251
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Affiliation(s)
- Jean M Connors
- From Brigham and Women's Hospital and Harvard Medical School, Boston
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252
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Baumann Kreuziger L, Jaffray J, Carrier M. Epidemiology, diagnosis, prevention and treatment of catheter-related thrombosis in children and adults. Thromb Res 2017; 157:64-71. [DOI: 10.1016/j.thromres.2017.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022]
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253
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El-Refai SM, Black EP, Adams VR, Talbert JC, Brown JD. Statin use and venous thromboembolism in cancer: A large, active comparator, propensity score matched cohort study. Thromb Res 2017; 158:49-58. [PMID: 28822240 DOI: 10.1016/j.thromres.2017.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/25/2017] [Accepted: 08/04/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Statins have been shown to have a protective effect for venous thromboembolism (VTE) in the general population. This study sought to assess the association between statins and the risk for cancer-associated deep vein thrombosis (DVT) and pulmonary embolism (PE). METHODS Patients with newly diagnosed cancer were followed for up to one year in a healthcare claims database (2010-2013). Three treatment groups included statin users, non-statin cholesterol lowering medication users, and an untreated group with pre-existing indications for statin therapy (hyperlipidemia, diabetes, or heart disease). Propensity score matched groups were compared using competing risks survival models for DVT and PE outcomes reporting the hazard ratios (HR) between the treatment groups. Sensitivity analyses assessed the influence of age and individual medications. RESULTS The total cohort included 170,459 patients, which, after matching, were similar on baseline characteristics. The overall model showed a statistically significant protective effect for statins compared to no treatment attributed only to leukemia for DVT (HR=0.77, 95% CI 0.61-0.99) and colorectal cancers for PE (HR=0.80, 95% CI 0.64-0.99) in stratified analyses. There were generally no differences in outcomes between statins and non-statins and no individual statin use showed results different from the class effect. CONCLUSIONS In this propensity score matched sample of patients with cancer, statins were shown to have a small protective effect in some cancers for DVT or PE compared to no treatment and little difference compared to an active control group. The lack of effect was consistent across statins and was also not found for any of the sensitivity analyses included.
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Affiliation(s)
- Sherif M El-Refai
- Department of Pharmaceutical Sciences, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Esther P Black
- Department of Pharmaceutical Sciences, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Val R Adams
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Jeffery C Talbert
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Joshua D Brown
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA; Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA.
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254
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Ay C, Kamphuisen PW, Agnelli G. Antithrombotic therapy for prophylaxis and treatment of venous thromboembolism in patients with cancer: review of the literature on current practice and emerging options. ESMO Open 2017; 2:e000188. [PMID: 28761749 PMCID: PMC5519804 DOI: 10.1136/esmoopen-2017-000188] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 03/14/2017] [Indexed: 01/04/2023] Open
Abstract
The treatment of cancer-associated venous thromboembolism (VTE) is difficult because cancer patients with VTE on anticoagulation are at an increased risk of bleeding compared with patients without VTE. This review summarises the evidence supporting the current standard of care and emerging treatment options. In difficult-to-treat subpopulations, where clinical data are often lacking, this review also provides the best clinical practice strategies based on the available data. The use of therapeutic doses of parenteral anticoagulants in patients with cancer-associated VTE for at least 3 to 6 months is supported by the current clinical data. After major cancer surgery, extended thromboprophylaxis for approximately 1 month following hospital discharge is also supported. In select populations of ambulatory cancer patients with solid tumours, or in patients with myeloma receiving immunomodulatory agents in combination with chemotherapy and/or corticosteroids, pharmacological prophylaxis could be considered. Although parenteral anticoagulants may not be tolerated by some patients, the data pertaining to the use of direct oral anticoagulants (DOACs) in cancer patients with VTE at this point can only be considered hypothesis generating. Clarity of the use of DOACs is awaiting the results of head-to-head trials between DOACs and parenteral anticoagulants. In addition, because of the lack of clinical trials, there are still unanswered questions on the optimal treatment regimens in subpopulations at increased risk of bleeding, including cancer patients with thrombocytopenia and those with brain metastases. For clinicians to balance the risk of recurrent thrombosis with the chance of bleeding, they need to assess the relevant clinical data. Current data support the use of parenteral anticoagulants in cancer patients with VTE, but many unanswered questions pertaining to the optimal regimens in special subpopulations and regarding the efficacy and safety of DOACs remain. To address this need, there are currently several clinical trials under way.
