Abstract
PurposeAnticoagulant therapy for at least 3–6 months is currently recommended for treatment of venous thromboembolism (VTE) in patients with cancer, but the optimal duration of treatment is unknown. This study examines the association between the duration of anticoagulation treatment and VTE recurrence in cancer patients.MethodsThe Humana claims database was used to identify newly diagnosed cancer patients who had their first VTE diagnosis between January 1, 2013, and May 31, 2015, and initiated injectable or oral anticoagulant therapy. Follow-up was calculated from the index treatment initiation to the end of eligibility or end of data (June 2015). VTE recurrence was defined as a hospitalization with a primary diagnosis of VTE. Cox proportional hazards models were used to evaluate the risk of VTE recurrence by duration of therapy in patients who discontinued therapy.ResultsThe study included 1158 patients. Compared to patients treated for 0 to 3 months, VTE recurrences were significantly lower among patients treated for 3 to 6, or over 6 months. After adjustment for baseline characteristics, patients treated for 3 to 6 months (HR [95%CI], 0.53; 0.37–0.76) and more than 6 months (HR [95%CI], 0.48; 0.34–0.68) were still significantly less likely to have VTE recurrences compared to patients treated for 0 to 3 months (both p < 0.01). Findings were similar using a VTE event definition that included outpatient visits.ConclusionsAmong newly diagnosed cancer patients with VTE, anticoagulant therapy lasting more than 3 months was associated with a lower risk of VTE recurrence.
Highlights
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Venous thromboembolism (VTE) is the second leading cause of morbidity and mortality in patients with cancer [1]
We examined the association between the duration of anticoagulation and rates of VTE recurrence and major bleeding in cancer patients
A total of 1158 newly diagnosed patients with cancer who developed VTE and were treated with anticoagulant agents were identified and stratified into three cohorts based on the duration of their index anticoagulant therapy: 629 in the duration of therapy (DOT) 0 to 3 months, 244 in the DOT 3 to 6 months, and 285 in the in the DOT over 6 months cohorts
Summary
It is estimated that the annual incidence of VTE is approximately 1 out of 200 in a population of cancer patients [2]. When compared to the general population, patients with cancer are associated with up to 6.5-fold higher risk of VTE [3, 4]. The risk of recurrence after a first episode of VTE is higher in cancer patients than in those without underlying malignancy [5]. Current guidelines recommend anticoagulation treatment with low-molecular-weight heparin (LMWH) monotherapy for at least 3 to 6 months for treatment and secondary prophylaxis in patients with cancer [6, 7]. Many patients with cancer are treated for less than the recommended 3 to 6 months, and more than half of patients are not treated with LMWH [8,9,10,11]
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