study

Thromboembolic and bleeding complications during oral anticoagulation therapy in cancer patients with atrial fibrillation: a Danish nationwide population‐based cohort study

Thrombosis in the setting of cancer

The Role of Direct Oral Anticoagulants in Treatment of Cancer-Associated Thrombosis

Contact Info

Product

Resources

About