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Affiliation(s)
- Cihan Ay
- Department of Medicine, Clinical Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | | | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
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255
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Forma de presentación, historia natural y evolución de la enfermedad tromboembólica venosa postoperatoria en pacientes operados por cáncer abdominal y pélvico. Análisis del registro RIETE. Cir Esp 2017. [DOI: 10.1016/j.ciresp.2017.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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256
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Monitoring of anticoagulant therapy in cancer patients with thrombosis and the usefulness of blood activation markers. Transfus Apher Sci 2017; 56:279-286. [PMID: 28552490 DOI: 10.1016/j.transci.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thrombotic diseases caused by cancer progression have been reported as one of the major causes of cancer associated morbidity and mortality along with cancer invasiveness and infectious complications. Moreover, anticoagulant therapy with heparin and heparin-like drugs, or vitamin K antagonists, or the Direct Oral Anticoagulants, is seeing an extended application in cancer patients and offers prolonged life expectancy to oncology patients for whom blood activation and thrombotic events have a variable incidence, depending on cancer type. Laboratory tools are highly useful for identifying patients at thrombotic risk through the measurement of blood activation markers and selecting those appropriate for anticoagulant therapy. Among the pathological markers, DDimer or Extracellular Vesicles have the highest diagnostic value in these pathological conditions. Global assays are useful for dosage adjustment, such as assessing either an induced anticoagulant effect or the measurement of drug activity. Various assays are also developed such as platelet aggregometry techniques for evaluating drug induced- aggregates or methods allowing measurement of the drug activity to its targeted coagulation factors such as: heparin to thrombin or Factor Xa; DOACs to Thrombin or Factor Xa (Dabigatran to thrombin and DiXaIs, Rivaroxaban, Apixaban, and Edoxaban, to Factor Xa). Such explorative techniques help to find the right dosage adjustment to protect patients from developing thrombosis without exposing them bleeding. It also permits exploration of unexpected drug behavior in treated patients, to check the right adherence to therapy in long-term anticoagulant protocols, and prevention of bleeding in patients with impaired renal or hepatic function. Complementary use of blood activation markers brings additional information on the curative effects of the anticoagulant therapy, and allows identification of pro-thrombotic activity in the clinically silent state. These issues are concisely addressed below.
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257
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Elalamy I, Mahé I, Ageno W, Meyer G. Long-term treatment of cancer-associated thrombosis: the choice of the optimal anticoagulant. J Thromb Haemost 2017; 15:848-857. [PMID: 28222250 DOI: 10.1111/jth.13659] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Indexed: 01/20/2023]
Abstract
Patients with cancer-associated thrombosis (CAT) carry a higher risk of recurrence, bleeding and mortality as compared with non-cancer patients. The specific profiles of cancer patients, combining frequent co-morbidities, the use of anti-tumoral therapies and the cancer progression itself, represent a major therapeutic challenge for choosing a long-term anticoagulant treatment. This review discusses the practical basis of making a choice between the available drugs for a long-term antithrombotic strategy, linked to their pharmacology, mechanism of action, evidence of clinical benefits, and advantages and limitations in such a complex clinical context. In patients with cancer, low-molecular-weight heparins (LMWHs) are the preferred option for the secondary prevention of venous thromboembolism according to current guidelines, because their efficacy is significantly superior to vitamin K antagonists (VKAs). Even though LMWHs are effective and safe in cancer patients, they require daily subcutaneous injections, which may be problematic for a long-term therapy that may exceed 6 months' duration. Compared with VKAs, non-vitamin-K antagonist oral anticoagulants or direct oral anticoagulants (DOACs) are more target specific and do not require laboratory monitoring, whereas the oral route of administration makes them potentially attractive alternatives to LMWH. In randomized controlled trials in the general population DOACs have been shown to be non-inferior to VKAs in terms of efficacy with a lower rate of clinically relevant or major bleeding. However, given the limited number of cancer patients enrolled in these studies (with poorly defined active cancer), available trials are inconclusive regarding the usefulness of DOACs in the cancer setting. Ongoing head-to-head comparisons vs. LMWH in patients with CAT may allow an informed choice to be made regarding the DOAC option.
