Low-molecular-weight heparins for cancer-associated thrombosis: Adherence to clinical practice guidelines and patient perception in TROPIQUE, a 409-patient prospective observational study

• TROPIQUE documents the long-term use of LMWH in CAT patients.
• Physician's adherence to clinical practice guidelines in CAT patients has improved.
• Prescribed and actually observed treatment duration are consistent with guidelines.
• A majority of patients express high expectations and find long-term LMWH convenient and satisfactory.

PurposeData on long-term treatment with low-molecular-weight heparins (LMWH) in cancer patients treated for venous thromboembolism are scarce. Study objectives were to document the long-term clinical use of LMWH and patient perception in this setting.MethodsAdult cancer patients receiving antineoplastic treatment or palliative care and LMWH for cancer associated venous thromboembolism (CAT) were eligible to participate in this prospective observational study. Main outcome was adherence to clinical practice guidelines based on recommended LMWH treatment doses for at least 3 months in the absence of severe renal insufficiency. Patients' perception of the treatment was assessed in an ancillary study using the Perception Anticoagulant Treatment Questionnaire (PACT-Q).ResultsAmong 409 included cancer patients aged 65 ± 12.1 years, overall adherence to practice guidelines as defined in the protocol was 55.3% (226 patients). However, 98.0% of patients received a prescription for 3 months or more and mean LMWH treatment duration for VTE was 6.27 ± 0.15 months which meets guidelines recommendations. Main patients' expectations scored on a 1–5 scale were blood clots prevention (mean 3.94 ± 0.75), symptom relief (mean 3.98 ± 1.04) and ease of use (mean 4.22 ± 0.9). LMWH treatment appeared convenient (global score 79.7 ± 17.1 on a 0 to 100 scale) and 69.1% of patients were satisfied or very satisfied.ConclusionDespite incomplete strict adherence to guidelines, treatment duration with LMWH was adequate showing substantial progress in the management of CAT patients. Patients expectations were high while treatment was perceived convenient with a high degree of satisfaction.