Patterns of Low Molecular Weight Heparin Dosage Regimen in Thai Cancer Patients with Venous Thromboembolism
Abstract
Cancer patients with venous thromboembolism (VTE) have a 2-6 times higher mortality rate than those without VTE. Low molecular weight heparin (LMWH) is the drug of choice for the treatment of VTE in cancer patients. Enoxaparin is the LMWH most often prescribed for VTE in Thai cancer patients. NCCN and ASCO recommend enoxaparin at a dose of 1 mg/kg subcutaneously twice daily or 1.5 mg/kg once a day, with dose adjustment according to renal function. However, in clinical practice, there are many patterns of use for enoxaparin for VTE in Thai cancer patients. This study aimed to explore the patterns of use for LMWH for VTE treatment among patients with cancer. We conducted a retrospective chart review of cancer patients with VTE who had received LMWH at King Chulalongkorn Memorial hospital between January 2014 and February 2019; the relevant data of 140 cancer patients were collected and reviewed . Most of the patients were female (59%) and the average age was 60 + 15 years. The most common cancer was lung cancer (33.6%) and most of the patients were in the advanced stage (85.7%). Deep vein thrombosis (DVT) was most common type of VTE found (51%). All patients were prescribed enoxaparin with optimal dose (50%). However, 45% of the cancer patients received enoxaparin at a subtherapeutic dose and 5% received enoxaparin in a supratherapeutic dose. At 3 months' follow-up, 72.9% and 71.4% of cancer patients had undergone efficacy evaluation by clinical assessment or venous radio-imaging, respectively. Adverse effects (bleeding) were found among 11%. Cancer patients who received supratherapeutic doses had significantly more bleeding (57%) than the optimal dose (8.6%) or subtherapeutic dose (9.5%) (P=0.000). In conclusion, most of the cancer patients with VTE received LMWH at the optimal dose and underwent clinical-symptom assessment and venous radio-imaging. Supratherapeutic doses of enoxaparin were associated with increased bleeding.
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