title: PO-40 - Real-life use of non-vitamin k antagonist oral anticoagulants in patients with cancer associated venous thromboembolism: data from a prospective cohort.
abstract: BACKGROUND
  Cancer associated thrombosis (CAT) has an increased risk of recurrent venous thromboembolism (VTE). Type, stage of cancer and chemotherapy (CHT) influence thromboembolic risk. The use of novel oral anticoagulants (NOACs) is controversial in patients with CAT.
  
  
  OBJECTIVE
  The aim of this study is to assess mortality, recurrent VTE and bleeding complications in patients with CAT and in patients without cancer receiving NOACs.
  
  
  METHODS
  Consecutive patients with acute objectively confirmed VTE receiving NOACs within 1 month from diagnosis are included from September 2013 in an ongoing prospective cohort study. Characteristics of patients and outcome are reported according to the presence of CAT. Chi-squared test and Student' t-test are used.
  
  
  RESULTS
  As for November 10(th) 2015, 472 patients were included in the study: 78 with CAT (16.5%). Lung, breast, gastrointestinal and genitourinary cancer was observed in 16%, 24%, 20% and 24% of patients with CAT, respectively. 31 patients with CAT (40%) were on CHT or radiotherapy (RT). 10 patients with CAT (13%) had at least an additional risk factor for VTE (4 had a CVC related thrombosis) and 34 (43.5%) were inpatients. Baseline characteristics of patients with and without CAT are reported in the Table. Pulmonary embolism was index VTE in 152 patients: 24.4% of patients with CAT and in 33.8% of those without cancer (p=0.10). DVT only was present in 320 patients and 78 had both DVT and PE. Among NOACs patients, 312 (66%) received initial loading dose: 61% of those with CAT and 67% without. 53 (11%) received reduced maintenance doses (10% with CAT, 11% without). As for nowadays, 272 patients had at least 3 months of follow-up, the mean follow-up being 8.6 months. 20 patients died (7.3%): 17 were cancer related deaths. Non cancer related death occurred in 1 patient with CAT (2%) and in 2 patients without (0.9%). No fatal bleedings or fatal VTE recurrences occurred. Patients recruitment and follow-up is currently ongoing aimed at assessing mortality, recurrent VTE and bleeding complications. Updated results on clinical outcomes will be presented at the congress.
  
  
  CONCLUSIONS
  Patients with CAT receiving NOACs are treated as patients without CAT in terms of use of loading doses and maintenance treatment. Upper arm thrombosis is more frequently involved in CAT patients and proximal lower vein in patients without CAT. Non cancer related mortality was higher in CAT patients but no fatal recurrences or fatal bleedings were observed so far.
authors.affiliation: University of Perugia, Perugia.
authors.forename: A
authors.initials: A
authors.lastname: Mancuso
authors.affiliation: University of Perugia, Perugia.
authors.forename: M C
authors.initials: MC
authors.lastname: Vedovati
authors.affiliation: Ravenna Hospital, Ravenna.
authors.forename: L
authors.initials: L
authors.lastname: Pierpaoli
authors.affiliation: Hospital of Città di Castello, Città di Castello.
authors.forename: U
authors.initials: U
authors.lastname: Paliani
authors.affiliation: S. Matteo degli Infermi Hospital, Spoleto.
authors.forename: S
authors.initials: S
authors.lastname: Conti
authors.affiliation: S. Giovanni Battista Hospital, Foligno.
authors.forename: E
authors.initials: E
authors.lastname: Filippucci
authors.affiliation: S.Maria Hospital, Terni; Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ascani
authors.affiliation: University of Perugia, Perugia.
authors.forename: S
authors.initials: S
authors.lastname: Radicchia
authors.affiliation: Hospital of Città di Castello, Città di Castello.
authors.forename: G
authors.initials: G
authors.lastname: Galeotti
authors.affiliation: University of Perugia, Perugia.
authors.forename: G
authors.initials: G
authors.lastname: Agnelli
authors.affiliation: University of Perugia, Perugia.
authors.forename: C
authors.initials: C
authors.lastname: Becattini