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.