Abstract
BackgroundCancer patients receiving chemotherapy are at increased risk of thrombosis. Nadroparin has been demonstrated to reduce the incidence of venous and arterial thrombotic events (TEs) by about 50% in cancer outpatients receiving chemotherapy. The aims of this retrospective analysis were to evaluate the thromboembolic risk and the benefit of thromboprophylaxis according to type of chemotherapy.MethodsCancer outpatients were randomly assigned to receive subcutaneous injections of nadroparin or placebo. The incidence of symptomatic TEs was assessed according to the type of chemotherapy. Results were reported as risk ratios with associated 95% CI and two-tailed probability values.Results769 and 381 patients have been evaluated in the nadroparin and placebo group, respectively. In the absence of thromboprophylaxis, the highest rate of TEs was found in patients receiving gemcitabine- (8.1%) or cisplatin-based chemotherapy (7.0%). The combination of gemcitabine and cisplatin or carboplatin increased the risk to 10.2%. Thromboprophylaxis reduced TE risk by 68% in patients receiving gemcitabine; with a further decrease to 78% in those receiving a combination of gemcitabine and platinum.ConclusionsThis retrospective analysis confirms that patients undergoing chemotherapy including gemcitabine, platinum analogues or their combination are at higher risk of TEs. Our results also suggest that outpatients receiving chemotherapy regimens including these agents might achieve an increased benefit from thromboprophylaxis with nadroparin. Clinical Trial registration number: NCT 00951574
Highlights
Cancer patients receiving chemotherapy are at increased risk of thrombosis
Overall, 1150 patients were included in the primary efficacy and safety analyses of the PROTECHT study
Fifteen of the 769 patients treated with nadroparin (2.0%) and 15 of the 381 patients treated with placebo (3.9%) had a thromboembolic event (P = 0.024)
Summary
Nadroparin has been demonstrated to reduce the incidence of venous and arterial thrombotic events (TEs) by about 50% in cancer outpatients receiving chemotherapy. Large studies have suggested that some solid malignancies including pancreatic, lung, colon, ovarian, primary hepatic and brain cancer are associated with a higher risk of TEs [6,7]. Risk factors, such as age, gender, bed-rest, venous catheters, surgery, radiotherapy and infections, increase the risk of thrombosis in cancer patients [8]
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