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Thromb Haemost 2024; 124(04): 363-373
DOI: 10.1055/a-2191-7510
Stroke, Systemic or Venous Thromboembolism

Enoxaparin for Long-Term Therapy of Venous Thromboembolism in Patients with Cancer and Renal Insufficiency

Patricia Sigüenza
1   Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
2   Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
,
Juan J. López-Núñez 
1   Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
2   Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
3   Fundació Institut Germans Trias i Pujol, Badalona, Barcelona, Spain
,
Conxita Falgá
4   Department of Internal Medicine, Hospital de Mataró, Spain
,
Covadonga Gómez-Cuervo 
5   Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
,
Antoni Riera-Mestre
6   Department of Internal Medicine, Hospital Universitari de Bellvitge, IDIBELL.L'Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, Spain
,
Aída Gil-Díaz 
7   Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
8   Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
,
Peter Verhamme 
9   Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
,
Ana Cristina Montenegro
10   Department of Vascular Medicine, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
,
Cristina Barbagelata
11   Department of Internal Medicine, Hospital Universitario A Coruña, Coruña, Spain
,
Egidio Imbalzano
12   Division of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
,
Manuel Monreal
13   Faculty of Health Sciences, Universidad Católica San Antonio de Murcia, CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
,
the RIETE Investigators › Author Affiliations
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Abstract

Background The optimal therapy of venous thromboembolism (VTE) in cancer patients with renal insufficiency (RI) is unknown. Current guidelines recommend to use low-molecular-weight heparin over direct oral anticoagulants to treat VTE in cancer patients at high risk of bleeding.

Methods We used the Registro Informatizado Enfermedad Tromboemb00F3lica (RIETE) registry to compare the 6-month incidence rates of (1) VTE recurrences versus major bleeding and (2) fatal pulmonary embolism (PE) versus fatal bleeding in three subgroups (those with mild, moderate, or severe RI) of cancer patients receiving enoxaparin monotherapy.

Results From January 2009 through June 2022, 2,844 patients with RI received enoxaparin for ≥6 months: 1,432 (50%) had mild RI, 1,168 (41%) moderate RI, and 244 (8.6%) had severe RI. Overall, 68, 62, and 12%, respectively, received the recommended doses. Among patients with mild RI, the rates of VTE recurrences versus major bleeding (4.6 vs. 5.4%) and fatal PE versus fatal bleeding (1.3 vs. 1.2%) were similar. Among patients with moderate RI, VTE recurrences were half as common as major bleeding (3.1 vs. 6.3%), but fatal PE and fatal bleeding were close (1.8 vs. 1.2%). Among patients with severe RI, VTE recurrences were threefold less common than major bleeding (4.1 vs. 13%), but fatal PE was threefold more frequent than fatal bleeding (2.5 vs. 0.8%). During the first 10 days, fatal PE was fivefold more common than fatal bleeding (2.1 vs. 0.4%).

Conclusion Among cancer patients with severe RI, fatal PE was fivefold more common than fatal bleeding. The recommended doses of enoxaparin in these patients should be revisited.

Keywords

venous thromboembolism - cancer - renal insufficiency - enoxaparin - pulmonary embolism

* A full list of the RIETE investigators is given in the [appendix].


Supplementary Material



Publication History

Received: 11 August 2023

Accepted: 12 October 2023

Accepted Manuscript online:
13 October 2023

Article published online:
15 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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