title: Long-term therapy with low-molecular-weight heparin in cancer patients with venous thromboembolism.
abstract: Long-term therapy with low-molecular-weight heparin (LMWH) is the treatment of choice for cancer patients with venous thromboembolism (VTE). However, the ideal doses of LMWH have not been thoroughly studied. We used the RIETE Registry data to assess the influence of the daily LMWH dosage on outcome during the first three months after VTE. We used propensity score-matching to compare patients who received <150 vs. those receiving ≥150 UI/kg/day LMWH. Up to July 2010, 3,222 cancer patients with VTE received long-term therapy with fixed doses of LMWH. Of these, 1,472 (46%) received <150 IU/kg/day (mean, 112 ± 28), and 1,750 received ≥150 IU/kg/day (mean, 184 ± 32). Results of the propensity score matching involved 1269 matched pairs. During follow-up, the incidence of pulmonary embolism (PE) recurrences was similar (1.2% vs. 1.9%), but patients receiving <150 IU/kg/day LMWH had a lower incidence of fatal PE than those treated with ≥150 IU/kg/day (0.2% vs. 1.0%; p=0.004). Multivariate analysis confirmed that patients receiving <150 IU/kg/day LMWH had a lower risk for fatal PE (odds ratio [OR]: 0.2; 95% confidence interval [CI]: 0.06-0.8) and for major bleeding (OR: 0.6; 95% CI: 0.3-1.0) than those treated with ≥150 IU/kg/day. In real life, one in every two cancer patients with VTE received lower doses of LMWH than those used in randomised trials, with large variations from patient to patient. Unexpectedly, patients treated with <150 IU/kg/day LMWH had fewer fatal PE cases and fewer major bleeding events than those receiving ≥150 IU/kg/day LMWH. This finding, however, should be validated in prospective clinical trials.
authors: Departamento de Medicina Interna y Urgencias, Parc Sanitari Sant Joan de Deu, Hospital General de Sant Boi, Spain.
authors: Pablo Javier
authors: PJ
authors: Marchena
authors: José Antonio
authors: JA
authors: Nieto
authors: María
authors: M
authors: Guil
authors: Ferrán
authors: F
authors: García-Bragado
authors: Ramón
authors: R
authors: Rabuñal
authors: Henri
authors: H
authors: Boccalon
authors: Javier
authors: J
authors: Trujillo-Santos
authors: Manuel
authors: M
authors: Monreal
mesh_terms: D000368:Aged; D000465:Algorithms; D004334:Drug Administration Schedule; D005260:Female; D006470:Hemorrhage; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy*; D011655:Pulmonary Embolism / Q000150:complications* / Q000517:prevention & control*; D012008:Recurrence; D012042:Registries; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000150:complications* / Q000188:drug therapy*
chemical_list: D006495:Heparin, Low-Molecular-Weight