An Analysis of Anticoagulation Treatment for Cancer Patients with Newly Diagnosed VTE

━━ Objective. Patients with lung cancer have a higher risk for venous thromboembolism (VTE). Anticoagulation treatment for VTE is important in addition to the treatment for lung cancer. Warfarin is one of the anticoagulation treatments for VTE, however, recurrence of VTE is often problematic during warfarin treatment. In January 2012, the subcutaneous injection of heparin calcium at home was covered by health insurance in Japan, which may be added to potential anticoagulation treatment for VTE. Methods. We conducted a retrospective analysis of 29 patients who received initial anticoagulation treatment, including a heparin injection into the vein, and were subsequently treated with warfarin among 39 lung cancer patients with newly diagnosed VTE in the First Department of Medicine, Hokkaido University Hospital, between October 2006 and April 2014. Results. Eleven patients had recurrence of VTE. Of these, 9 patients received a subcutaneous injection of heparin calcium and 1 patient received fondaparinux sodium and responded. Although all 9 patients ultimately died of cancer, the subcutaneous injection of heparin calcium enabled 2 patients to continue to receive chemotherapy and ambulatory treatments for VTE without recurrence of VTE. Conclusions. This study demonstrates that patients with recurrence of VTE can continue to receive regular ambulatory chemotherapy for cancers in combination with the subcutaneous injection of heparin calcium at home. (JJLC. 2015;55:1001-1007) KEY WORDS━━Venous thromboembolism, Anticoagulation, Lung cancer, Warfarin, Heparin calcium Reprints: Jun Sakakibara, First Department of Medicine, Hokkaido University School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8648, Japan (e-mail: konishj@med.hokudai.ac.jp). Received June 4, 2015; accepted August 25, 2015. 要旨━━目的.肺癌において静脈血栓塞栓症(VTE)の 合併はしばしば認められ,抗凝固療法は肺癌治療ととも に重要である.ワルファリン内服はVTEに対する抗凝 固療法の選択肢の一つだが,内服中のVTEの再発・増 悪が問題となる場合も多い.本邦でも 2012 年 1 月よりヘ パリンカルシウム在宅自己注射が保険適応となり,抗凝 固治療の選択肢が広がってきている.方法.2006 年 10 月から 2014 年 4 月に,北海道大学病院内科 Iで肺癌に VTEを合併した 39 例中,ヘパリンなどの初期治療導入 後,ワルファリン単独内服治療に移行できた 29 例を後ろ 向きに検討した.結果.29 例中,VTEの再発を 11 例認 めた.そのうち 10 例はヘパリンカルシウムまたはXa 阻害薬であるフォンダパリヌクスナトリウムの皮下注射 に変更され,全例でVTEはコントロールされた.11 例中 9例は原病の悪化で死亡したが,残り 2例はヘパリンカ ルシウム在宅自己注射導入後,VTEの増悪を認めず外来 治療継続中である.結論.肺癌に合併したワルファリン 不応性VTE症例において,ヘパリンカルシウム在宅自 己注射導入は有用な治療戦略である可能性が示唆され た. 1北海道大学病院内科 I. 別刷請求先:榊原 純,北海道大学病院内科 I,〒060-8648 北 海道札幌市北区北 15 条西 7丁目(e-mail: konishj@med.hokudai.ac. jp). 受付日:2015 年 6 月 4 日,採択日:2015 年 8 月 25 日. (肺癌.2015;55:1001-1007) 2015 The Japan Lung Cancer Society Anticoagulation for Patients with Lung Cancer with Newly Diagnosed VTE―Ikezawa et al 1002 Japanese Journal of Lung Cancer―Vol 55, No 6, Oct 20, 2015―www.haigan.gr.jp 索引用語━━静脈血栓塞栓症,抗凝固療法,肺癌,ワル ファリン,ヘパリンカルシウム