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Affiliation(s)
- I Elalamy
- Biological Hematology Department, Hôpital TENON APHP Hôpitaux Universitaires de l'Est Parisien, INSERM UMRS 938 Université Pierre et Marie Curie, Paris 6, Paris, France
| | - I Mahé
- Internal Medicine Department, Hôpital Louis Mourier, APHP, Colombes, France
- Université Paris-Diderot Paris 7, EA 7334, Sorbonne Paris Cité, Paris, France
| | - W Ageno
- Research Center on Thromboembolic Diseases and Antithrombotic Therapies, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - G Meyer
- Respiratory and Intensive Care, Hôpital Européen Georges Pompidou, APHP, Paris, France
- Université Paris Descartes Paris 5, Sorbonne Paris Cité, Paris, France
- INSERM UMRS 970, CIC 1418, Paris, France
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258
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Raschi E, Bianchin M, De Ponti R, De Ponti F, Ageno W. Emerging therapeutic uses of direct-acting oral anticoagulants: An evidence-based perspective. Pharmacol Res 2017; 120:206-218. [PMID: 28366835 DOI: 10.1016/j.phrs.2017.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/22/2017] [Accepted: 03/29/2017] [Indexed: 12/24/2022]
Abstract
Direct-acting oral anticoagulants (DOACs) were claimed to cause a potential paradigm shift in the therapeutic scenario of patients requiring short- and long-term anticoagulation, by virtue of their pharmacological properties, perceived as innovative. The evidence gathered so far (from pre-approval pivotal trials to real-world post-marketing observational data) consistently confirmed that DOACs are overall comparable to vitamin-K antagonists (VKAs) in terms of safety, efficacy and effectiveness and unequivocally documented a consistent and clinically relevant reduced risk of intracranial bleeding in the settings of non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE). Interestingly, two parallel paths can be identified in the current research scenario: A) in the aforementioned consolidated therapeutic indications, an innovative approach is directed towards tailored treatment strategies, to identify patients most likely to benefit from one of the different anticoagulant drugs, in particular subpopulations at increased risk of adverse events (e.g., bleeding); B) in unconventional settings, DOACs are gaining interest for potential use in emerging diseases characterized by arterial and venous thromboembolic risk. In these scenarios, the risk-benefit profile of DOACs, as compared to VKAs or heparins, is less defined. The aim of this review is to critically assess the body of evidence underlying emerging therapeutic uses of DOACs (e.g., heparin-induced thrombocytopenia, anti-phospholipid antibody syndrome), including evolving issues in special populations (e.g., patients with VTE and cancer or cirrhosis). This will be achieved by analyzing the strength (i.e., systematic reviews, randomized clinical trials, observational studies, case report/series) and consistency (i.e., concordance) of both published and unpublished evidence registered in major public repositories.
