Trial reportJournal of thrombosis and thrombolysis2016
A post hoc analysis of dalteparin versus oral anticoagulant (VKA) therapy for the prevention of recurrent venous thromboembolism (rVTE) in patients with cancer and renal impairment.
Trial report in Journal of thrombosis and thrombolysis, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 4 syntheses or guidelines pooled it, 47 citations in OpenAlex.
- Anticoagulant for treatment and prophylaxis of venous thromboembolism patients with renal dysfunction: A systematic review and network meta-analysis.Frontiers in medicine · 2022Pooled it
- Low-molecular-weight heparins for the prevention of recurrent venous thromboembolism in patients with cancer: A systematic literature review of efficacy and cost-effectiveness.Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners · 2019Pooled it
- Treatment algorithm in cancer-associated thrombosis: Canadian expert consensus.Current oncology (Toronto, Ont.) · 2018Pooled it
- Anticoagulation for the long-term treatment of venous thromboembolism in people with cancer.The Cochrane database of systematic reviews · 2018Pooled it
- Renal function and clinical outcome of patients with cancer-associated venous thromboembolism randomized to receive apixaban or dalteparin. Results from the Caravaggio trialHaematologica · 2022Trial
- Low-molecular-weight-heparin versus a coumarin for the prevention of recurrent venous thromboembolism in high- and low-risk patients with active cancer: a post hoc analysis of the CLOT Study.Journal of thrombosis and thrombolysis · 2019Trial
- Efficacy and safety of anticoagulant for treatment and prophylaxis of VTE patients with renal insufficiency: a systemic review and meta-analysis.Thrombosis journal · 2024Review
- LMWHs dosage and outcomes in acute pulmonary embolism with renal insufficiency, an analysis from a large real-world study.Thrombosis journal · 2022Article
- Incidence, risk factors, and management of bleeding in patients receiving anticoagulants for the treatment of cancer-associated thrombosis.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2022Review
- New Oral Anticoagulants Open New Horizons for Cancer Patients with Venous Thromboembolism.Drug design, development and therapy · 2022Review
- Current status of treatment of cancer-associated venous thromboembolism.Thrombosis journal · 2021Review
- Natural Coumarins: Exploring the Pharmacological Complexity and Underlying Molecular Mechanisms.Oxidative medicine and cellular longevity · 2021Review
- Tinzaparin Sodium Pharmacokinetics in Patients with Chronic Kidney Disease: Practical Implications.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2020Review
- Current Management of Cancer-associated Venous Thromboembolism: Focus on Direct Oral Anticoagulants.Journal of Korean medical science · 2019Review
- Anticoagulation in Cancer Patients: a Summary of Pitfalls to Avoid.Current oncology reports · 2019Review
- Dalteparin or vitamin K antagonists to prevent recurrent venous thromboembolism in cancer patients: a patient-level economic analysis for France and Austria.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2017Article
- Dalteparin versus vitamin K antagonists for the prevention of recurrent venous thromboembolism in patients with cancer and renal impairment: a Canadian pharmacoeconomic analysis.ClinicoEconomics and outcomes research : CEOR · 2017Article
- Use of Low Molecular Weight Heparins in Patients with Renal Failure; Time to Re-evaluate Our Preconceptions.Journal of general internal medicine · 2016Article
- Venous Thromboembolism In Cancer Patients: "From Evidence to Care".Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Venous thromboembolism (VTE) is a common and serious complication in patients with cancer; treatment guidelines recommend extended therapy of ≥6 months with low-molecular-weight heparin (LMWH) for treatment and prevention of recurrent VTE (rVTE) in this population. This post hoc analysis used data from the CLOT study-a phase III, randomized, open-label, controlled study (N = 676)-to compare the efficacy and safety of dalteparin, a LMWH, versus vitamin K antagonist (VKA) for prevention of rVTE in patients with cancer and renal impairment (creatinine clearance <60 ml/min). Overall, 162/676 (24 %) patients had renal impairment at baseline. Patients received subcutaneous dalteparin 200 IU/kg once daily during month 1, followed by 150 IU/kg once daily for months 2-6; or VKA once daily for 6 months, with initial overlapping subcutaneous dalteparin 200 IU/kg once daily for ≥5 days until international normalized ratio was 2.0-3.0 for 2 consecutive days. Endpoints included the rates of rVTE (primary) and bleeding events. Overall, fewer dalteparin-treated patients (2/74 [2.7 %]) experienced ≥1 adjudicated symptomatic rVTE compared with VKA-treated patients (15/88 [17.0 %]; hazard ratio = 0.15 [95 % confidence interval 0.03-0.65]; p = 0.01). Bleeding event rates for both treatments were similar (p = 0.47). In summary, compared with VKA, dalteparin significantly reduced risk of rVTE in patients with cancer and renal impairment (p = 0.01) while exhibiting a comparable safety profile. This analysis supports dosing patients with renal impairment in accordance with patients with normal renal function; however, anti-Xa monitoring could be considered to further support safety in selected patients, particularly those with very severe renal impairment.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.