Anticoagulant treatment for cancer-associated venous thromboembolism (VTE) should be continued until patients are cured from cancer.1
Although guidelines recommend considering the continuation anticoagulant treatment for cancer-associated VTE until patients are cured from cancer, the safety of stopping anticoagulant treatment after cancer is cured remains unclear.
For the cohort study, researchers at Leiden University Medical Center in the Netherlands analyzed data from 358 patients diagnosed with cancer-associated VTE at their institution between January 2001 and January 2010. Patients were followed to evaluate the impact of cancer treatment, occurrence or recurrent VTE, major hemorrhage, and death.
Results showed that of the 358 patients, anticoagulant treatment was continued until death in 207 patients and in another 12 because of an alternative indication despite cure from cancer.
Anticoagulant treatment was stopped in 50 patients for reasons other than major hemorrhage despite active cancer, in 21 patients after major hemorrhage, and in 68 patients after cure from cancer.
Researchers found that among those 68 who continued anticoagulant treatment until cure from cancer, 10 patients were diagnosed with symptomatic recurrent VTE during follow-up.
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Of those 10, 7 were also diagnosed with cancer relapse during follow-up care. In the 50 patients who discontinued anticoagulant treatment despite active cancer, there were 11 cases of recurrent VTE during 59 years of follow-up.
The findings suggest that a cancer relapse appears to be a strong risk factor for recurrent symptomatic VTE, and ultimately support the recommendation to stop anticoagulant therapy in patients cured from cancer.
- van der Hulle T, den Exter PL, van den Hoven P, et al. Cohort study on the management of cancer-associated venous thromboembolism aimed at the safety of stopping anticoagulant therapy in patients cured from cancer [published online ahead of print January 2016]. Chest. doi: 10.1016/j.chest.2015.10.069.