Prophylaxis of cancer‑associated venous thromboembolism with low‑molecular‑weight heparin‑tinzaparin: Real world evidence

Christopoulou,Athina; Ardavanis,Alexandros; Papandreou,Christos; Koumakis,Georgios; Papatsimpas,Georgios; Papakotoulas,Pavlos; Tsoukalas,Nikolaos; Andreadis,Charalambos; Samelis,Georgios; Papakostas,Pavlos; Aravantinos,Gerasimos; Ziras,Nikolaos; Souggleri,Maria; Kalofonos,Charalambos; Samantas,Epameinondas; Makrantonakis,Paris; Pentheroudakis,Georgios; Athanasiadis,Athanasios; Stergiou,Helen; Bokas,Alexandros; Grivas,Anastasios; Tripodaki,Elli-Sofia; Varthalitis,Ioannis; Timotheadou,Eleni; Boukovinas,Ioannis

doi:10.3892/ol.2022.13235

Prophylaxis of cancer‑associated venous thromboembolism with low‑molecular‑weight heparin‑tinzaparin: Real world evidence

Authors:
- Athina Christopoulou
- Alexandros Ardavanis
- Christos Papandreou
- Georgios Koumakis
- Georgios Papatsimpas
- Pavlos Papakotoulas
- Nikolaos Tsoukalas
- Charalambos Andreadis
- Georgios Samelis
- Pavlos Papakostas
- Gerasimos Aravantinos
- Nikolaos Ziras
- Maria Souggleri
- Charalambos Kalofonos
- Epameinondas Samantas
- Paris Makrantonakis
- Georgios Pentheroudakis
- Athanasios Athanasiadis
- Helen Stergiou
- Alexandros Bokas
- Anastasios Grivas
- Elli-Sofia Tripodaki
- Ioannis Varthalitis
- Eleni Timotheadou
- Ioannis Boukovinas
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Affiliations: Oncology/Chemotherapy Department, ‘Saint Andrew’ General Hospital, 26335 Patras, Greece, 1st Department of Oncology, ‘Agios Savvas’ Anticancer Hospital, 11522 Athens, Greece, Oncology Department, ‘Papageorgiou’ General Hospital, 56429 Thessaloniki, Greece, Oncology Department, IASO Thessalias Hospital, 41500 Larissa, Greece, 1st Chemotherapy/Oncology Department, ‘Theagenio’ Anticancer Hospital, 54639 Thessaloniki, Greece, Oncology Department, 401 General Military Hospital, 11525 Athens, Greece, Oncology Department, ‘Ippokrateio’ General Hospital, 11527 Athens, Greece, 2nd Oncology Department, Metropolitan General Hospital, 15562 Athens, Greece, 2nd Oncology Department, ‘Agioi Anargyroi’ Anticancer Hospital, 14564 Athens, Greece, Oncology Department, ‘Metaxa’ Anticancer Hospital, 18537 Piraeus, Greece, Oncology Department, General Hospital University of Patras, 26504 Rio, Greece, Oncology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece, Oncology Department, General Hospital University of Ioannina, 45500 Ioannina, Greece, Oncology Department, General Hospital of Larissa, 41221 Larissa, Greece, Oncology Department, Bioclinic Hospital, 54622 Thessaloniki, Greece, Oncology Department, ‘Errikos Dunant’ Hospital, 11526 Athens, Greece, Oncology Department, ‘Papageorgiou’ General Hospital, 56429 Thessaloniki, Greece, Oncology Department, Bioclinic Hospital, 54622 Thessaloniki, Greece
Published online on: February 9, 2022 https://doi.org/10.3892/ol.2022.13235
Article Number: 115
Copyright: © Christopoulou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Thromboprophylaxis, as a preventive measure for cancer‑associated thrombosis (CAT), may be beneficial for patients with active cancer and high‑risk for thrombosis. The present post hoc analysis include a total of 407 patients enrolled in the Greek Management of Thrombosis study, who received thromboprophylaxis with tinzaparin. The objectives of the present analysis were: i) To obtain sufficient evidence for the administration of prophylaxis in patients with active cancer, irrespective of Khorana risk assessment model score; ii) to identify the selection criteria for both dose and duration of tinzaparin; and iii) to evaluate the efficacy and safety of tinzaparin administered for CAT prophylaxis. The main tumor types for the patients included in the present study were as follows: Lung (25.1%), pancreatic (14.3%), breast (9.1%), stomach (8.4%), colorectal (7.9%) and ovarian (7.6%). Furthermore, metastatic disease was observed in 69.5% of the patients. High thrombotic burden agents (HTBAs) were administered to 66.3% of the patients, and 17.4% received erythropoietin. A total of 43.7% of the patients exhibited a Khorana score <2. The results of the present study demonstrated that both the presence of metastatic disease and the use of HTBAs seemed to influence oncologists' decisions for the use of thromboprophylaxis in patients with active cancer, regardless of Khorana score. Tinzaparin, in dose expressed in the standard notation for heparins, i.e., anti‑Xa factor international units (Anti‑Xa IU), was administered at an intermediate dose (InterD; 8,000‑12,000 Anti‑Xa IU; once daily) to 52.4% of patients, while the remaining patients received a prophylactic dose (ProD; ≤4,500 Anti‑Xa IU; once daily). The average duration of thromoprophylaxis was 5 months. Furthermore, a total of 14 (3.4%) thrombotic events and 6 (1.5%) minor bleeding events were recorded. A total of four thrombotic events were observed following an InterD treatment of tinzaparin, while 10 thrombotic events were observed following ProD treatment. The present study also demonstrated that an InterD of tinzaparin was administered more frequently to patients with a body mass index >30 kg/m², a history of smoking and a history of metastatic disease, along with administration of erythropoietin. InterD tinzaparin treatment was found to be potentially more efficacious and without safety concerns. The present study is a registered clinical trial (ClinicalTrials.gov code, NCT03292107; registration date, September 25, 2017).

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