Idraparinux versus standard therapy in the treatment of deep venous thrombosis in cancer patients: A subgroup analysis of the Van Gogh DVT trial

Frederiek F. Van Doormaal, Alexander T. Cohen, Bruce L. Davidson, Herve Decousus, Alexander S. Gallus, Michael Gent, Franco Piovella, Martin H. Prins, Gary E. Raskob, Harry R. Büller

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Standard treatment with heparin followed by vitamin K antagonists is frequently complicated by bleeding and recurrent venous thromboembolism (VTE) in cancer patients with VTE. To compare the efficacy, safety and overall survival of long-term idraparinux treatment to standard therapy in cancer patients we conducted a post-hoc analysis in the subgroup of non-active and active cancer patients included in the Van Gogh DVT clinical trial. The cancer patients with deep venous thrombosis (DVT) and without pulmonary embolism (PE) were randomised to standard treatment or a once-weekly subcutaneous injection of idraparinux (2.5 mg), a synthetic pentasaccharide. 421 cancer patients were included. A total of 220 patients received idraparinux and 201 were allocated to standard therapy for three months (8%) or six months (92%). A recurrent VTE was observed during the first six months in 2.5% (n=5) of the idraparinux recipients compared to 6.4% (n=12) in the standard therapy group (hazard ratio 0.39, 95% confidence interval [CI]; 0.14-1.11). The rate of bleeding was comparable (odds ratio 0.89, 95% CI; 0.50-1.59). The outcomes were similar at three months after randomisation in all patients. Of the idraparinux recipients, 22.7% (n=50) died during the study period compared to 48 patients (23.9%) in the standard treatment group (hazard ratio 0.99, 95% CI; 0.66-1.48). In conclusion, no significant safety or survival differences were observed between cancer patients with DVT treated with idraparinux for six months compared to standard therapy. Fewer recurrent VTEs were observed in the idraparinux group; however, this was not statistically significant and also because of study limitations this should be interpreted with caution.

Original languageEnglish
Pages (from-to)86-91
Number of pages6
JournalThrombosis and Haemostasis
Volume104
Issue number1
DOIs
Publication statusPublished - Jul 2010

Fingerprint

Venous Thrombosis
Neoplasms
Venous Thromboembolism
Therapeutics
Confidence Intervals
Hemorrhage
Safety
idraparinux
Survival
Vitamin K
Subcutaneous Injections
Group Psychotherapy
Random Allocation
Pulmonary Embolism
Heparin
Odds Ratio
Clinical Trials

Keywords

  • Anticoagulation
  • Cancer
  • Deep venous thrombosis
  • Idraparinux

ASJC Scopus subject areas

  • Hematology

Cite this

Idraparinux versus standard therapy in the treatment of deep venous thrombosis in cancer patients : A subgroup analysis of the Van Gogh DVT trial. / Van Doormaal, Frederiek F.; Cohen, Alexander T.; Davidson, Bruce L.; Decousus, Herve; Gallus, Alexander S.; Gent, Michael; Piovella, Franco; Prins, Martin H.; Raskob, Gary E.; Büller, Harry R.

In: Thrombosis and Haemostasis, Vol. 104, No. 1, 07.2010, p. 86-91.

Research output: Contribution to journalArticle

Van Doormaal, FF, Cohen, AT, Davidson, BL, Decousus, H, Gallus, AS, Gent, M, Piovella, F, Prins, MH, Raskob, GE & Büller, HR 2010, 'Idraparinux versus standard therapy in the treatment of deep venous thrombosis in cancer patients: A subgroup analysis of the Van Gogh DVT trial', Thrombosis and Haemostasis, vol. 104, no. 1, pp. 86-91. https://doi.org/10.1160/TH09-12-0870
Van Doormaal, Frederiek F. ; Cohen, Alexander T. ; Davidson, Bruce L. ; Decousus, Herve ; Gallus, Alexander S. ; Gent, Michael ; Piovella, Franco ; Prins, Martin H. ; Raskob, Gary E. ; Büller, Harry R. / Idraparinux versus standard therapy in the treatment of deep venous thrombosis in cancer patients : A subgroup analysis of the Van Gogh DVT trial. In: Thrombosis and Haemostasis. 2010 ; Vol. 104, No. 1. pp. 86-91.
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abstract = "Standard treatment with heparin followed by vitamin K antagonists is frequently complicated by bleeding and recurrent venous thromboembolism (VTE) in cancer patients with VTE. To compare the efficacy, safety and overall survival of long-term idraparinux treatment to standard therapy in cancer patients we conducted a post-hoc analysis in the subgroup of non-active and active cancer patients included in the Van Gogh DVT clinical trial. The cancer patients with deep venous thrombosis (DVT) and without pulmonary embolism (PE) were randomised to standard treatment or a once-weekly subcutaneous injection of idraparinux (2.5 mg), a synthetic pentasaccharide. 421 cancer patients were included. A total of 220 patients received idraparinux and 201 were allocated to standard therapy for three months (8{\%}) or six months (92{\%}). A recurrent VTE was observed during the first six months in 2.5{\%} (n=5) of the idraparinux recipients compared to 6.4{\%} (n=12) in the standard therapy group (hazard ratio 0.39, 95{\%} confidence interval [CI]; 0.14-1.11). The rate of bleeding was comparable (odds ratio 0.89, 95{\%} CI; 0.50-1.59). The outcomes were similar at three months after randomisation in all patients. Of the idraparinux recipients, 22.7{\%} (n=50) died during the study period compared to 48 patients (23.9{\%}) in the standard treatment group (hazard ratio 0.99, 95{\%} CI; 0.66-1.48). In conclusion, no significant safety or survival differences were observed between cancer patients with DVT treated with idraparinux for six months compared to standard therapy. Fewer recurrent VTEs were observed in the idraparinux group; however, this was not statistically significant and also because of study limitations this should be interpreted with caution.",
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