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Mahé I, Agnelli G, Ay C, Bamias A, Becattini C, Carrier M, Chapelle C, Cohen AT, Girard P, Huisman MV, Klok FA, López-Núñez JJ, Maraveyas A, Mayeur D, Mir O, Monreal M, Righini M, Samama CM, Syrigos K, Szmit S, Torbicki A, Verhamme P, Vicaut E, Wang TF, Meyer G, Laporte S. Extended Anticoagulant Treatment with Full- or Reduced-Dose Apixaban in Patients with Cancer-Associated Venous Thromboembolism: Rationale and Design of the API-CAT Study. Thromb Haemost 2022; 122:646-656. [PMID: 34535037 PMCID: PMC9113855 DOI: 10.1055/a-1647-9896] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/08/2021] [Indexed: 01/12/2023]
Abstract
Cancer-associated thrombosis (CT) is associated with a high risk of recurrent venous thromboembolic (VTE) events that require extended anticoagulation in patients with active cancer, putting them at risk of bleeding. The aim of the API-CAT study (NCT03692065) is to assess whether a reduced-dose regimen of apixaban (2.5 mg twice daily [bid]) is noninferior to a full-dose regimen of apixaban (5 mg bid) for the prevention of recurrent VTE in patients with active cancer who have completed ≥6 months of anticoagulant therapy for a documented index event of proximal deep-vein thrombosis and/or pulmonary embolism. API-CAT is an international, randomized, parallel-group, double-blind, noninferiority trial with blinded adjudication of outcome events. Consecutive patients are randomized to receive apixaban 2.5 or 5 mg bid for 12 months. The primary efficacy outcome is a composite of recurrent symptomatic or incidental VTE during the treatment period. The principal safety endpoint is clinically relevant bleeding, defined as a composite of major bleeding or nonmajor clinically relevant bleeding. Assuming a 12-month incidence of the primary outcome of 4% with apixaban and an upper limit of the two-sided 95% confidence interval of the hazard ratio <2.0, 1,722 patients will be randomized, assuming an up to 10% loss in total patient-years (β = 80%; α one-sided = 0.025). This trial has the potential to demonstrate that a regimen of extended treatment for patients with CT beyond an initial 6 months, with a reduced apixaban dose, has an acceptable risk of recurrent VTE recurrence and decreases the risk of bleeding.
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Affiliation(s)
- Isabelle Mahé
- Service de Médecine Interne, Hôpital Louis Mourier, AP-HP, Colombes, France
- Université de Paris, Paris, France
- Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris, France
- INNOVTE-FCRIN, Saint-Etienne, France
| | - Giancarlo Agnelli
- Internal Vascular and Emergency Medicine – Stroke Unit, University of Perugia, Perugia, Italy
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Medicine, ATTIKON University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Cecilia Becattini
- Internal Vascular and Emergency Medicine – Stroke Unit, University of Perugia, Perugia, Italy
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Céline Chapelle
- Unité de Recherche Clinique Innovation et Pharmacologie, CHU de Saint-Etienne, Saint-Etienne, France
- SAINBIOSE INSERM U1059, Université Jean Monnet, Université de Lyon, Saint-Etienne, France
| | - Alexander T. Cohen
- Guy's and St. Thomas' NHS Foundation Trust Hospital, King's College London, London, United Kingdom
| | - Philippe Girard
- Département de Pneumologie, Institut Mutualiste Montsouris, Paris, France
| | - Menno V. Huisman
- Department of Medicine − Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederikus A. Klok
- Department of Medicine − Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Juan J. López-Núñez
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anthony Maraveyas
- Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals NHS Trust, Hull York Medical School, Cottingham, Hull, United Kingdom
| | | | | | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Universidad Católica de Murcia, Murcia, Spain
| | - Marc Righini
- Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Charles M. Samama
- Intensive Care and Perioperative Medicine, Department of Anaesthesia, Hôpital Cochin, GHU AP-HP Centre-Université de Paris, Paris, France
| | - Kostas Syrigos
- Department of Medicine, Sotiria General Hospital, Athens School of Medicine, National & Kapodistrian University, Athens, Greece
| | - Sebastian Szmit
- Departments of Pulmonary Circulation, Thromboembolic Diseases, and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Adam Torbicki
- Departments of Pulmonary Circulation, Thromboembolic Diseases, and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Peter Verhamme
- Vascular Medicine and Haemostasis, University Hospitals Leuven, Leuven, Belgium
| | - Eric Vicaut
- URC Lariboisière – Saint-Louis, AP-HP, Université de Paris, Paris, France
| | - Tzu-Fei Wang
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Guy Meyer
- Université de Paris, Paris, France
- INNOVTE-FCRIN, Saint-Etienne, France
- Hôpital Européen Georges Pompidou, APHP, Sorbonne Paris Cité, Paris, France
| | - Silvy Laporte
