Outpatient use of low molecular weight heparin monotherapy for first-line treatment of venous thromboembolism in advanced cancer

Thomas Delate, Daniel M. Witt, Debra Ritzwoller, Jane C. Weeks, Lawrence Kushi, Mark C. Hornbrook, Erin J. Aiello Bowles, Deborah Schrag

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background. Evidence-based treatment guidelines recommend low molecular weight heparin (LMWH) monotherapy for cancer-associated venous thromboembolism (VTE). This analysis assessed the first-line treatment strategies for VTE in patients with advanced solid tumors. Methods. Using administrative data from advanced lung, prostate, colon, or breast cancer patients diagnosed between January 2000 and December 2007 at four HMOs with integrated delivery systems, patients with an inpatient or outpatient VTE diagnosed within 2 years after cancer diagnosis and an outpatient purchase of warfarin, LMWH, and/or fondaparinux anticoagulant within 7 days of the VTE diagnosis were identified. First-line outpatient VTE pharmacological treatment and factors independently associated with receipt/non-receipt of LMWH monotherapy were assessed. Results. Overall, 25% of the 1,089 eligible patients received LMWH monotherapy as primary VTE treatment. The percentage increased steadily over time from 18% among patients diagnosed in 2000 to 31% among those diagnosed in 2007. Factors associated with LMWH monotherapy included VTE diagnosis year, chemotherapy within 60 days prior to VTE diagnosis, history of VTE prior to cancer diagnosis, and invasive surgery in the 90 days following VTE diagnosis. Colorectal and prostate cancer patients versus lung cancer patients and stage III versus stage IV patients were less likely to be treated with LMWH monotherapy. Conclusions. Adoption of LMWH monotherapy as initial treatment for cancer-associated VTE was low but increased steadily over the study period. Future studies should explore reasons underlying the underutilization of this preferred evidence-based treatment as well as the comparative effectiveness of LMWH versus warfarin-based anticoagulation in real-world cancer patients with VTE.

Original languageEnglish (US)
Pages (from-to)419-427
Number of pages9
JournalOncologist
Volume17
Issue number3
DOIs
StatePublished - 2012
Externally publishedYes

Fingerprint

Low Molecular Weight Heparin
Venous Thromboembolism
Outpatients
Neoplasms
Therapeutics
Warfarin
Prostatic Neoplasms
Integrated Delivery of Health Care
Second Primary Neoplasms
Health Maintenance Organizations
Colonic Neoplasms
Anticoagulants
Inpatients
Colorectal Neoplasms
Lung Neoplasms
Pharmacology
Guidelines
Breast Neoplasms

Keywords

  • Ambulatory care
  • Anticoagulants
  • Neoplasms
  • Venous thromboembolism

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Delate, T., Witt, D. M., Ritzwoller, D., Weeks, J. C., Kushi, L., Hornbrook, M. C., ... Schrag, D. (2012). Outpatient use of low molecular weight heparin monotherapy for first-line treatment of venous thromboembolism in advanced cancer. Oncologist, 17(3), 419-427. https://doi.org/10.1634/theoncologist.2011-0323

Outpatient use of low molecular weight heparin monotherapy for first-line treatment of venous thromboembolism in advanced cancer. / Delate, Thomas; Witt, Daniel M.; Ritzwoller, Debra; Weeks, Jane C.; Kushi, Lawrence; Hornbrook, Mark C.; Aiello Bowles, Erin J.; Schrag, Deborah.

In: Oncologist, Vol. 17, No. 3, 2012, p. 419-427.

