Recurrent thrombosis in malignant neoplasms: clinical significance of long-term anticoagulant prophylaxis

Aim: to stratify the risk of thrombosis and assess frequency of recurrent venous thromboembolism (VTE) and bleeding during long-term anticoagulant therapy (АСТ) in patients with stage III–IV ovarian cancer (ОС).

Materials and Methods. A prospective interventional comparative non-randomized study was conducted by enrolling 126 patients with stage III–IV ОС, of whom 66 had VTE and received long-term АСТ for 60–72 months, whereas 60 subjects comprised comparison group without thrombotic complications. Risk stratification was performed using the Khorana, Vienna-CATS, and Tic-Onco scales. The frequency of VTE recurrence and bleeding as well as the prognostic significance of the above noted scales were assessed.

Results. It was found that recurrent VTE (deep vein thrombosis – in 12.1 %, pulmonary embolism – in 6.1 %) developed in 18.2 % of patients receiving anticoagulants, so that two thirds of cases occurred within the first year of therapy. In comparison group, VTE incidence was 16.7 %. Major bleeding was recorded in 6.1 % patients, clinically significant moderate bleeding – in 21.2 % cases. The Vienna-CATS (AUC = 0.719) and Tic-Onco (AUC = 0.730) scales demonstrated better predictive ability compared to Khorana model (AUC = 0.671).

Conclusion. 60–72-month-long АСТ in patients with high thrombotic risk allows to significantly reduce the frequency of VTE recurrence with acceptable level of hemorrhagic complications and can be considered as a preferred strategy for secondary prevention in active oncological processes.

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