Abstract
BackgroundOptimal duration of anticoagulation for cancer-associated thrombosis (CAT) remains unclear. This study assessed D-dimer (DD) and high-sensitivity C-reactive protein (hs-CRP) levels after the withdrawal of anticoagulation treatment to predict the risk of venous thromboembolism (VTE) recurrence among patients with CAT.MethodsProspective, multicentre study to evaluate CAT with ≥3 months of anticoagulation that was subsequently discontinued. Blood samples were taken when patients stopped the anticoagulation and 21 days later to determine the DD and hs-CRP levels. All patients were followed up for 6 months to detect VTE recurrence.ResultsBetween 2013 and 2015, 325 patients were evaluated and 114 patients were ultimately enrolled in the study. The mean age was 62 ± 14 years and nearly 40% had metastasis. Ten patients developed VTE recurrence within 6 months (8.8%, 95% confidence interval [CI]: 4.3–15.5%). The DD and hs-CRP levels after 21 days were associated with VTE recurrence. The subdistribution hazard ratios were 9.82 for hs-CRP (95% CI: 19–52) and 5.81 for DD (95% CI: 1.1–31.7).ConclusionsThis study identified that hs-CRP and DD were potential biomarkers of VTE recurrence after discontinuation of anticoagulation in CAT. A risk-adapted strategy could identify low-risk patients who may benefit from discontinuation of anticoagulation.
Highlights
The incidence of venous thromboembolism (VTE) is steadily increasing among cancer patients, who have an elevated risk of VTE recurrence and bleeding
Hokusai VTE Cancer is an open-label, non-inferiority trial that compared the use of edoxaban vs. dalteparin for the treatment of cancer-associated thrombosis (CAT) for at least 6 months and up to 12 months
The optimal levels of DD and high-sensitivity C-reactive protein (hs-CRP) for predicting VTE recurrence were evaluated using a receiver operating characteristic (ROC) curve, and we evaluated whether the area under the curve was >0.5 based on the standard error obtained using DeLong’s method
Summary
The relationship between venous thromboembolism (VTE) and cancer is well known, with cancer being a major independent risk factor for VTE, being the second leading cause of death among patients with cancer. the incidence of VTE is steadily increasing among cancer patients, who have an elevated risk of VTE recurrence and bleeding. Anticoagulation treatment for 3–6 months has been shown to be safe and effective for patients with cancer and VTE, and the guidelines recommend first-line treatment for 3–6 months using low-molecular-weight heparin (LMWH) among patients with cancer-associated VTE. there are limited data regarding prolonged use of LMWH. Anticoagulation treatment for 3–6 months has been shown to be safe and effective for patients with cancer and VTE, and the guidelines recommend first-line treatment for 3–6 months using low-molecular-weight heparin (LMWH) among patients with cancer-associated VTE.. Hokusai VTE Cancer is an open-label, non-inferiority trial that compared the use of edoxaban vs dalteparin for the treatment of cancer-associated thrombosis (CAT) for at least 6 months and up to 12 months.. This study assessed D-dimer (DD) and high-sensitivity C-reactive protein (hs-CRP) levels after the withdrawal of anticoagulation treatment to predict the risk of venous thromboembolism (VTE) recurrence among patients with CAT. METHODS: Prospective, multicentre study to evaluate CAT with ≥3 months of anticoagulation that was subsequently discontinued. CONCLUSIONS: This study identified that hs-CRP and DD were potential biomarkers of VTE recurrence after discontinuation of anticoagulation in CAT. A risk-adapted strategy could identify low-risk patients who may benefit from discontinuation of anticoagulation
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