Treatment of Cancer-associated Thrombosis with Six Months of Prophylactic-dose Enoxaparin after Initial Full-dose Anticoagulation: A Pilot Study

J. Popov¹, S. Coelho², M. Carrier³, C. Sperlich⁴, S. Solymoss^5,6, N. Routhier^7,8, S. Shivakumar^9,10, W. Aibibula², S. Kahn^1,2, V. Tagalakis^1,2

¹McGill University, Montreal, Canada, ²Jewish General Hospital/Lady Davis Institute, Montreal, Canada, ³Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Canada, ⁴CSSS Charles-Le Moyne, Greenfield Park, Canada, ⁵McGill University Health Centre, Montreal, Canada, ⁶St. Mary's Hospital, Montreal, Canada, ⁷Université de Montréal, Montréal, Canada, ⁸Hôpital Sacré Coeur, Montréal, Canada, ⁹Dalhousie University, Halifax, Canada, ¹⁰Queen Elizabeth II Health Sciences Centre, Halifax, Canada

Abstract Number: PB1116

Meeting: ISTH 2021 Congress

Theme: Venous Thromboembolism » Cancer Associated Thrombosis

Background: Patients with cancer-associated thrombosis (CAT) are treated with full-dose anticoagulation for at least three months. Optimal dosing thereafter is unknown.

Aims: We explored efficacy and safety of reduced-dose low molecular weight heparin (LMWH) following a minimum of three months of full-dose LMWH.

Methods: We conducted a multicenter prospective pilot study of patients with CAT who completed at least three months of weight-adjusted LMWH. Patients received six months of prophylactic-dose (40 mg) subcutaneous enoxaparin. The primary outcome was recurrence of deep vein thrombosis (DVT) or pulmonary embolism (PE) and secondary outcomes included major, clinically relevant non-major (CRNM), and minor bleeding. The research ethics boards of participating centers approved the study, and informed consent was obtained from all participants.

Results: From August 2016 to May 2019, 52 patients with a mean age of 64.1 ± 9.7 years were included. The study was stopped early due to poor recruitment following approval of direct oral anticoagulants for CAT. Breast (23.1%) and colon (11.5%) were the most common cancers; 61.0% had stage IV malignancy. CAT consisted of DVT alone in 57.7% of patients and PE with or without DVT in 42.3%. Patients received a mean of 7.6 ± 7.4 months of weight-adjusted LMWH prior to enrollment. During a mean follow-up of 5.6 ± 1.4 months, 1 patient was diagnosed with incidental PE. There were no major bleeding events, and 1 CRNM and 1 minor bleeding event. Eight (15.4%) patients died: 6 due to cancer and 2 due to respiratory disease unrelated to PE.

Conclusions: Among patients with CAT treated with at least three months of full-dose anticoagulation, we observed one incidental PE and two non-major bleeding events during six months of prophylactic-dose LMWH. Our results provide support for clinical trials of reduced-dose anticoagulation for secondary prevention of CAT.

To cite this abstract in AMA style:

Popov J, Coelho S, Carrier M, Sperlich C, Solymoss S, Routhier N, Shivakumar S, Aibibula W, Kahn S, Tagalakis V. Treatment of Cancer-associated Thrombosis with Six Months of Prophylactic-dose Enoxaparin after Initial Full-dose Anticoagulation: A Pilot Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/treatment-of-cancer-associated-thrombosis-with-six-months-of-prophylactic-dose-enoxaparin-after-initial-full-dose-anticoagulation-a-pilot-study/. Accessed December 6, 2023.

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