PB0483 - Enoxaparin for the long-term therapy of venous thromboembolism in patients with cancer and renal insufficiency. The RIETECAT-RI study.

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Manuel Monreal, PhD, MD

Senior consultant
Universidad Catolica de Murcia
Barcelona, Catalonia, Spain

Co-Author(s)

JL

Juan José López-Núñez

Head
Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
Barcelona, Catalonia, Spain
PS

Patricia Sigüenza

Dr
Department of Internal Medicine, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
Barcelona, Catalonia, Spain
CF

Conxita Falgá

Staff Physician
University of Barcelona
Barcelona, Catalonia, Spain
CG

Covadonga Gómez-Cuervo

Department of Internal Medicine
Hospital Universitario 12 de Octubre. Madrid. Spain
Madrid, Madrid, Spain
AR

Antoni Riera-Mestre

Head of Internal Medicine
Hospital Universitari de Bellvitge. Barcelona. Spain
Barcelona, Catalonia, Spain
AG

Aida Gil-Diaz

Department of Internal Medicine
Hospital Universitario Dr Juan Negrin
Las Palmas de Gran Canaria, Canarias, Spain
PV

Peter Verhamme, MD, PhD

MD, PhD
University Hospitals Leuven, Belgium
Leuven, Vlaams-Brabant, Belgium
AM

Ana Cristina Montenegro

Department of Vascular Medicine
Hospital Universitario Fundación Santa Fe de Bogotá. Colombia.
Bogotá, Distrito Capital de Bogota, Colombia
CB

Cristina Barbagelata

Department of Internal Medicine
Hospital Universitario A Coruña. Spain
Coruña, Galicia, Spain

Background: The optimal doses of enoxaparin to treat venous thromboembolism (VTE) in patients with cancer and renal insufficiency (RI) have not been consistently evaluated.

Aims: To compare the effectiveness and safety of the recommended (vs. higher- or lower-) doses of enoxaparin in VTE patients with active cancer and several degrees of RI. Major outcome was major bleeding during the first 6 months.

Methods: We used the RIETE registry to compare the effectiveness and safety of the recommended (vs. higher- or lower-) doses of enoxaparin monotherapy in patients with active cancer and several degrees of renal insufficiency. Patients were categorized according to creatinine clearance levels at baseline: 60-89 mL/min (mild RI), 30-59 mL/min (moderate RI), or < 30 mL/min (severe RI).

Results: From January 2009 through June 2022, 3,769 cancer patients with VTE and RI received enoxaparin monotherapy. Of these, 1,965 (52%) had mild RI, 1,524 (40%) moderate RI, and 280 (7.4%) had severe RI. Among patients with mild RI, 72% received the recommended doses of enoxaparin, 7.7% higher- and 20% lower doses. Among patients with moderate RI, the proportions were: 66%, 12% and 22%, respectively. Among patients with severe RI, there were: 10%, 86% and 3.9%, respectively. At 6 months, the rates of major bleeding in patients with mild-, moderate- or severe RI were: 3.2%, 3.5% and 9.6%, respectively; mortality was: 21%, 25% and 30%, respectively; and VTE recurrences was: 2.2%, 1.4% and 2.1%, respectively. On multivariable analysis, patients receiving higher than recommended doses of enoxaparin were at increased risk for major bleeding (adjusted hazard ratio (aHR): 1.79; 95%CI: 1.01-3.21).

Conclusion(s): 85% of cancer patients with VTE and severe RI received the recommended doses of enoxaparin . This use was associated with an increased risk for major bleeding.