Among pulmonary embolism patients with malignancy, post-treatment lengths of survival were higher for those who received long-term low-molecular-weight heparin (LMWH) than for those who received oral vitamin K agonist (VKA), according to a prospective study.
Of the 92 PE patients with malignancy studied, 56 received long-term LMWH and 36 received oral VKA. The long-term LMWH treatment group had a median survival time of 30 months, which was significantly longer than the 12.5-month median survival time of the VKA treatment group, according to Shuai Zhang and colleagues.
The overall mortality rate for patients with malignancy was 48.9%, and the mortality rates of patients with malignancy treated with LMWH and VKA were 44.4% and 55.4%, respectively. Although a higher percentage of the LMWH treatment group survived than the VKA treatment group, the difference between the groups’ overall survival rates was not significant. However, the median survival time was significantly longer in the LMWH group than the VKA group (30 months vs. 12.5 months; P = .041), with the rate of all-cause death in the first 6 months decreased by long-term therapy with LMWH (19.6% vs. 41.7%; P = .022). In the multivariable Cox regression, long-term LMWH was a protective factor for all-cause death in the first 6 months (hazard ratio, 0.399; P = .022).
PE patients with malignancies could more effectively protect their lives and extend their survival time by using LMWH for at least 3 months instead of oral VKA, the investigators said. “In order to evaluate the impact of extended duration of LMWH on mortality, randomized controlled trials with [a] large sample size need to be designed,” they said.
Find the full study in Thrombosis Research (doi.org/10.1016/j.thromres.2014.11.015).