Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients Export

@article{citeulike:4403136, abstract = {Summary. Background: Cancer patients with venous thromboembolism (VTE) are at high risk of recurrent VTE despite standard anticoagulation. To date, very little published literature is available to guide the treatment of cancer patients with recurrent VTE. Objectives: To evaluate the benefit and risk of low molecular weight heparin (LMWH) dose escalation in cancer patients with recurrent VTE. Patients and methods: This was a retrospective cohort study of consecutive cancer outpatients referred for management of a symptomatic, recurrent VTE while receiving an anticoagulant. Confirmed episodes of recurrent VTE were treated with either dose escalation of LMWH in patients already anticoagulated with LMWH, or initiation of therapeutic dose LMWH in patients who were taking a vitamin K antagonist (VKA). All patients were followed for a minimum of 3 months after the index recurrent VTE unless they died during this period. Results: Seventy cancer patients with a recurrent VTE despite ongoing anticoagulation were included. At the time of the recurrence, 67\% of patients were receiving LMWH, and 33\% were receiving a VKA. A total of six patients [8.6\%; 95\% confidence interval (CI) 4.0201317.5\%] had a second recurrent VTE during the 3-month follow-up period, at an event rate of 9.9 per 100 patient-years (95\% CI  2.0201317.8\%). Three patients (4.3\%; 95\% CI  1.5201311.9\%), or 4.8 per 100 patient-years (95\% CI  0.0201310.3\%) of follow-up, had bleeding complications. The median time between the index recurrent VTE to death was 11.4 months (range, 0201383.9 months). Conclusions: Cancer patients with recurrent VTE have a short median survival. Escalating the dose of LMWH can be effective for treating cases that are resistant to standard, weight-adjusted doses of LMWH or a VKA.}, address = {Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON; Clinical Epidemiology Program, The Ottawa Health Research Institute, Ottawa, ON; Department of Internal Medicine and Chest Diseases, EA3878, Brest University Hospital, Brest, France; Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON; Thrombosis Program, Department of Medicine, University of British Columbia, Vancouver, BC and Department of Medicine, McMaster University, Hamilton, ON, Canada}, author = {Carrier, M. and Gal, G. Le and Cho, R. and Tierney, S. and Rodger, M. and Lee, A. Y.}, citeulike-article-id = {4403136}, citeulike-linkout-0 = {http://dx.doi.org/10.1111/j.1538-7836.2009.03326.x}, citeulike-linkout-1 = {http://www.ingentaconnect.com/content/bsc/jth/2009/00000007/00000005/art00006}, citeulike-linkout-2 = {http://www3.interscience.wiley.com/cgi-bin/abstract/122217458/ABSTRACT}, doi = {10.1111/j.1538-7836.2009.03326.x}, issn = {1538-7836}, journal = {Journal of Thrombosis and Haemostasis}, keywords = {cancer, dvt, enoxaparin, heparin, lmwh, malignancy, pte, thromboembolism}, number = {5}, pages = {760--765}, posted-at = {2009-10-10 04:01:24}, priority = {3}, publisher = {Blackwell Publishing}, title = {Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients}, url = {http://dx.doi.org/10.1111/j.1538-7836.2009.03326.x}, volume = {7}, year = {2009} }

TY - JOUR ID - citeulike:4403136 L3 - citeulike-article-id:4403136 N2 - Summary. Background: Cancer patients with venous thromboembolism (VTE) are at high risk of recurrent VTE despite standard anticoagulation. To date, very little published literature is available to guide the treatment of cancer patients with recurrent VTE. Objectives: To evaluate the benefit and risk of low molecular weight heparin (LMWH) dose escalation in cancer patients with recurrent VTE. Patients and methods: This was a retrospective cohort study of consecutive cancer outpatients referred for management of a symptomatic, recurrent VTE while receiving an anticoagulant. Confirmed episodes of recurrent VTE were treated with either dose escalation of LMWH in patients already anticoagulated with LMWH, or initiation of therapeutic dose LMWH in patients who were taking a vitamin K antagonist (VKA). All patients were followed for a minimum of 3 months after the index recurrent VTE unless they died during this period. Results: Seventy cancer patients with a recurrent VTE despite ongoing anticoagulation were included. At the time of the recurrence, 67% of patients were receiving LMWH, and 33% were receiving a VKA. A total of six patients [8.6%; 95% confidence interval (CI) 4.0201317.5%] had a second recurrent VTE during the 3-month follow-up period, at an event rate of 9.9 per 100 patient-years (95% CI  2.0201317.8%). Three patients (4.3%; 95% CI  1.5201311.9%), or 4.8 per 100 patient-years (95% CI  0.0201310.3%) of follow-up, had bleeding complications. The median time between the index recurrent VTE to death was 11.4 months (range, 0201383.9 months). Conclusions: Cancer patients with recurrent VTE have a short median survival. Escalating the dose of LMWH can be effective for treating cases that are resistant to standard, weight-adjusted doses of LMWH or a VKA. IS - 5 JF - Journal of Thrombosis and Haemostasis SN - 1538-7836 AD - Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON; Clinical Epidemiology Program, The Ottawa Health Research Institute, Ottawa, ON; Department of Internal Medicine and Chest Diseases, EA3878, Brest University Hospital, Brest, France; Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON; Thrombosis Program, Department of Medicine, University of British Columbia, Vancouver, BC and Department of Medicine, McMaster University, Hamilton, ON, Canada EP - 765 TI - Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients PB - Blackwell Publishing VL - 7 SP - 760 KW - cancer KW - dvt KW - enoxaparin KW - heparin KW - lmwh KW - malignancy KW - pte KW - thromboembolism AU - Carrier, M AU - Gal, Le AU - Cho, R AU - Tierney, S AU - Rodger, M AU - Lee, AY PY - 2009/// UR - http://dx.doi.org/10.1111/j.1538-7836.2009.03326.x ER -