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Hamostaseologie 2022; 42(03): 166-173
DOI: 10.1055/a-1554-4664
Original Article

Anticoagulation Therapy in Cancer Patients with Thrombosis in the Outpatient Sector of Germany (The CERTIFICAT Initiative)—German Practice of Anticoagulation Therapy of Cancer Patients with Thrombosis

Hanno Riess
1   Mediziniasche Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité, Universitätsmedizin Berlin, Berlin, Germany
,
Albrecht Kretzschmar
2   MVZ Mitte, Leipzig, Germany
,
Andreas Heinken
3   Aspen Germany GmbH, München, Germany
,
Damon Mohebbi
4   HGC Healthcare Consultants GmbH, Düsseldorf, Germany
,
Melanie May
4   HGC Healthcare Consultants GmbH, Düsseldorf, Germany
,
Sebastian Schellong
5   Department of Angiology, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany
› Author Affiliations Funding This study was supported by Aspen Germany GmbH.
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Abstract

Objective This article aims to investigate the reality of anticoagulation treatment for cancer patients with thrombosis in the outpatient sector of Germany.

Methods For the analysis period 2012 to 2015, anonymized data from 4.1 million statutory insured patients were analyzed. Cancer patients with incident thrombosis and an outpatient prescription of anticoagulant drugs were identified and evaluated for three subsequent quarters with regard to anticoagulant use.

Results A total of 7,313 cancer patients with incident thrombosis (ICD-10: I80*) were evaluated. About, 90% of patients with thromboses were diagnosed and treated in the ambulatory sector. More than 80% of the prescriptions were issued by general practitioners. And 57% of patients were anticoagulated predominantly (>50% of the time) with different low-molecular-weight heparins (LMWHs), 24% predominantly with vitamin K antagonists (VKAs), and 17% with direct oral anticoagulants (DOACs). Anticoagulants were prescribed for an average of 4.5 months. LMWH had a substantially longer prescription period (90–135 days) than VKA (53 days) or DOAC (47 days). Gastrointestinal bleeding in conjunction with hospitalization was documented in 1.76% of patients with a range of 1.3 to 3% for the different LMWHs.

Conclusion The prescription practice documented by this representative and comprehensive evaluation demonstrates an anticoagulation duration in accordance with the guidelines, although the choice of the respective anticoagulant was often not in compliance with the contemporary label or guidelines.

Keywords

anticoagulation therapy - thrombosis - oncology - heparin - oral anticoagulants - claims data - CERTIFICAT


