Gemcitabine versus gemcitabine plus dalteparin thromboprophylaxis in pancreatic cancer

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• 作者：A. Maraveyas^a ; ⁱ ; ^j ; ^{Anthony.maraveyas@hey.nhs.uk} ; ^{Anthony.maraveyas@gmail.com} ; J. Waters^b ; ^j ; R. Roy^c ; ^j ; D. Fyfe^d ; ^j ; D. Propper^e ; ^j ; F. Lofts^f ; ^j ; J. Sgouros^a ; ^g ; ^j ; E. Gardiner^a ; ^j ; K. Wedgwood^a ; ^j ; C. Ettelaie^h ; ^j ; G. Bozas^a ; ^j
• 关键词：Anticoagulation ; Dalteparin ; Pancreatic cancer ; Thrombosis
• 刊名：European Journal of Cancer
• 出版年：2012
• 期刊代码：88_09598049
• 类别：med
• 出版时间：June, 2012
• 卷：48
• 期：9
• 页码：1283-1292
• 文件大小：607 K

摘要

Background

Annualised figures show an up to 7-fold higher incidence of vascular thromboembolism (VTE) in patients with advanced pancreatic cancer (APC) compared to other common malignancies. Concurrent VTE has been shown to confer a worse overall prognosis in APC.

Methods

One hundred and twenty three APC patients were randomised to receive either gemcitabine 1000 mg/m² or the same with weight-adjusted dalteparin (WAD) for 12 weeks. Primary end-point was the reduction of all-type VTE during the study period. , ISRCTN: 76464767.

Findings

The incidence of all-type VTE during the WAD treatment period (<100 days from randomisation) was reduced from 23%to 3.4%(p = 0.002), with a risk ratio (RR)of 0.145, 95%confidence interval (CI) (0.035-0.612) and an 85%risk reduction. All-type VTE throughout the whole follow-up period was reduced from 28%to 12%(p = 0.039), RR = 0.419, 95%CI (0.187-0.935) and a 58%risk reduction. Lethal VTE <100 days was seen only in the control arm, 8.3%compared to 0%(p = 0.057), RR = 0.092, 95%CI (0.005-1.635).

Interpretation

Weight adjusted dalteparin used as primary prophylaxis for 12 weeks is safe and produces a highly significant reduction of all-type VTE during the prophylaxis period. The benefit is maintained after dalteparin withdrawal although decreases with time.