- INNOVTE-FCRIN, Saint-Etienne, France
- Unité de Recherche Clinique Innovation et Pharmacologie, CHU de Saint-Etienne, Saint-Etienne, France
- SAINBIOSE INSERM U1059, Université Jean Monnet, Université de Lyon, Saint-Etienne, France
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Li J, Qiang WM, Wang Y, Wang XY. Development and validation of a risk assessment nomogram for venous thromboembolism associated with hospitalized postoperative Chinese breast cancer patients. J Adv Nurs 2020; 77:473-483. [PMID: 33159325 DOI: 10.1111/jan.14571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022]
Abstract
AIM The purpose of this study was to develop and validate an individualized nomogram to predict venous thromboembolism (VTE) risk in hospitalized postoperative breast cancer patients. DESIGN A single-central retrospective and non-interventional trial. METHODS For model development, we used data from 4,755 breast cancer patients between 1 November 2016-30 June 2018 (3,310 patients in the development group and 1,445 in the validation group). Overall, 216 patients developed VTE (150 in development group and 66 in validation group). The model was validated by receiver operating characteristic curves and the calibration plot. The clinical utility of the model was determined through decision curve analysis. RESULTS The individualized nomogram consisted of six clinical factors: age, body mass index, number of cardiovascular comorbidities, neoadjuvant chemotherapy, surgical treatment, hospital length of stay and two pre-operative biomarkers of Homocysteine and D-dimer. The model at the 3.9% optimal cut-off had the area under the curve of 0.854 (95% CI, 0.824-0.884) and 0.805 (95% CI, 0.740-0.870) in the development and validation groups. A p = 0.570 of the calibration test showed that the model was well-calibrated. The net benefit of the model was better between threshold probabilities of 5%-30% in decision curve analysis. CONCLUSION The nomogram of VTE risk assessment, is applicable to hospitalized postoperative breast cancer patients. However, multi-central prospective studies are needed to improve and validate the model. Effectiveness and safety of thromboprophylaxis in high-risk patients are needed to demonstrate in interventional trials. IMPACT This nomogram can be used in clinical to inform practice of physicians and nurses to predict the VTE probability and maybe direct personalized decision making for thromboprophylaxis in hospitalized postoperative breast cancer patients.
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Affiliation(s)
- Jing Li
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
| | - Wan-Min Qiang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
| | - Yan Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
| | - Xiao-Yuan Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
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Ohashi Y, Ikeda M, Kunitoh H, Sasako M, Okusaka T, Mukai H, Fujiwara K, Nakamura M, Oba MS, Kimura T, Ibusuki K, Sakon M. Venous thromboembolism in cancer patients: report of baseline data from the multicentre, prospective Cancer-VTE Registry. Jpn J Clin Oncol 2020; 50:1246-1253. [PMID: 32715307 PMCID: PMC7579341 DOI: 10.1093/jjco/hyaa112] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Cancer-VTE Registry evaluates the occurrence and management of venous thromboembolism in Japanese participants with major solid tumors. Using Registry data, we evaluated the frequency of concurrent venous thromboembolism in cancer patients prior to treatment initiation by cancer type. METHODS The Cancer-VTE Registry is an ongoing (March 2017-September 2020) prospective cohort study using a nationwide, multicentre clinical registry. Participants aged ≥20 years with colorectal, lung, stomach, pancreatic, breast or gynecologic cancer, confirmed staging, ≥6 months life expectancy post-registration and who had undergone venous thromboembolism screening were managed with routine clinical care. Venous thromboembolism frequency at registration was evaluated. RESULTS Of 9735 participants, 571 (5.9%) had venous thromboembolism at baseline, including asymptomatic [5.5% (n = 540)] and symptomatic venous thromboembolism [0.3% (n = 31)]. Most participants with venous thromboembolism (n = 506, 5.2%) had deep vein thrombosis only; 65 (0.7%) had pulmonary embolism with/without deep vein thrombosis. The prevalence of distal and proximal deep vein thrombosis was 4.8% (n = 466) and 0.9% (n = 83), respectively. The highest prevalence of venous thromboembolism was for pancreatic cancer (8.5%) and the lowest for breast cancer (2.0%). Venous thromboembolism prevalence increased as cancer stage advanced. CONCLUSIONS Although there was a marked difference in venous thromboembolism by cancer type, the data suggest that cancer stage is an important risk factor for venous thromboembolism. Thus, metastasis seems a critical risk factor for venous thromboembolism. This is the first demonstration of venous thromboembolism prevalence and risk factors in Japanese cancer patients prior to treatment. TRIAL REGISTRATION UMIN000024942.
