Long-Term Management of Anticoagulants in Patients with Cancer-Associated Thrombosis (CAT) Beyond 6 Months: A 432-Patient Retrospective Non-Interventional Study

L. Plaisance¹, C. Chapelle², S. Laporte², B. Planquette³, L. Bertoletti⁴, N. Falvo⁵, F. Coururaud⁶, L. Falchero⁷, I. Mahé⁸, H. Helfer⁹, J. Chidiac⁹, G. Meyer¹⁰, I. Mahé¹¹, USCAT Group

¹Université de Paris, APHP, Médecine Interne, Colombes, France, ²SAINBIOSE INSERM U 1059, Université Jean Monnet, Université de Lyon, CHU Saint-Etienne, Unité de Recherche Clinique, Innovation, Pharmacologie, Saint-Etienne, France, ³Université de Paris, APHP, Hôpital Européen Georges Pompidou, Paris, France, ⁴CHU de St-Etienne, INSERM, UMR 1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, INSERM, CIC-1408, Service de Médecine Vasculaire et Thérapeutique, Saint-Etienne, France, ⁵CHU de Dijon, Service de Médecine Interne, Dijon, France, ⁶Hôpital de la Cavale Blanche, CHRU de Brest, CIC INSERM 1412, EA 3878 (GETBO), Service de Pneumologie, Brest, France, ⁷Hôpital Nord-Ouest Villefranche-sur-Saône, Gleize, France, ⁸APHP, Hôpital Louis Mourier, Médecine Interne, Colombes, France, ⁹Université de Paris, APHP, Hôpital Louis Mourier, Médecine Interne, Colombes, France, ¹⁰Université de Paris, APHP, Hôpital Européen Georges Pompidou, Pneumologie, Paris, France, ¹¹Université de Paris, APHP, Hôpital Louis Mourier, INSERM UMR_S 1140, Innovations Thérapeutiques en Hémostase, Colombes, France

Abstract Number: PB2416

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment

Background: Few data are available about anticoagulation management beyond 6 months in CAT patients.

Aims: Our objective was to describe anticoagulant modalities beyond 6 months and up to 12 months in CAT patients initially treated with low molecular weight heparin (LMWH).

Methods: CAT patients previously included in two prospective cohort studies (aXa-NCT02898051; PREDICARE – NCT03099031) and still alive at the end of the initial 6-month treatment period were eligible to participate in this retrospective non-interventional French multicenter study.
Main study outcome was to describe anticoagulant treatment in the management of CAT patients in usual medical care from 7^th month to 12^th month. Clinical outcomes including venous thromboembolism recurrence, bleeding and deaths were presented previously.

Results: Among the 432 patients (aged 66.5±12.7 years) alive after 6 months of anticoagulant therapy for CAT and included in the study, 332 were followed up to 12 months while 96 patients deceased before study end and 4 patients were lost-to follow-up. Anticoagulant modalities were missing for 10 patients.
At 6 months, anticoagulant therapy was stopped in 74 patients, 56 were switched to vitamin K antagonists (VKA) (16.1% [95%CI, 12.4%-20.4]), 30 to direct oral anticoagulants (DOAC) (8.6% [95%CI, 5.9%-12.1]) and 6 to others. LMWHs were maintained in 256 patients (73.6% [95%CI, 68.6-78.1]). Among them, beyond 6 months, LMWHs were definitively discontinued in 86 patients (33.7%), the main reason being a favorable course of the cancer (16 patients, 18.6%), whereas concern about bleeding risk is low (2 patients, 2.3%) patients. Anticoagulation switches from 7 to 12 months are reported in the table.

Conclusions: Anticoagulation with LMWH was maintained beyond 6 months and up to 12 months in the vast majority of patients with CAT. They were in accordance with clinical practice guidelines suggesting that treatment should be maintained as long cancer is active or in the absence of bleeding risk.

Treatment at inclusion (at 6 months from the index event)	LMWH (n = 256)	VKA (n = 56)	DOAC (n = 30)
Median duration beyond 6 months (IQR)	4.6 mo. (2.0-6.0)	6 mo. (5.2-6.0)	6 mo. (5.4-6.0)
Treatment discontinuation from 7 to 12 months [n (%)]	86 (33.7)	12 (21.8)	8 (27.6)
Treatment switch from 7 to 12 months to [n (%)]
LMWH	7 (2.7)	7 (12.7)	0
VKA	20 (7.8)	–	0
DOAC	13 (5.1)	0	–
UFH	2 (0.8)	1 (1.8)	0

[Management of the anticoagulant treatment beyond 6 months (IQR: interquartile range; mo: months)]

To cite this abstract in AMA style:

Plaisance L, Chapelle C, Laporte S, Planquette B, Bertoletti L, Falvo N, Coururaud F, Falchero L, Mahé I, Helfer H, Chidiac J, Meyer G, Mahé I, USCAT Group . Long-Term Management of Anticoagulants in Patients with Cancer-Associated Thrombosis (CAT) Beyond 6 Months: A 432-Patient Retrospective Non-Interventional Study [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/long-term-management-of-anticoagulants-in-patients-with-cancer-associated-thrombosis-cat-beyond-6-months-a-432-patient-retrospective-non-interventional-study/. Accessed November 30, 2023.

« Back to ISTH 2020 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/long-term-management-of-anticoagulants-in-patients-with-cancer-associated-thrombosis-cat-beyond-6-months-a-432-patient-retrospective-non-interventional-study/