Abstract Number: PB1097
Meeting: ISTH 2021 Congress
Background: The cross talk between malignancy and thrombosis imposes serious consequences for patients with active cancer. Cancer Associated Thrombosis (CAT) is the 1st cause of death in ambulatory patients undergoing chemotherapy. Tumor type, treatment, and patient related factors contribute to High Thrombotic Burden (HTB) in ambulatory patients with active cancer.
Aims: The study ACT4CAT aims to record clinical practice for CAT management regarding anticoagulation in patients with active cancer.
Methods: A prospective observational clinical study (ACT4CAT) conducted by HeSMO across Greece involved ambulatory, active cancer patients who received thromboprophylaxis. Patients enrolled after informed consent form signing.
Results: Preliminary results regarding 431 patients from 18 oncology departments are presented; 65.4% of them have completed the study. Tumor types were: 39.8% gastrointestinal, 28.8% lung, 7.0% gynecological, 7.0% urological, 4.4% breast and 20% others; 88.2% of patients treated with High-Risk for Thrombosis Chemotherapy Agents (HRTCAs) including: 55.9% platinum, 44.7% antimetabolites and 12.6% immunotherapy. Concerning clinical setting: 62.1% 1st line, 18.4% 2nd line, 8.9% adjuvant and 2.4% neoadjuvant. Analysis depicted in Table.
Average thromboprophylaxis duration was 5.3±3.6 months. Duration per tumor type depicted in Figure. Anticoagulants administered: tinzaparin 90.8%, fondaparinux 5.5%, bemiparin 1.5%, enoxaparin 1.2%, apixaban 0.5% and rivaroxaban 0.5%. Intermediate doses received 70.9% of patients regardless clinical setting (1st or 2nd line, adjuvant, neoadjuvant: 70.2%, 79.2%, 51.3%, 70.0% respectively, p=0.0254), although intermediate dose used more in metastatic stages (OR: 2.4 95%CI: 1.4-4.2, p=0.0028).
About efficacy: 9 thrombotic events reported (2.1%, 95%CI: 1.1-3.9%), with a trend towards prophylactic doses. Eleven minor bleedings reported (2.6%, 95%CI: 1.4-4.5%), regardless clinical setting or dose used.
Conclusions: Thromboprophylaxis in patients with active cancer is safe and effective. Besides Khorana score, factors such as metastases, HRTCAs and drug-drug interactions influence the clinical decision of thromboprophylaxis in cancer patients mainly with LMWHs and frequently on intermediate doses regardless clinical setting. CAT can be preventable.
To cite this abstract in AMA style:Tsoukalas N, Christopoulou A, Timotheadou E, Koumarianou A, Athanasiadis I, Peroukidis S, Samelis G, Psyrri A, Kapodistrias N, Kalofonos C, Andreadis C, Ardavanis A, Samantas E, Bokas A, Barbounis V, Kentepozidis N, Mavroudis D, Athanasiadis A, Papakotoulas P, Boukovinas I. Could Thromboprophylaxis Influence the Clinical Course of Patients with Active Cancer? Preliminary Results from the ACT4CAT Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/could-thromboprophylaxis-influence-the-clinical-course-of-patients-with-active-cancer-preliminary-results-from-the-act4cat-study/. Accessed November 29, 2021.
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