How PATP May Benefit Patients With Lung Cancer Who Are at Risk of VTE

Patients with lung cancer who are at a high risk for venous thromboembolism (VTE) may benefit from primary ambulatory thromboprophylaxis (PATP), updated study results showed.

The researchers, who presented their findings during the European Hematology Association 2024 Congress, reviewed 11 randomized studies to determine the potential benefit of PATP with low-molecular weight heparins and direct oral anticoagulants.

“Lung cancer remains the number one cause of cancer mortality while thrombosis confers the second leading cause of death in such patients,” the researchers said.

MEDLINE and EMBASE databases were searched through December 2023 and more than 5500 patients with lung cancer were identified from 5 randomized clinical trials (RCTs) and subgroups of an additional 6 RCTs, all of which had reduction in VTE as a primary or secondary endpoint. The anticoagulants used in these clinical trials included the following: apixaban, bemiparin, certoparin, dalteparin, enoxaparin, nadroparin, rivaroxaban, semuloparin, and tinzaparin. Duration of the anticoagulant treatment ranged from 3-6 months. All studies were randomized 1:1 except for the PROTECHT study, which was 2:1.

The researchers calculated risk ratio (RR) and risk difference (RD) for the analysis using the Mantel-Haenszel method.

In examining nearly a dozen studies, they discovered that by providing PATP the relative risk reduction is 47% with a number needed to treat of 25 to prevent 1 VTE in ambulatory patients with lung cancer. Moreover, the VTE incidence was 116 (4.1%) in the PATP group compared with 207 (8.1%) in the control group. There was an RR of 0.51 (P < .00001) and an absolute RD in VTE of -0.04 (P < .00001).

In a subgroup analysis of PATP trials, there were 114 (4.2%) VTE events in the PATP group versus 215 (8.2%) in the control group. This analysis showed a RR of 0.51 (P < .00001) and an absolute RD of -0.04 (P < .00001).

Although this study provides insight into how PATP can help patients with lung cancer from experiencing a serious and potentially life-threatening condition, the researchers emphasized the importance of selecting the appropriate patients who are high risk for VTE. In addition, they pushed for future studies to help establish the high-risk subsets of patients with lung cancer who are receiving systemic therapy and may benefit from PATP.

Reference

Win Htut T, Zin Thein K, Hlaing Oo T. Primary ambulatory thromboprophylaxis (PATP) in patients with lung cancer undergoing systemic therapy: updated analysis of randomized studies. P1661. Presented at the European Hematology Association 2024 Congress; June 13-16; Madrid, Spain.