Comparative safety of enoxaparin versus other low-molecular-weight heparins in cancer-associated venous thromboembolism: a real-world cohort study from RIETE
| Title: | Comparative safety of enoxaparin versus other low-molecular-weight heparins in cancer-associated venous thromboembolism: a real-world cohort study from RIETE |
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| Authors: | Manuel Monreal; Benjamin Brenner; Covadonga Gómez-Cuervo; Najib Dally; Alicia Alda-Lozano; María Lourdes Pesce; Joaquín Alfonso-Megido; Jacinto Hernández-Borge; Raphael L.E. Mao; Paolo Prandoni; Raquel Barba; Peter Verhamme; Hugo Hyung Bok Yoo; Radovan Malý; Laurent Bertoletti; Sebastian Schellong; Inna Tzoran; Pierpaolo Di Micco; Abilio Reis; Marijan Bosevski; Lucia Mazzolai; Joseph A. Caprini; Hanh My Bui; A. Abad-Fernández; M.D. Adarraga; J. Aibar; A. Alda; J. Alfonso; C. Amado; M. Angelina-García; J.I. Arcelus; A. Ballaz; R. Barba; C. Barbagelata; M. Barrón; B. Barrón-Andrés; F. Beddar-Chaib; Á. Blanco-Molina; C.S. Bonavila; L. Chasco; G. Claver; P. Crecente; J. Criado; C. De Juana-Izquierdo; J. Del Toro; N. Delgado-Casado; P. Demelo-Rodríguez; M.C. Díaz-Pedroche; J.A. Díaz-Peromingo; Á. Dubois-Silva; D. Durán; J.C. Escribano; L.A. Fernández-Bermejo; C. Fernández-Capitán; J.L. Fernández-Reyes; M.Á. Fidalgo; M. Fuentes Spínola; C. Gabara; F. Galeano-Valle; A. García-Ortega; O. Gavín-Sebastián; A. Gil-Díaz; C. Gómez-Cuervo; J. González Martínez; A. González-Munera; J. Gorostidi-Pérez; L. Guirado; J. Gutiérrez-Guisado; L. Hernández-Blasco; J. Hernández-Borge; M.J. Hernández-Vidal; D. Jiménez; M.D. Joya; A. Lalueza; R. Lecumberri; P. Llamas; H. López-Brull; L. López-Jiménez; P. López-Miguel; J.J. López-Núñez; A. López-Ruiz; J.B. López-Sáez; A. Lorenzo; A. Maestre; P.J. Marchena; M. Marcos; R. Marín-Baselga; M. Martín-del Pozo; M.I. Mercado; J. Moisés-Lafuente; M. Monreal; L. Monzón; S. Moreno-Casas; A. Moreno-Fernández; M.S. Navas; J.A. Nieto; M.J. Núñez-Fernández; M. Olid; M.C. Olivares; J.L. Orcastegui; L. Ordieres-Ortega; M. Ortiz; J. Osorio; S. Otálora; J. Pagán; P. Parra-Caballero; P. Parra-Rosado; J.M. Pedrajas; C. Pérez-Ductor; M. Pérez-Pinar; M.L. Peris; M.L. Pesce; J.A. Porras; L.M. Prieto-Gañán; G. Puche; A. Rivas; F. Rivera-Cívico; A. Rivera-Gallego; A. Rodríguez-Cobo; P. Ruiz-Artacho; N. Ruiz-Giménez; P. Ruiz-Torregrosa; G. Salgueiro; T. Sancho; V. Sendín; G. Sierra-Palomares; A. Solé; S. Soler; S. Suárez-Fernández; R. Tascón-Rodríguez; R. Tirado; M.R. Toda; C. Tolosa; J. Trujillo-Santos; L. Tudela; Y. Tung-Chen; F. Uresandi; R. Valle; J.F. Varona; E. Vega-Romero; D. Vicente-Navarro; G. Vidal; P. Villares; J.S. You; C. Ay; S. Nopp; I. Pabinger; M. Erard; Q. Van Thillo; P. Verhamme; A.T. Rocha; H.H.B. Yoo; C.A. Jiménez-Echandía; A.C. Montenegro; J. Roa; P. Grenar; J. Hirmerova; R. Malý; S. Accassat; L. Bertoletti; A. Bura-Riviere; J. Catella; R. Chopard; F. Couturaud; O. Espitia; R. Le Mao; B. Leclercq; I. Mahé; L. Plaisance; G. Poenou; I. Quéré; G. Sarlon-Bartoli; P. Suchon; E. Versini; S. Schellong; Y. Jenab; A. Khodayari; F. Rashidi; P. Sadeghipour; S. Yadangi; B. Brenner; N. Dally; I. Tzoran; M. Basaglia; F. Bilora; D. Bissacco; C. Bortoluzzi; M. Bortoluzzi; B. Brandolin; R. Casana; M.M. Ciammaichella; P. Di Micco; E. Imbalzano; D. Lambertenghi-Deliliers; R. Pesavento; V. Pizzuti; P. Prandoni; P. Scarinzi; C. Siniscalchi; A. Visonà; N. Vo Hong; B. Zalunardo; A. Skride; L.F. Hernández-Rivera; M.