Dose escalation of low molecular weight heparin in patients with recurrent cancer-associated thrombosis.
BACKGROUND
Patients with cancer-associated thrombosis are at a high risk of developing recurrent events despite anticoagulant therapy. Escalation of the dose of low molecular weight heparin (LMWH) has been suggested as a potential treatment option to manage these patients. We sought to confirm the benefit and risk of this management strategy in patients with recurrent cancer-associated thrombosis.


METHODS
A retrospective cohort study of consecutive cancer outpatients seen for management of a symptomatic recurrent cancer-associated thrombosis while on anticoagulation was undertaken. Objectively confirmed episodes of recurrent thrombosis were treated with either dose escalation of LMWH or initiation of therapeutic dose of LMWH in patients already anticoagulated with LMWH or vitamin K antagonist (VKA) respectively. Included patients were followed for a minimum of 3 months after the index recurrent event.


RESULTS
Fifty-five cancer patients with a recurrent venous thromboembolism (VTE) despite anticoagulation were included. At the time of the recurrence, 89% of patients were on LMWH. The median time between the initial cancer-associated thrombosis to the index recurrent event was 2.3 months (range 0.1 to 30.4 months). Four patients (7.3%; 95% CI: 2.0 to 17.6%) had a second recurrent VTE during the 3-month follow-up period. Three patients (5.5%; 95% CI 1.1 to 15.1%) had major bleeding complications after dose escalation of LMWH. There were no recurrent fatal VTE or major bleeding episodes.


CONCLUSIONS
Escalating the dose of LMWH seems effective and safe for managing patients with recurrent cancer-associated thrombosis despite anticoagulant therapy.
Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ontario Canada.
Ryma
R
Ihaddadene
Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ontario Canada; Département de Médecine Interne, EA3878, University of Brest, Brest, France.
Grégoire
G
Le Gal
Département de Médecine Interne, EA3878, University of Brest, Brest, France.
Aurélien
A
Delluc
Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ontario Canada; Institut de Recherche de l'Hôpital Montfort, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: mcarrier@ottawahospital.on.ca.
Marc
M
Carrier
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
Hemorrhage; Heparin; Low molecular weight; Neoplasm; Venous thromboembolism; Venous thrombosis