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Affiliation(s)
- Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matteo Bianchin
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Farge D, Bounameaux H, Bauersachs RM, Brenner B. Women, thrombosis, and cancer: A gender-specific analysis. Thromb Res 2017; 151 Suppl 1:S21-S29. [DOI: 10.1016/s0049-3848(17)30062-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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260
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Mahé I, Chidiac J, Bertoletti L, Font C, Trujillo-Santos J, Peris M, Pérez Ductor C, Nieto S, Grandone E, Monreal M, Arcelus J, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Casado I, Culla A, de Miguel J, del Toro J, Díaz-Peromingo J, Falgá C, Fernández-Capitán C, Font C, Font L, Gallego P, García-Bragado F, García-Brotons P, Gómez V, González J, Grau E, Grimón A, Guirado L, Gutiérrez J, Hernández G, Hernández-Blasco L, Isern V, Jara-Palomares L, Jaras M, Jiménez D, Lacruz B, Lecumberri R, Lobo J, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Madridano O, Marchena P, Martín-Antorán J, Martín-Martos F, Monreal M, Morales M, Nauffal D, Nieto J, Nieto S, Núñez M, Otalora S, Otero R, Pagán B, Pedrajas J, Pérez C, Pérez G, Peris M, Porras J, Ramírez L, Reig O, Riera A, Rivas A, Rodríguez-Dávila M, Rosa V, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Martínez C, Sampériz A, Sala C, Sanz O, Soler S, Sopeña B, Suarez I, Suriñach J, Tiberio G, Tolosa C, Trujillo-Santos J, Uresandi F, Valle R, Vela J, Villalta J, Malfante P, Verhamme P, Wells P, Hirmerova J, Malý R, Tomko T, Salgado E, Bertoletti L, Bura-Riviere A, Farge-Bancel D, Hij A, Mahé I, Merah A, Papadakis M, Braester A, Brenner B, Tzoran I, Apollonio A, Barillari G, Candeloro G, Ciammaichella M, Di Micco P, Ferrazzi P, Grandone E, Lessiani G, Lodigiani C, Mastroiacovo D, Pace F, Pinelli M, Prandoni P, Rota L, Tiraferri E, Tufano A, Visonà A, Belovs A, Skride A, Moreira M, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Alatri A, Bounameaux H, Calanca L, Mazzolai L, Serrano J, Decousus H, Reis A. The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site. Am J Med 2017; 130:337-347. [PMID: 27884650 DOI: 10.1016/j.amjmed.2016.10.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site. AIM AND METHODS We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer). RESULTS As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal, and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95% confidence interval (CI), 3.8-8.1] vs 4.1 [95% CI, 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95% CI, 7.6-13] vs 12 [95% CI, 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95% CI, 4.4-10] vs 13 [95% CI, 9.2-17] events per 100 patient-years), whereas in those with lung cancer, the rate of thromboembolic recurrences was twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years). CONCLUSIONS Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.
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Affiliation(s)
- Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France.
| | - Jean Chidiac
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France
| | - Laurent Bertoletti
- Department of Vascular and Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, French Clinical Research Infrastructure Network (F-CRIN), INNOVTE
| | - Carme Font
- Department of Medical Oncology, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clinic de Barcelona, Spain
| | - Javier Trujillo-Santos
- Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain
| | - Marisa Peris
- Department of Internal Medicine, Hospital Provincial Castellon; CEU Cardenal Herrero University, Spain
| | - Cristina Pérez Ductor
- Department of Emergency Medicine, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Santiago Nieto
- Department of Haematology, Hospital de la Vega Lorenzo Guirao, Murcia, Spain
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain
