Real-world Data on Treatment Patterns and Bleeding in Cancer-associated Thrombosis: Data from the TROLL Registry

Zygimantas Zaboras; Camilla Tøvik Jørgensen; Andreas Stensvold; Heidi Hassel Pettersen; Aleksandra Galovic Grdinic; Sigrid Kufaas Brækkan; Waleed Ghanima; Mazdak Tavoly

doi:10.1055/s-0044-1782219

Real-world Data on Treatment Patterns and Bleeding in Cancer-associated Thrombosis: Data from the TROLL Registry

TH Open. 2024 Mar 26;8(1):e132-e140. doi: 10.1055/s-0044-1782219. eCollection 2024 Jan.

Authors

Affiliations

¹ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
² Department of Emergency Medicine, Østfold Hospital, Sarpsborg, Norway.
³ Department of Oncology, Østfold Hospital, Sarpsborg, Norway.
⁴ Department of Research, Østfold Hospital, Sarpsborg, Norway.
⁵ Clinic of Internal Medicine, Østfold Hospital, Sarpsborg, Norway.
⁶ Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
⁷ Department of Clinical Medicine, Thrombosis Research Group (TREC), UiT - The Arctic University of Norway, Tromsø, Norway.
⁸ Department of Hematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁹ Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.

Abstract

Background International guidelines are increasingly recommending direct oral anticoagulants (DOACs) as the first-line treatment for cancer-associated thrombosis (CAT). However, data regarding treatment patterns and adherence to guidelines in patients with CAT are scarce. Objectives This study aimed to explore anticoagulant treatment patterns in patients with CAT and to calculate the incidence rates of bleeding events. Methods Patients ≥18 years with active cancer and a first-time venous thromboembolism between 2005 and 2020 were identified through the Venous T hrombosis R egistry in Østf OL d Hospita L . Outcome measures were patterns of anticoagulant treatment during the study period and bleeding events. We calculated overall incidence rates per 100 person-years and 6- and 12-month cumulative incidence of major and clinically relevant nonmajor bleeding (CRNMB) during anticoagulant treatment. Results Median age of 842 CAT patients at the time of thrombosis was 69 years (interquartile range 61-77), and 443 (52.6%) were men. In total, 526 patients (62.5%) had pulmonary embolism and 255 (30.3%) had deep vein thrombosis. Low molecular weight heparin (LMWH) was prescribed to 713 (85.8%) patients, whereas 64 (7.7%) received DOACs and 54 (6.5%) received vitamin K antagonists as the initial anticoagulant treatment. Prescription of DOACs as initial treatment increased from 3.0% in 2013/2014 to 18.0% in 2019/2020. The incidence rate of major bleeding was 6.9 (95% confidence interval [CI] 5.2-9.2) and 10.1 (95% CI 8.0-12.9) in CRNMB. Conclusion Most patients were treated with LMWH. However, a gradual shift in treatment toward DOACs was observed. Overall, bleeding complications were rare and comparable to those reported in randomized trials.

Keywords: anticoagulants; bleeding; cancer-associated thrombosis; direct oral anticoagulants; low molecular weight heparin; venous thromboembolism.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).

Grants and funding

Funding None.