Abstract Number: PB2113
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Cancer Associated Thrombosis
Background: Low molecular weight heparins (LMWH) are indicated for thromboprophylaxis, and for extended secondary thromboprophylaxis beyond oral anticoagulants in patients with active cancer and venous thromboembolism (VTE).
Aims: To evaluate the effectiveness (recurrent VTE) and safety (bleeding rates) of extended (≥3 months) enoxaparin treatment in patients with active cancer and concurrent VTE.
Methods: A systematic literature review was performed by searching key biomedical databases (inception-September 2019) and conference proceedings (January 2016-September 2019) through combining search terms for ‘cancers’ and ‘enoxaparin’ (limited to English). Standard methodology from the Cochrane Handbook for Systematic Reviews of Interventions was followed. Quality assessment was completed using standardized tools according to study design. Results were reported as per PRISMA guidelines.
Results: Of the 3,577 total citations retrieved from the searches, 15 publications (three randomized controlled trials, two prospective, and nine retrospective cohort studies, and one case-control study) were included. Proportions of patients with recurrent VTE ranged from 3.1% to 21.7% in enoxaparin-treated patients, 0% to 12.5% in warfarin-treated patients, 2.7% to 3% in LMWH- (dalteparin) treated patients, and 0% to 10.53% in DOAC- (apixaban or rivaroxaban) treated patients. One observational study reported no significant difference in recurrent VTE rates for apixaban vs. enoxaparin (HR 1.14, 95% CI: 0.54-2.42), or rivaroxaban vs. enoxaparin (HR 0.85, 95% CI: 0.36-2.06). Major bleeding was the most commonly reported bleeding outcome, with proportions ranging from 1.2-15% for enoxaparin, 2.9-16% for enoxaparin + warfarin, 0-25% for apixaban, 0-11% for apixaban/rivaroxaban, 0-17% for rivaroxaban, and 0-20% for warfarin.
Conclusions: Affirmative conclusions cannot be drawn on the effectiveness and safety of extended treatment with enoxaparin in comparison to other therapies due to the limitations in the evidence and inability to conduct a meta-analysis with the available data. Further studies are needed to address the optimal treatment strategy for patients with cancer and VTE.
To cite this abstract in AMA style:
Shan J, Sayre T, Hofer K, Shojaei ET. Effectiveness and Safety of Enoxaparin in Patients with Active Cancer and Venous Thromboembolism (VTE): A Systematic Literature Review [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/effectiveness-and-safety-of-enoxaparin-in-patients-with-active-cancer-and-venous-thromboembolism-vte-a-systematic-literature-review/. Accessed March 22, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/effectiveness-and-safety-of-enoxaparin-in-patients-with-active-cancer-and-venous-thromboembolism-vte-a-systematic-literature-review/