Research output: Contribution to journalArticle

Delate, T, Witt, DM, Ritzwoller, D, Weeks, JC, Kushi, L, Hornbrook, MC, Aiello Bowles, EJ & Schrag, D 2012, 'Outpatient use of low molecular weight heparin monotherapy for first-line treatment of venous thromboembolism in advanced cancer', Oncologist, vol. 17, no. 3, pp. 419-427. https://doi.org/10.1634/theoncologist.2011-0323
Delate, Thomas ; Witt, Daniel M. ; Ritzwoller, Debra ; Weeks, Jane C. ; Kushi, Lawrence ; Hornbrook, Mark C. ; Aiello Bowles, Erin J. ; Schrag, Deborah. / Outpatient use of low molecular weight heparin monotherapy for first-line treatment of venous thromboembolism in advanced cancer. In: Oncologist. 2012 ; Vol. 17, No. 3. pp. 419-427.
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AU - Aiello Bowles, Erin J.

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N2 - Background. Evidence-based treatment guidelines recommend low molecular weight heparin (LMWH) monotherapy for cancer-associated venous thromboembolism (VTE). This analysis assessed the first-line treatment strategies for VTE in patients with advanced solid tumors. Methods. Using administrative data from advanced lung, prostate, colon, or breast cancer patients diagnosed between January 2000 and December 2007 at four HMOs with integrated delivery systems, patients with an inpatient or outpatient VTE diagnosed within 2 years after cancer diagnosis and an outpatient purchase of warfarin, LMWH, and/or fondaparinux anticoagulant within 7 days of the VTE diagnosis were identified. First-line outpatient VTE pharmacological treatment and factors independently associated with receipt/non-receipt of LMWH monotherapy were assessed. Results. Overall, 25% of the 1,089 eligible patients received LMWH monotherapy as primary VTE treatment. The percentage increased steadily over time from 18% among patients diagnosed in 2000 to 31% among those diagnosed in 2007. Factors associated with LMWH monotherapy included VTE diagnosis year, chemotherapy within 60 days prior to VTE diagnosis, history of VTE prior to cancer diagnosis, and invasive surgery in the 90 days following VTE diagnosis. Colorectal and prostate cancer patients versus lung cancer patients and stage III versus stage IV patients were less likely to be treated with LMWH monotherapy. Conclusions. Adoption of LMWH monotherapy as initial treatment for cancer-associated VTE was low but increased steadily over the study period. Future studies should explore reasons underlying the underutilization of this preferred evidence-based treatment as well as the comparative effectiveness of LMWH versus warfarin-based anticoagulation in real-world cancer patients with VTE.

AB - Background. Evidence-based treatment guidelines recommend low molecular weight heparin (LMWH) monotherapy for cancer-associated venous thromboembolism (VTE). This analysis assessed the first-line treatment strategies for VTE in patients with advanced solid tumors. Methods. Using administrative data from advanced lung, prostate, colon, or breast cancer patients diagnosed between January 2000 and December 2007 at four HMOs with integrated delivery systems, patients with an inpatient or outpatient VTE diagnosed within 2 years after cancer diagnosis and an outpatient purchase of warfarin, LMWH, and/or fondaparinux anticoagulant within 7 days of the VTE diagnosis were identified. First-line outpatient VTE pharmacological treatment and factors independently associated with receipt/non-receipt of LMWH monotherapy were assessed. Results. Overall, 25% of the 1,089 eligible patients received LMWH monotherapy as primary VTE treatment. The percentage increased steadily over time from 18% among patients diagnosed in 2000 to 31% among those diagnosed in 2007. Factors associated with LMWH monotherapy included VTE diagnosis year, chemotherapy within 60 days prior to VTE diagnosis, history of VTE prior to cancer diagnosis, and invasive surgery in the 90 days following VTE diagnosis. Colorectal and prostate cancer patients versus lung cancer patients and stage III versus stage IV patients were less likely to be treated with LMWH monotherapy. Conclusions. Adoption of LMWH monotherapy as initial treatment for cancer-associated VTE was low but increased steadily over the study period. Future studies should explore reasons underlying the underutilization of this preferred evidence-based treatment as well as the comparative effectiveness of LMWH versus warfarin-based anticoagulation in real-world cancer patients with VTE.

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