Á. Mendoza Romo-Ramírez; M. Molina-Avilés; Z. Tazi-Mezalek; S. Fonseca; C. Fontes; J. Meireles; B. Soeiro; M. Bosevski; S. Barco; L. Mazzolai; D.J. Angiolillo; J.A. Caprini; L. Ortega-Paz; A.J. Tafur; H.M. Bui; S.T. Nguyen; K.Q. Pham; G.B. Tran |
| Source: | Research and Practice in Thrombosis and Haemostasis, Vol 9, Iss 8, Pp 103244- (2025) |
| Publisher Information: | Elsevier, 2025. |
| Publication Year: | 2025 |
| Collection: | LCC:Diseases of the blood and blood-forming organs |
| Subject Terms: | bleeding; cancer; low-molecular-weight heparins; mortality; recurrences; venous thromboembolism; Diseases of the blood and blood-forming organs; RC633-647.5 |
| Description: | Background: Low-molecular-weight heparins (LMWHs) are widely used in the treatment of cancer-associated venous thromboembolism (VTE), yet their long-term safety profiles remain insufficiently compared in clinical practice. Objectives: The primary outcome was major bleeding over a 6-month follow-up. Secondary outcomes included VTE recurrence, non-major clinically relevant bleeding, and all-cause mortality. Methods: We analyzed 7287 patients with active cancer and acute VTE from the RIETE registry (2009-2022) who were treated with full-dose enoxaparin (n = 5628) or tinzaparin/dalteparin (n = 1659). Analyses were adjusted using multivariable Cox models, Fine-Gray competing risk models, frailty models clustered by center, and propensity score approaches. Results: Major bleeding occurred in 3.84% of patients receiving enoxaparin versus 2.53% in the tinzaparin/dalteparin group (adjusted hazard ratio [aHR] 1.56; 95% CI: 1.11-2.19), with consistent findings across all sensitivity analyses. Enoxaparin was also associated with higher all-cause mortality (28.3% vs 25.1%; aHR 1.22; 95% CI: 1.09-1.37). No significant differences were observed in VTE recurrence (3.59% vs 3.07%) or non-major bleeding (3.98% vs 3.25%). Importantly, during the first 10 days of therapy, major bleeding occurred in 1.2% of patients treated with enoxaparin twice-daily, compared to 0.4% with once-daily dosing and 0.1% in the tinzaparin/dalteparin group (P < .001). Conclusion: In this large, observational study, enoxaparin, particularly in twice-daily regimens, was associated with significantly increased risks of bleeding and mortality compared to tinzaparin/dalteparin. These findings may help refine LMWH selection and dosing strategies in patients with cancer-associated VTE and warrant further investigation in prospective studies. |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 2475-0379 |
| Relation: | http://www.sciencedirect.com/science/article/pii/S2475037925005680; https://doaj.org/toc/2475-0379 |
| DOI: | 10.1016/j.rpth.2025.103244 |
| Access URL: | https://doaj.org/article/fa9aa75a7ec242db9a2a5f4cd5be5faa |
| Accession Number: | edsdoj.fa9aa75a7ec242db9a2a5f4cd5be5faa |
| Database: | Directory of Open Access Journals |