预测癌症患者中复发性静脉血栓栓塞和主要出血的预测因素：二次分析
Predictors of recurrent venous thromboembolism and major bleeding in patients with cancer: A secondary analysis of the CANVAS trial
影响因子:3.40000
分区:医学3区 / 血液学2区 外周血管病3区
发表日期:2024 Dec
作者:
Hajime Uno, Hong Xiong, Christine Cronin, Deborah Schrag, Jean M Connors
摘要
与没有癌症的抗凝患者相比，癌症患者患有静脉血栓栓塞（VTE）的风险增加，但患有复发性VTE和抗凝性患者的风险也增加。画布是一项随机务实的有效性试验，比较了直接口服抗凝剂的类别与低分子量肝素的类别，用于治疗癌症患者的新VTE。该画布试验的预先指定的二级分析的目的是鉴定癌症患者的复发性VTE和大量出血的预测指标，并使用分析人群中671名参与者的新VTE.DATA来识别6个月治疗期间的复发VTE和流血的预测指标。在多变量模型中携带了单变量模型中确定的重要预测因素，以识别这两种风险的独立预测因子。复发性VTE的独立预测因子包括ECOG性能状态≥2（HR，3.19 [95％CI，1.45-7.02]； P <.005），p <.005），存在于体内疾病（HR，2.57％，1.57％，1.14 CI，1.14％，1.14-2.57％，1.14 ci，1.14 ci，1.14 ci，1.14 ci; p = .023），用贝伐单抗治疗（HR，2.50 [95％CI，1.04-5.99]; P = .041）和无肺栓塞的深静脉血栓形成为索引VTE（HR，HR，1.86 [95％CI，1.04-3.33]; P = .037）。主要出血的独立预测因子包括血清白蛋白<3.5 g/dL（HR 1.97 [95％CI，1.02-3.79]; P = .044）和转移性疾病（HR 2.80 [95％CI，1.08-7.22]; p = .034; P = .034）。在癌症和新VTE的参与者中，反映了当前的肿瘤学临床实践。结果可用于在实践中识别风险患者，并为新的风险预测模型提供信息以改善这些患者的护理。
Abstract
Patients with cancer have an increased risk of developing venous thromboembolism (VTE) but also have an increased risk of both recurrent VTE and bleeding with anticoagulation compared to anticoagulated patients without cancer. CANVAS, a randomized pragmatic effectiveness trial, compared the direct oral anticoagulants a class to low molecular weight heparin for treatment of a new VTE in patients with cancer. The aim of this prespecified secondary analysis of the CANVAS trial is to identify predictors of both recurrent VTE and major bleeding in patients with cancer and new VTE.Data from the 671 participants in the analysis population were used to identify predictors of recurrent VTE and bleeding during the 6-month treatment period. Significant predictors identified in the univariable models were carried forward in the multivariable models to identify independent predictors of both risks.Independent predictors of recurrent VTE include ECOG performance status ≥2 (HR, 3.19 [95 % CI, 1.45-7.02]; P < .005), presence of metastatic disease (HR, 2.57 [95 % CI, 1.14-5.80]; P = .023), treatment with bevacizumab (HR, 2.50 [95 % CI, 1.04-5.99]; P = .041), and deep vein thrombosis without pulmonary embolus as index VTE (HR, 1.86 [95 % CI, 1.04-3.33]; P = .037). Independent predictors of major bleeding include serum albumin <3.5 g/dL (HR 1.97 [95 % CI, 1.02-3.79]; P = .044) and metastatic disease (HR 2.80 [95 % CI, 1.08-7.22]; P = .034).Findings from this pre-specified analysis of the CANVAS trial identified risk factors for recurrent VTE and major bleeding in a population of participants with cancer and new VTE that reflect current oncology clinical practice. Results can be used to identify at risk patients in practice and inform new risk prediction models to improve the care of these patients.