Treatment Patterns and Clinical Outcomes in Korean Cancer Patients With Venous Thromboembolism: A Retrospective Cohort Study

Abstract

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.

Dynamic Patterns and Persistence of Anticoagulation Therapy in Patients with Venous Thromboembolism in South Korea: A Nationwide Cohort Study

“…Third, we could not accurately investigate the exact reasons behind each type of anticoagulant treatment non-persistence; i.e., whether those decisions were made by clinicians because of the occurrence of adverse events or whether they were based on other causes. However, our findings were largely consistent with the previous research using electronic medical records from eight tertiary hospitals in Korea with respect to the proportion of anticoagulant initiators and treatment duration [18]. Fourth, the reimbursement criteria for NOACs that were in place during our study period could limit the validity of longterm persistence in this study.…”

“…[15][16][17] However, the current guidelines are generally based on data from Western populations, thus rendering it challenging to apply them to the Asian population directly; evidence from this population would be beneficial for filling knowledge gaps and guiding clinicians toward better decision-making. Currently, as previous studies were limited to specific populations or focused on either epidemiology or patterns, 3,18,19 there is a strong need for comprehensive research that reflects the persistence and patterns of anticoagulant treatment according to the presence/absence of active cancer in routine clinical practice.…”

Safe and effective treatment of venous Thromboembolism associated with Cancer: focus on direct Oral Anticoagulants in Asian patients

“…With regard to recurrent VTE and bleeding, similar findings were reported in a Korean retrospective cohort study involving patients with CAT treated with DOACs (n = 132), LMWHs (n = 119), or other anticoagulants (n = 372) for ≥ 3 months [63]. During the initial 6 months of treatment, the respective overall cumulative incidence of VTE recurrence and bleeding events were 16.7% and 12.3% with DOACs, 8.3% and 11.0% with LMWH, and 20.7% and 30.7% with other anticoagulants, with no significant differences between DOACs and LMWH.…”

“…Although Asian patients with cancer were rarely included in pivotal RCTs of DOACs for the treatment of CAT [49][50][51][52], data from general VTE RCTs indicate that DOACs have similar efficacy to standard of care treatment with no increased safety concerns in Asian populations [10]. Although RCTs specifically addressing the efficacy and safety of DOACs in Asian patients with CAT are warranted, real-world clinical evidence supports factor Xa inhibitor DOACs as an effective and safe alternative to LMWH for the treatment of CAT in Asian patients [18,28,63]. Appropriate utilization of these convenient agents is especially important for patients with cancer who already carry a major burden of disease.…”

“…Supplementing the results of RCTs, analyses of realworld data of the efficacy and safety of DOACs have been conducted in US and Asian populations of patients with CAT [18,[63][64][65][66]. These studies show that DOACs are effective and safe alternatives to LMWH for the treatment of CAT in real-world practice.…”