Reduced- versus full-dose anticoagulants for the extended treatment of cancer-associated venous thromboembolism in Thai patients

IF 3.4 3区医学 Q2 HEMATOLOGY Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-01-01 DOI:10.1016/j.rpth.2024.102643

Kawin Vichaidit, Pichika Chantrathammachart, Pimjai Niparuck, Teeraya Puawilai, Pantep Angchaisuksiri MD, Kochawan Boonyawat

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Abstract

Background

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.

Objectives

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.

Methods

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.

Results

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 (P = .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 (P = .35), respectively. The median follow-up time was 1.5 years (IQR, 1-3.1).

Conclusion

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.

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减少与全剂量抗凝治疗癌症相关静脉血栓栓塞在泰国患者的扩展治疗。

背景：减少剂量抗凝治疗已被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，它可能会增加静脉血栓栓塞复发的风险。目的：研究泰国接受全剂量或小剂量抗凝治疗的癌症相关性静脉血栓栓塞患者静脉血栓栓塞复发率和出血并发症。方法：在某单中心学术医院进行回顾性队列研究。对2016-2023年的电子病历进行了审查。对接受抗凝治疗至少3个月的癌症相关性静脉血栓栓塞患者进行评估。减少剂量抗凝剂被定义为低于推荐标准剂量的剂量。主要终点为静脉血栓栓塞复发。次要结局为大出血和临床相关的非大出血。结果：共纳入229例患者。中位年龄为65岁（IQR, 54-72）。在减少剂量组，年龄和既往出血史高于全剂量组。169例（74%）患者和60例（26%）患者接受了全剂量和小剂量抗凝剂治疗。减少剂量的中位时间为3.6个月（IQR, 0.7-5.5）。静脉血栓栓塞复发7例（3.1%），全剂量组4例（2.4%），减剂量组3例（5.0%）（P = 0.4）。静脉血栓栓塞复发的中位时间为7.2个月（IQR, 3.5-12.4）。全剂量组和减剂量组出血事件分别为8例（3.5%）、7例（4.1%）和1例（1.7%）（P = 0.35）。中位随访时间为1.5年（IQR, 1-3.1）。结论：年龄较大和既往出血史与减剂量抗凝剂的使用有关。与接受全剂量抗凝剂治疗的患者相比，接受减少剂量抗凝剂治疗的癌症相关性静脉血栓栓塞患者有更高的静脉血栓栓塞复发风险和更低的出血结局。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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