Abstract

DOACs have emerged as first-line treatment in most cancer-associated thrombosis (CAT), representing a paradigm shift in its management. However, CAT management remains challenging and requires careful risk–benefit considerations. A retrospective analysis of CAT presentations to a tertiary referral centre from January 2011 to December 2020. Outcomes in CAT patients were compared to VTE patients without malignancy. Subgroup analysis was also conducted for CAT according to anticoagulation type. 514 CAT cases from 491 patients were identified from 3230 total VTE cases. CAT patients had higher rates of major VTE (PE and/or proximal DVT) compared to patients without malignancy (78.4% vs. 66.8%, p < 0.001). CAT patients also had higher rates of VTE recurrence (HR 1.66, 95%CI 1.23–2.26), major bleeding (HR 3.41, 95%CI 2.36–4.93), VTE-related mortality (HR 2.59, 95%CI 1.46–4.62) and bleeding-related mortality (HR 2.66, 95%CI 1.05–6.73). There were no significant differences in rates of VTE recurrence, major bleeding, VTE-related mortality or fatal bleeding between CAT patients treated with DOACs, enoxaparin or warfarin. In the subgroup of CAT treated with DOACs, there was no significant difference in rates of GI bleeding compared to the enoxaparin subgroup (HR 0.17, 95%CI 0.02–1.26). CAT was associated with a larger clot burden and higher rates of VTE recurrence, major bleeding and mortality compared to VTE patients without malignancy in this large real-world study. This study demonstrated no significant differences in complication rates for CAT patients treated with DOACs over enoxaparin, suggesting that DOACs can be safely used in most cases of CAT.

中文翻译：

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癌症相关血栓与非癌症静脉血栓栓塞的治疗和结果的十年比较：从传统抗凝剂到直接口服抗凝剂

摘要

DOAC 已成为大多数癌症相关血栓形成 (CAT) 的一线治疗方法，代表了其治疗模式的转变。然而，CAT 管理仍然具有挑战性，需要仔细考虑风险收益。对 2011 年 1 月至 2020 年 12 月期间向三级转诊中心就诊的 CAT 进行回顾性分析。将 CAT 患者的结果与无恶性肿瘤的 VTE 患者进行比较。还根据抗凝类型对 CAT 进行了亚组分析。从 3230 例 VTE 病例中鉴定出 491 名患者的 514 例 CAT 病例。与非恶性肿瘤患者相比，CAT 患者的主要 VTE（PE 和/或近端 DVT）发生率较高（78.4% vs. 66.8%，p < 0.001）。CAT 患者的 VTE 复发率（HR 1.66，95%CI 1.23–2.26）、大出血率（HR 3.41，95%CI 2.36–4.93）和 VTE 相关死亡率（HR 2.59，95%CI 1.46–4.62）也较高和出血相关死亡率（HR 2.66，95%CI 1.05–6.73）。接受 DOAC、依诺肝素或华法林治疗的 CAT 患者之间，VTE 复发率、大出血、VTE 相关死亡率或致命性出血率没有显着差异。在接受 DOAC 治疗的 CAT 亚组中，与依诺肝素亚组相比，胃肠道出血率没有显着差异（HR 0.17，95% CI 0.02-1.26）。在这项大型现实世界研究中，与无恶性肿瘤的 VTE 患者相比，CAT 与更大的血栓负荷以及更高的 VTE 复发率、大出血和死亡率相关。这项研究表明，使用 DOAC 治疗的 CAT 患者与依诺肝素治疗的并发症发生率没有显着差异，这表明 DOAC 可以安全地用于大多数 CAT 病例。