Issue: 2014 > November > original article

Anticoagulant treatment of cancer patients with pulmonary embolism in the real world. Actual use of low-molecular-weight heparin in cancer

A. Kleinjan, B.A. Hutten, M. Di Nisio, , P.W. Kamphuisen


Background: Since 2004, guidelines recommend long-term treatment with low-molecular-weight heparin (LMWH) in patients with cancer and pulmonary embolism
(PE). We assessed the proportion of cancer patients with
PE actually treated with LMWH and the duration of
anticoagulant treatment in the Netherlands. Methods: A retrospective cohort study in patients that were hospitalised for PE between 1998-2008. Patients with PE
were selected from national hospital discharge records,
after linkage to a national pharmacy database. Cancer
patients with PE were matched for age, sex and year of
diagnosis of PE to subjects with PE without cancer.
Results: 600 cancer patients with PE were matched to
1200 patients with PE without cancer. Long-term LMWH
was prescribed in 82 (13.7%) of the cancer patients and
in eight (0.7%) of the cancer-free patients (p < 0.001); all the other patients received vitamin K antagonists (VKA). From 1998-2008, there was an increase in the use of LMWH in cancer patients: in 2007-2008, LMWH was prescribed in 42 (32%) cases, compared with one (1.7%) of the cancer patients with PE in 1998-1999. Median duration of treatment was 5.8 months (interquartile range 3.1-8.8) in cancer patients, compared with 7.0 months (4.9-11) in patients without cancer (p < 0.001), a difference that persisted after adjustment for mortality. Conclusions: Although the use of LMWH in patients with cancer and PE is increasing, in 2008, patients in the Netherlands are still mostly treated with VKA, and not with LMWH as recommended by guidelines. Cancer patients with PE on average receive shorter treatment than matched patients without cancer.