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Affiliation(s)
- Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan
| | - Masataka Ikeda
- Division of Lower Gastrointestinal Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hideo Kunitoh
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Mitsuru Sasako
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hirofumi Mukai
- Division of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Mashio Nakamura
- Department of Internal Medicine, Pediatrics and Cardiology, Nakamura Medical Clinic, Kuwana, Japan
| | - Mari S Oba
- Department of Medical Statistics, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Tetsuya Kimura
- Medical Science Department, Daiichi Sankyo Co. Ltd., Tokyo, Japan
| | - Kei Ibusuki
- Medical Science Department, Daiichi Sankyo Co. Ltd., Tokyo, Japan
| | - Masato Sakon
- Department of Gastrointestinal Surgery, Osaka International Cancer Institute, Osaka, Japan
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Hase EA, de Barros VIPVL, Igai AMK, Francisco RPV, Zugaib M. Risk assessment of venous thromboembolism and thromboprophylaxis in pregnant women hospitalized with cancer: Preliminary results from a risk score. Clinics (Sao Paulo) 2018; 73:e368. [PMID: 30365820 PMCID: PMC6172981 DOI: 10.6061/clinics/2018/e368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/19/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Hospitalized patients with cancer are at high risk of developing venous thromboembolism, and the risk increases with pregnancy. The aim of this study was to apply a thromboprophylaxis protocol with a venous thromboembolism risk score for hospitalized pregnant women with cancer and to evaluate the effects on maternal morbidity and mortality. METHODS A longitudinal and prospective study was conducted from December 2014 to July 2016. The venous thromboembolism risk score was modified from the guidelines of the Royal College of Obstetricians and Gynaecologists. Patients were classified as low (score <3) or high risk (score ≥3). The high-risk group received thromboprophylaxis with low-molecular-weight heparin, unless the patient had a contraindication for anticoagulation. One patient could have undergone more than one evaluation. RESULTS Fifty-two ratings were descriptively analyzed: 34 (65.4%) were classified as high risk, and 28/34 (82.3%) received low-molecular-weight heparin, 1 received unfractionated heparin, and 5 did not receive intervention. Most patients (23/52; 44.2%) had breast cancer. The main risk factors for venous thromboembolism in the high-risk group were chemotherapy (within 6 months; 22/34; 64.7%). No patient exhibited venous thromboembolism, adverse effects of anticoagulation or death up to three months after hospitalization. CONCLUSIONS Most pregnant women with cancer had a high risk for venous thromboembolism at the time of hospitalization. Breast cancer was the most prevalent cancer, and recent chemotherapy was the main risk factor for anticoagulation. The application of a thromboprophylaxis protocol and determination of a venous thromboembolism risk score for these patients was useful for the prevention of maternal morbidity and mortality due to venous thromboembolism.