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Jimenez-Fonseca P, Carmona-Bayonas A, Calderon C, Fontcuberta Boj J, Font C, Lecumberri R, Monreal M, Muñoz Martín AJ, Otero R, Rubio A, Ruiz-Artacho P, Suarez Fernández C, Colome E, Pérez Segura P. FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer-associated thrombosis in areas of uncertainty and low quality of evidence. Clin Transl Oncol 2017; 19:997-1009. [PMID: 28243988 DOI: 10.1007/s12094-017-1632-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Decision-making in cancer-related venous thromboembolism (VTE) is often founded on scant lines of evidence and weak recommendations. The aim of this work is to evaluate the percentage of agreement surrounding a series of statements about complex, clinically relevant, and highly uncertain aspects to formulate explicit action guidelines. MATERIALS AND METHODS Opinions were based on a structured questionnaire with appropriate scores and were agreed upon using a Delphi method. Questions were selected based on a list of recommendations with low evidence from the Spanish Society of Oncology Clinical Guideline for Thrombosis. The questionnaire was completed in two iterations by a multidisciplinary panel of experts in thrombosis. RESULTS Of the 123 statements analyzed, the panel concurred on 22 (17%) and another 81 (65%) were agreed on by qualified majority, including important aspects of long-term and prolonged anticoagulation, major bleeding and rethrombosis management, treatment in special situations, catheter-related thrombosis and thromboprophylaxis. Among them, the panelists agreed the incidental events should be equated to symptomatic ones, long-term and extended use of full-dose low-molecular weight heparin, and concluded that the Khorana score is not sensitive enough to uphold an effective thromboprophylaxis strategy. CONCLUSION Though the level of consensus varied depending on the scenario presented, overall, the iterative process achieved broad agreement as to the general treatment principles of cancer-associated VTE. Clinical validation of these statements in genuine practice conditions would be useful.
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Affiliation(s)
- P Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - A Carmona-Bayonas
- Hematology and Medical Oncology Department, UMU, IMIB, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - C Calderon
- Clinical Psychology and Psychobiology Department, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - J Fontcuberta Boj
- Unitat d'Hemostàsia i Trombosi, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - C Font
- Medical Oncology Department, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Universitari Clínic, Barcelona, Spain
| | - R Lecumberri
- Hemaotology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - M Monreal
- Internal Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - A J Muñoz Martín
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - R Otero
- Medical-Surgical Unit for Respiratory Disease, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Sevilla, Spain
| | - A Rubio
- Pharmacy Department, Hospital Virgen de la Salud, Toledo, Spain
| | - P Ruiz-Artacho
- Emergency Department, Hospital Universitario Clínico San Carlos, IdISSC, Madrid, Spain
| | - C Suarez Fernández
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
| | - E Colome
- Scientific Affairs, LEO Pharma, Barcelona, S.A, Spain
| | - P Pérez Segura
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
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262
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Mazzolai L, Aboyans V, Ageno W, Agnelli G, Alatri A, Bauersachs R, Brekelmans MPA, Büller HR, Elias A, Farge D, Konstantinides S, Palareti G, Prandoni P, Righini M, Torbicki A, Vlachopoulos C, Brodmann M. Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. Eur Heart J 2017; 39:4208-4218. [DOI: 10.1093/eurheartj/ehx003] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/09/2017] [Indexed: 01/08/2023] Open
Affiliation(s)
- Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Ch du Mont-Paisible 18, Lausanne, Switzerland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and, Inserm 1098, Tropical Neuroepidemiology, School of Medicine, 2 avenue martin Luther-King, Limoges cedex, France
| | - Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Via Ravasi 2, Varese, Italy
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, S. Andrea delle Fratte, Perugia, Italy
| | - Adriano Alatri
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Ch du Mont-Paisible 18, Lausanne, Switzerland
| | - Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmbH, Grafenstraße 9, Darmstadt, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, Mainz, Germany
| | - Marjolein P A Brekelmans
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Harry R Büller
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Antoine Elias
- Cardiology and Vascular Medicine, Toulon Hospital Centre, 54 Rue Henri Sainte-Claire Deville, Toulon, France
| | - Dominique Farge
- Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Internal Medicine and Vascular Disease Unit and Groupe Francophone on Thrombosis and Cancer, Paris 7 Diderot University, Sorbonne Paris Cité, 1, Avenue Claude Vellefaux, Paris, France
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Greece
| | - Gualtiero Palareti
- Cardiovascular Diseases, University of Bologna, Via Albertoni 15, Bologna, Italy
| | - Paolo Prandoni
- Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Via Nicolò Giustiniani, 2, Padua, Italy
| | - Marc Righini
- Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospital, Rue Gabrielle Perret-Gentil 4, Geneva, Switzerland
| | - Adam Torbicki
- Department of Pulmonary Circulation and Thromboembolic Diseases, Medical Center for Postgraduate Education, ul Plocka 26, Warszawa, Otwock, Poland
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Venous thrombosis in children and adolescents with Hodgkin lymphoma in Sweden. Thromb Res 2017; 152:64-68. [PMID: 28249199 DOI: 10.1016/j.thromres.2017.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/30/2017] [Accepted: 02/14/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Pediatric patients with Hodgkin lymphoma (HL) have several risk factors for venous thromboembolism (VTE). Although these patients are occasionally treated with thromboprophylaxis, no guidelines are implemented in Sweden. Scarce data from adult patients indicate an increased risk of VTE, but pediatric data is largely missing. Given the favorable overall survival of HL, there should reasonably be more focus on preventing complications. MATERIALS AND METHODS We conducted a retrospective cohort study, including all patients registered in the Childhood Cancer Registry under the age of 18years diagnosed with HL between January 2005 and December 2015 in Sweden. RESULTS Data was retrieved from the medical records of all 163 patients (100%) at six Swedish pediatric cancer centers. The incidence of VTE was 7.7% (symptomatic VTE 3.9%). The median follow-up was 3.4years (range 0.3-10.5). Only five patients (3.1%) were treated with thromboprophylaxis. All VTE events occurred in the older age category (11-17years) and all but one (92.7%) had a mediastinal mass. While the VTE did not significantly affect the treatment of HL, it caused increased morbidity and 2/12 developed a post-thrombotic syndrome. No significant risk factors for VTE were identified. CONCLUSIONS VTE is a relatively common complication of HL and its treatment, causing increased acute and long-term morbidity. However, due to limited number of events we could not demonstrate risk-factors for VTE that would identify patients who might benefit from thromboprophylaxis.
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Bala MM, Paszek EM, Wloch-Kopec D, Lesniak W, Undas A. Antiplatelet and anticoagulant agents for primary prevention of thrombosis in individuals with antiphospholipid antibodies. Hippokratia 2017. [DOI: 10.1002/14651858.cd012534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Malgorzata M Bala
- Jagiellonian University Medical College; Department of Hygiene and Dietetics; Systematic Reviews Unit - Polish Cochrane Branch; Kopernika 7 Krakow Poland 31-034
| | - Elzbieta M Paszek
- Jagiellonian University Medical College; Department of Interventional Cardiology; Pradnicka 80 Krakow Poland
| | - Dorota Wloch-Kopec
- Jagiellonian University Medical College; Neurology Department; Botaniczna 3 Krakow Poland 31-503
| | - Wiktoria Lesniak
- Jagiellonian University Medical College; 2nd Department of Internal Medicine; ul. Skawinska 8 Krakow Poland 31-066
| | - Anetta Undas
- Jagiellonian University Medical College; Institute of Cardiology; Pradnicka 80 Krakow Poland 31-202
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Häner JD, Seiler C. Simultaneous large bi-atrial device-related thrombi. J Thromb Thrombolysis 2016; 43:130-131. [PMID: 27822906 DOI: 10.1007/s11239-016-1453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Simultaneous appearance of a pacemaker-lead associated thrombus and a left atrial appendage closure device related thrombus in a patient with urothelial carcinoma shown in a transesophageal echocardiography.
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Affiliation(s)
- Jonas Dominik Häner
- Department of Cardiology, Inselspital, University of Bern Hospital, 3010, Bern, Switzerland.
| | - Christian Seiler
- Department of Cardiology, Inselspital, University of Bern Hospital, 3010, Bern, Switzerland
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