Publication History

Received: 15 February 2021

Accepted: 19 July 2021

Article published online:
08 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Blom JW, Vanderschoot JPM, Oostindiër MJ, Osanto S, van der Meer FJM, Rosendaal FR. Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost 2006; 4 (03) 529-535
    CrossrefPubMedGoogle Scholar
  • 2 Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 2006; 166 (04) 458-464
    CrossrefPubMedGoogle Scholar
  • 3 Gary T. Cancer related venous thromboembolism - prophylaxis and therapy. Vasa 2014; 43 (04) 245-251
    CrossrefPubMedGoogle Scholar
  • 4 Decousus H, Quéré I, Presles E. et al; POST (Prospective Observational Superficial Thrombophlebitis) Study Group. Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med 2010; 152 (04) 218-224
    CrossrefPubMedGoogle Scholar
  • 5 Décousus H, Bertoletti L, Frappé P. et al. Recent findings in the epidemiology, diagnosis and treatment of superficial-vein thrombosis. Thromb Res 2011; 127 (Suppl. 03) S81-S85
    CrossrefPubMedGoogle Scholar
  • 6 Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000; 343 (25) 1846-1850
    CrossrefPubMedGoogle Scholar
  • 7 Gary T, Belaj K, Steidl K. et al. Asymptomatic deep vein thrombosis and superficial vein thrombosis in ambulatory cancer patients: impact on short-term survival. Br J Cancer 2012; 107 (08) 1244-1248
    CrossrefPubMedGoogle Scholar
  • 8 Galanaud J-P, Blaise S, Sevestre M-A. et al; OPTIMEV-SFMV Investigators. Long-term outcomes of isolated superficial vein thrombosis in patients with active cancer. Thromb Res 2018; 171: 179-186
    CrossrefPubMedGoogle Scholar
  • 9 Ay C, Pabinger I, Cohen AT. Cancer-associated venous thromboembolism: burden, mechanisms, and management. Thromb Haemost 2017; 117 (02) 219-230
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Prandoni P, Lensing AWA, Piccioli A. et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100 (10) 3484-3488
    CrossrefPubMedGoogle Scholar
  • 11 AWMF. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. 2015. S2-Leitlinie: Diagnostik und Therapie der Venenthrombose und der Lungenembolie. Datum der Verabschiedung: 10. Oktober 2015. Gültigkeitsdatum: 09. Oktober 2020. AWMF Leitlinien-Register Nr. 065/002
    PubMedGoogle Scholar
  • 12 Riess H, Pabinger-Fasching I, Alt-Epping B. et al. Venöse Thromboembolien (VTE) bei Tumorpatienten. Accessed June 6, 2021 at: www.onkopedia.com
    PubMedGoogle Scholar
  • 13 Lyman GH, Carrier M, Ay C. et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv 2021; 5: 927-974
    Google Scholar
  • 14 Carrier M, Cameron C, Delluc A, Castellucci L, Khorana AA, Lee AYY. Efficacy and safety of anticoagulant therapy for the treatment of acute cancer-associated thrombosis: a systematic review and meta-analysis. Thromb Res 2014; 134 (06) 1214-1219
    CrossrefPubMedGoogle Scholar
  • 15 Lee AYY, Levine MN, Baker RI. et al; Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349 (02) 146-153
    CrossrefPubMedGoogle Scholar
  • 16 Lee AYY, Kamphuisen PW, Meyer G. et al; CATCH Investigators. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: a randomized clinical trial. JAMA 2015; 314 (07) 677-686
    CrossrefPubMedGoogle Scholar
  • 17 Schellong S, Kretzschmar A, Heinken A. et al. Anticoagulation treatment of cancer patients with deep or superficial leg vein thrombosis - a retrospective observational study of German statutory health insurance claims data (the CERTIFICAT initiative). Vasa 2020; 49 (05) 403-409
    CrossrefPubMedGoogle Scholar
  • 18 Andersohn F, Walker J. Characteristics and external validity of the German Health Risk Institute (HRI) Database. Pharmacoepidemiol Drug Saf 2016; 25 (01) 106-109
    CrossrefPubMedGoogle Scholar
  • 19 Blom JW, Osanto S, Rosendaal FR. The risk of a venous thrombotic event in lung cancer patients: higher risk for adenocarcinoma than squamous cell carcinoma. J Thromb Haemost 2004; 2 (10) 1760-1765
    CrossrefPubMedGoogle Scholar
  • 20 Blom JW, Doggen CJM, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 2005; 293 (06) 715-722
    CrossrefPubMedGoogle Scholar
  • 21 Diehm C, Noppeney T, Nüllen H. Epidemiologie der venösen Thromboembolie. Gefasschirurgie 2012; 17 (04) 275-279
    CrossrefPubMedGoogle Scholar
  • 22 Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood 2013; 122 (10) 1712-1723
    CrossrefPubMedGoogle Scholar
  • 23 Mahé I, Elalamy I, Gerotziafas GT, Girard P. Treatment of cancer-associated thrombosis: beyond HOKUSAI. TH Open 2019; 3 (03) e309-e315
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Beyer-Westendorf J, Klamroth R, Kreher S, Langer F, Matzdorff A, Riess H. Non-vitamin K antagonist oral anticoagulants (NOAC) as an alternative treatment option in tumor-related venous thromboembolism. Dtsch Arztebl Int 2019; 116 (03) 31-38
    PubMedGoogle Scholar
  • 25 Matzdorff A, Ledig B, Stuecker M, Riess H. Practice patterns for prophylaxis and treatment of venous thromboembolism in German cancer patients. Oncol Res Treat 2016; 39 (04) 194-201
    CrossrefPubMedGoogle Scholar
  • 26 Shaw J, de Wit C, Le Gal G, Carrier M. Thrombotic and bleeding outcomes following perioperative interruption of direct oral anticoagulants in patients with venous thromboembolic disease. J Thromb Haemost 2017; 15 (05) 925-930
    CrossrefPubMedGoogle Scholar
  • 27 Long E, Kofman A. Best clinical practice: Current controversies in pulmonary embolism imaging and treatment of subsegmental thromboembolic disease. J Emerg Med 2017; 52 (02) 184-193
    CrossrefPubMedGoogle Scholar
  • 28 O'Connell C. How I treat incidental pulmonary embolism. Blood 2015; 125 (12) 1877-1882 , quiz 2009
    CrossrefPubMedGoogle Scholar