OUTPATIENT TREATMENT OF PATIENTS WITH CANCER AND VENOUS THROMBOEMBOLISM

Abstract

Background: Patients with cancer are at increased risk for venous thromboembolism (VTE). Cancer-associated VTE increases the burden of malignant disease and has an unfavorable effect on survival. Aim: To establish the safety and efficiency of ambulatory treatment of patients with cancer and VTE. Methods: In retrospective longitudinal cohort study we investigated documentation of all patients with cancer and VTE who were ambulatory treated at our department from November 2005 to February 2011. Their clinical features and complications while on anticoagulant treatment were analyzed. Patients were followed for at least two years from the date of VTE event. Results: 290 patients with cancer and VTE were enrolled (134 women; mean age 68±12 years; 78,2% proximal venous thrombosis (VT); 10% pulmonary embolism (PE); 74,5% metastatic disease). They were treated with low-molecular-weight heparin (LMWH) in the first six months, later on with coumarins. 94 bleeding (33% major and 67% minor) and 41 recurrent VTE events (34,2% PE and 65,8% VT) were recorded. Two-year survival rate was 45,5%. The cause of death was progression of cancer in 87,4%, major bleeding in 2,5% and PE in 1,9% of patients. Advanced stage of cancer, low body mass index and low hemoglobin concentration at initiation of anticoagulant treatment turned out to be the independent prognostic factors of survival. Conclusions: Ambulatory treatment of patients with cancer and VTE is safe and efficient. Survival of patients with cancer and VTE predominantly depends on advanced stage of cancer and general performance status of a patient.