Low-molecular-weight heparins for cancer-associated thrombosis: Adherence to clinical practice guidelines and patient perception in TROPIQUE, a 409-patient prospective observational study.
OBJECTIVE
Data on long-term treatment with low-molecular-weight heparins (LMWH) in cancer patients treated for venous thromboembolism are scarce. Study objectives were to document the long-term clinical use of LMWH and patient perception in this setting.


METHODS
Adult cancer patients receiving antineoplastic treatment or palliative care and LMWH for cancer associated venous thromboembolism (CAT) were eligible to participate in this prospective observational study. Main outcome was adherence to clinical practice guidelines based on recommended LMWH treatment doses for at least 3months in the absence of severe renal insufficiency. Patients' perception of the treatment was assessed in an ancillary study using the Perception Anticoagulant Treatment Questionnaire (PACT-Q).


RESULTS
Among 409 included cancer patients aged 65±12.1years, overall adherence to practice guidelines as defined in the protocol was 55.3% (226 patients). However, 98.0% of patients received a prescription for 3months or more and mean LMWH treatment duration for VTE was 6.27±0.15months which meets guidelines recommendations. Main patients' expectations scored on a 1-5 scale were blood clots prevention (mean 3.94±0.75), symptom relief (mean 3.98±1.04) and ease of use (mean 4.22±0.9). LMWH treatment appeared convenient (global score 79.7±17.1 on a 0 to 100 scale) and 69.1% of patients were satisfied or very satisfied.


CONCLUSIONS
Despite incomplete strict adherence to guidelines, treatment duration with LMWH was adequate showing substantial progress in the management of CAT patients. Patients expectations were high while treatment was perceived convenient with a high degree of satisfaction.
Oncologie Médicale, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
F
F
Cajfinger
Oncologie, Institut Sainte Catherine, 250 Chemin de Baigne-pieds CS 800005, 84918 Avignon Cedex 9, , France.
P
P
Debourdeau
LEO Pharma France, 2 rue René Caudron, F-78960, Voisins-le-Bretonneux, France.
A
A
Lamblin
HEATHICS Clinical Consultants, 111, rue des Tennerolles, 92210 Saint-Cloud, France. Electronic address: vidal.benatar@heathics.com.
V
V
Benatar
Département de Pathologie Vasculaire, CHU Dijon, 14 rue Gaffarel, 21079 Dijon cedex, France.
N
N
Falvo
Département de Médecine Interne, INSERM U1096, Centre Hospitalier Universitaire de Rouen, 1 rue de Germont, 76000 Rouen, France.
Y
Y
Benhamou
Service de Médecine Vasculaire, CHU Amiens-Picardie- Site Sud, 80054 Amiens cedex, France.
M A
MA
Sevestre
Unité de Médecine Interne et Pathologie Vasculaire, INSERM UMRS 1160, Hopital St Louis, 1 avenue Claude Vellefaux, 75010 Paris, France.
D
D
Farge-Bancel
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications*; D011446:Prospective Studies; D054556:Venous Thromboembolism / Q000097:blood / Q000150:complications* / Q000188:drug therapy*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
Cancer-associated-VTE; Compliance with guidelines; Long-term LMWH