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Affiliation(s)
- Eliane Azeka Hase
- Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
- Corresponding author. E-mail:
| | | | - Ana Maria Kondo Igai
- Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | | | - Marcelo Zugaib
- Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
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Benzidia I, Connault J, Solanilla A, Michon-Pasturel U, Jamelot M, Nguessan MK, Hij A, Le Maignan C, Farge D, Frère C. [New international guidelines for curative treatment and prophylaxis for venous thromboembolism (VTE) in cancer patients and the dedicated smartphone application]. JOURNAL DE MEDECINE VASCULAIRE 2017; 42:375-383. [PMID: 29203044 DOI: 10.1016/j.jdmv.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 09/17/2017] [Indexed: 06/07/2023]
Abstract
Venous thromboembolism (VTE) is a frequent and serious complication in cancer patients, and the second leading cause of death in this setting. Cancer patients are also more likely to present recurrent VTE and major bleeding while taking anticoagulants. Management of VTE in these patients is always challenging and remains suboptimal worldwide. In 2013, the International Initiative on Thrombosis and Cancer (ITAC-CME) released international guidelines for the treatment and prophylaxis of VTE and central venous catheter-associated thrombosis, based on a systematic review of the literature ranked according to the Grading of Recommendations Assessment, Development, and Evaluation scale. An update of these ITAC-CME consensus guidelines, including the use of direct oral anticoagulants, was recently published. In this review, we summarize these updated guidelines. Better adherence to the international guidelines, involving an adequate educational and active implementation strategies, will substantially decrease the burden of VTE and allow to increase survival in cancer patients.
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Affiliation(s)
- I Benzidia
- UF04 maladies auto-immunes et pathologie vasculaire, service de médecine interne, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - J Connault
- Service de médecine interne, CHU de Nantes, 44000 Nantes, France
| | - A Solanilla
- Service de médecine vasculaire, hôpital Saint-André, 33076 Bordeaux, France
| | - U Michon-Pasturel
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - M Jamelot
- Service d'oncologie médicale, centre Henri-Becquerel, rue d'Amiens, 76000 Rouen, France
| | - M K Nguessan
- Département de médecine interne et gériatrie, centre hospitalier universitaire de Treichville, université Félix Houphouet Boigny d'Abidjan, Abidjan, Côte d'Ivoire
| | - A Hij
- UF04 maladies auto-immunes et pathologie vasculaire, service de médecine interne, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Le Maignan
- Service d'oncologie médicale, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - D Farge
- UF04 maladies auto-immunes et pathologie vasculaire, service de médecine interne, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Frère
- Service d'hématologie biologique, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Zhou LF, Zhang MX, Kong LQ, Lyman GH, Wang K, Lu W, Feng QM, Wei B, Zhao LP. Costs, Trends, and Related Factors in Treating Lung Cancer Patients in 67 Hospitals in Guangxi, China. Cancer Invest 2017; 35:345-357. [PMID: 28368669 DOI: 10.1080/07357907.2017.1296156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lung cancer is a common disease with high mortality in China. Recent economic advances have led to improved medical capabilities, while costs associated with treating this disease have increased. Such change contributes to a commonly held belief that healthcare costs are out of control. However, few studies have examined this issue. Here, we use 34,678 hospitalization summary reports from 67 Guangxi hospitals (period 2013-2016) to document costs, temporal trends, and associated factors. Findings from this study are surprising in that they debunk the myth of uncontrolled healthcare costs. In addition, results and experiences from Guangxi are informative for other comparable regions.
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Affiliation(s)
- Li-Fang Zhou
- a Information and Management School , Guangxi Medical University , Nanning , China.,b Fourth Affiliated Hospital of Guangxi Medical University , Liuzhou , China.,c Division of Public Health Science , Fred Hutchinson Cancer Research Center and University of Washington , Seattle , Washington , USA
| | - Mao-Xin Zhang
- a Information and Management School , Guangxi Medical University , Nanning , China
| | - Ling-Qian Kong
- d Information Center and Medical Administration Division , Health and Family Planning Commission of Guangxi , Nanning , China
| | - Gary H Lyman
- c Division of Public Health Science , Fred Hutchinson Cancer Research Center and University of Washington , Seattle , Washington , USA
| | - Ke Wang
- a Information and Management School , Guangxi Medical University , Nanning , China.,e Respiratory Department , First Affiliated Hospital of Guangxi Medical University , Nanning , China
| | - Wei Lu
- d Information Center and Medical Administration Division , Health and Family Planning Commission of Guangxi , Nanning , China
| | - Qi-Ming Feng
- a Information and Management School , Guangxi Medical University , Nanning , China
| | - Bo Wei
- a Information and Management School , Guangxi Medical University , Nanning , China
| | - Lue Ping Zhao
- c Division of Public Health Science , Fred Hutchinson Cancer Research Center and University of Washington , Seattle , Washington , USA
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