PB0455 - Low molecular weight heparin beyond 12 months in patients with cancer associated thrombosis. CAT-LONG study.

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Sergio Lopez-Ruz, MBBS

Pulmonologist
Hospital Universitario Virgen del Rocio, Sevilla, Spain
Sevilla, Andalucia, Spain

Co-Author(s)

MB

Maria Barca-Hernando

Pulmonologist
Medical Surgical Unit of Respiratory Diseases. Hospital Universitario Virgen del Rocio, Sevilla, Spain
Sevilla, Andalucia, Spain
SM

Samira Marin-Romero

Pulmonologist
Medical Surgical Unit of Respiratory Diseases. Hospital Universitario Virgen del Rocio, Sevilla, Spain. Instituto de Biomedicina de Sevilla (IbiS), Sevilla, Spain. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid
Córdoba, Andalucia, Spain
ME

Maria Teresa Elias-Hernandez

Pulmonologist
Medical Surgical Unit of Respiratory Diseases. Hospital Universitario Virgen del Rocio, Sevilla, Spain. Instituto de Biomedicina de Sevilla (IbiS), Sevilla, Spain. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid
Sevilla, Andalucia, Spain
RO

Remedios Otero

MD, PhD
Pneumology Department, Hospital Universitario Virgen del Rocío-IBIS-US_CIBERES
Seville, Andalucia, Spain
LJ

Luis Jara-Palomares

Senior consultant
Hospital Universitario Virgen del Rocío, Seville, Spain
Sevilla, Andalucia, Spain

Background: The clinical guidelines suggest that, in patients with cancer associated thrombosis (CAT), anticoagulant treatment should be continued beyond 6 months as long as the cancer is active. But data beyond 12 months is scarce, and we know that risk of bleeding is not fixed over time, as showed those studies that analyse anticoagulant treatment up 12 months.

Aims: Analyse safety of low molecular weight heparin (LMWH) beyond 12 months in patients with CAT.

Methods: We performed a post-hoc analysis of consecutive CAT patients evaluated in several prospective studies from Oct-2008 to Dec-2019 (Qca, TiCAT, endothelial dysfunction). Primary outcome was clinically relevant bleeding (CRB) according to ISTH criteria. We compare two periods (1-12 vs. 12-24 months). For the survival analysis (time to event), the curves were compared using the Log Rank test (Mantel-Cox) or the Generalized Wilcoxon test. Cox regression was performed with non-parametric proportional hazards adjustment. We performed a sensitivity analysis to investigate the potential heterogeneity of treatment effects. For the competing risks analysis, the Fine-Gray test was used.

Results: 588 patients were included, of which 33.8% (n = 199) received LMWH beyond 12 months. During the 2 years of follow-up, there were 85 CRB (14%), 71 in the period 1-12 months and 14 in the period 12-24 months. Comparing 12-24 vs. 1-12 months, hazard ratio (HR) of CRB was 0.2 (95%CI: 0.1-0.37; p< 0.001). The competing risk analysis of CRB of both periods (1-12 vs. 12-24 months) showed a lower subdistribution hazard ratio (SHR) during the period 12-24 months (SHR: 0.3, 95%CI: 0.16-0.55, p< 0.001). In the period 12-24 months, subgroup analyses (metastasis, age, incidental thrombosis, ECOG performance status and sex) revealed no differences in CRB.

Conclusion(s): In cancer associated thrombosis, clinically relevant bleedings during LMWH treatment were significantly lower beyond 12 months.