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Zhou H, Lei H, Zhao H, Huang K, Wang Y, Hong R, Huo J, Luo L, Li F. Development and validation of a multi-parameter nomogram for venous thromboembolism in gastric cancer patients: a retrospective analysis. PeerJ 2024; 12:e17527. [PMID: 38948205 PMCID: PMC11212615 DOI: 10.7717/peerj.17527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/17/2024] [Indexed: 07/02/2024] Open
Abstract
Objective Gastric cancer (GC), one of the highest venous thromboembolism (VTE) incidence rates in cancer, contributes to considerable morbidity, mortality, and, prominently, extra cost. However, up to now, there is not a high-quality VTE model to steadily predict the risk for VTE in China. Consequently, setting up a prediction model to predict the VTE risk is imperative. Methods Data from 3,092 patients from December 15, 2017, to December 31, 2022, were retrospectively analyzed. Multiple logistic regression analysis was performed to assess risk factors for GC, and a nomogram was constructed based on screened risk factors. A receiver operating curve (ROC) and calibration plot was created to evaluate the accuracy of the nomogram. Results The risk factors of suffering from VTE were older age (OR = 1.02, 95% CI [1.00-1.04]), Karnofsky Performance Status (KPS) ≥ 70 (OR = 0.45, 95% CI [0.25-0.83]), Blood transfusion (OR = 2.37, 95% CI [1.47-3.84]), advanced clinical stage (OR = 3.98, 95% CI [1.59-9.99]), central venous catheterization (CVC) (OR = 4.27, 95% CI [2.03-8.99]), operation (OR = 2.72, 95% CI [1.55-4.77]), fibrinogen degradation product (FDP) >5 µg/mL (OR = 1.92, 95% CI [1.13-3.25]), and D-dimer > 0.5 mg/L (OR = 2.50, 95% CI [1.19-5.28]). The area under the ROC curve (AUC) was 0.82 in the training set and 0.85 in the validation set. Conclusion Our prediction model can accurately predict the risk of the appearance of VTE in gastric cancer patients and can be used as a robust and efficient tool for evaluating the possibility of VTE.
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Affiliation(s)
- Hang Zhou
- Department of Ultrasound in Medicine, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, China
| | - Haike Lei
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Huai Zhao
- Department of Ultrasound in Medicine, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, China
| | - Kaifeng Huang
- Department of Ultrasound in Medicine, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, China
| | - Yundong Wang
- Department of Ultrasound in Medicine, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, China
| | - Ruixia Hong
- Department of Ultrasound in Medicine, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, China
| | - Jishun Huo
- Department of Ultrasound in Medicine, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, China
| | - Li Luo
- Department of Ultrasound in Medicine, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, China
| | - Fang Li
- Department of Ultrasound in Medicine, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, China
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Glodeanu MC, Mutruc V, Apetrei CM, Ursaru M, Sorodoc L, Lionte C. Unprovoked venous thromboembolism recurrence and arterial embolism revealing lung cancer: a case report. Thromb J 2024; 22:51. [PMID: 38890693 PMCID: PMC11186263 DOI: 10.1186/s12959-024-00622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
The link between venous thromboembolism (VTE) and cancer is well known. VTE could be the initial sign of an occult malignancy. There are more diagnoses of cancer after an unprovoked VTE compared to a provoked VTE, with a reported prevalence between 4.5% and 5.6% over 12 months, within the first 6 months of VTE diagnosis. There are no recommended guidelines and scores yet adopted in clinical practice, but many studies support occult cancer screening in unprovoked VTE patients. We report the case of a patient with a history of unprovoked pulmonary embolism (PE) diagnosed with bronchopulmonary neoplasm in an advanced stage one year after the thromboembolic event. When the cancer was first diagnosed, the patient's condition was already serious, being too late for the adoption of measures meant to decrease the risk of mortality and increase the duration of survival. We wanted to emphasize the importance of occult cancer screening in patients with unprovoked VTE and the fact that early cancer diagnosis reduces the risk of cancer progression, decreasing mortality and morbidity related to it.
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Affiliation(s)
- Maria-Cristina Glodeanu
- 2nd Internal Medicine Clinic, "Sf. Spiridon" Emergency Clinical County Hospital, Iasi, Romania.
| | - Victoria Mutruc
- Rheumatology Department, Clinical Recovery Hospital, Iasi, Romania
| | - Camelia-Maria Apetrei
- 2nd Internal Medicine Clinic, "Sf. Spiridon" Emergency Clinical County Hospital, Iasi, Romania
| | - Manuela Ursaru
- Radiology Department, "Sf. Spiridon" Emergency Clinical County Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Laurentiu Sorodoc
- 2nd Internal Medicine Clinic, "Sf. Spiridon" Emergency Clinical County Hospital, Iasi, Romania
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Catalina Lionte
- 2nd Internal Medicine Clinic, "Sf. Spiridon" Emergency Clinical County Hospital, Iasi, Romania
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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Hisatake S, Kiuchi S, Dobashi S, Murakami Y, Ikeda T. Evaluation of acute thrombus regression effect of edoxaban for deep vein thrombosis in patients with cancer: a single-center prospective observational study. Heart Vessels 2024:10.1007/s00380-024-02418-1. [PMID: 38771333 DOI: 10.1007/s00380-024-02418-1] [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] [Received: 01/22/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Although there are reports on the recurrence prevention in the chronic phase using direct oral anticoagulants (DOACs) for deep vein thrombosis (DVT) in patients with cancer, acute thrombus regression effect using DOACs has not been assessed. This study aimed to assess the thrombus regression effect of initial treatment using edoxaban for acute lower-extremity DVT in patients with active cancer. METHODS AND RESULTS In this observational study, among the inpatients with cancer and lower-extremity DVT who underwent initial treatment with edoxaban at our hospital from November 2019 to December 2021, 34 consenting patients were recruited in this study. The quantitative ultrasound thrombus (QUT) score of thrombus volume was calculated at baseline (before administration) and 7-14 days after the start of edoxaban administration, using lower-extremity venous ultrasound to evaluate changes in thrombus volume. The primary and secondary endpoints were the acute thrombus regression effect of edoxaban and the impact of patients' clinical frailty on the thrombus regression effect, respectively. Anticoagulant therapy with edoxaban significantly reduced QUT score (p < 0.001). In addition, regardless of the Clinical Frailty Scale scores, QUT score decreased significantly. CONCLUSION Initial treatment with edoxaban was effective for lower-extremity DVT in patients with cancer. In addition, the effect was the same independent of the degree of frailty.
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Affiliation(s)
- Shinji Hisatake
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-Ku, Tokyo, 143-8541, Japan.
| | - Shunsuke Kiuchi
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Shintaro Dobashi
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Yoshiki Murakami
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-Ku, Tokyo, 143-8541, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-Ku, Tokyo, 143-8541, Japan
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Adrianzen-Herrera D, Giorgio K, Walker RF, Sparks AD, Gergi M, Zakai NA, Lutsey PL. Bleeding risk from anticoagulant thromboprophylaxis in patients with multiple myeloma: a MarketScan analysis. Res Pract Thromb Haemost 2024; 8:102418. [PMID: 38798793 PMCID: PMC11127259 DOI: 10.1016/j.rpth.2024.102418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
Background Multiple myeloma (MM) is associated with high risk of venous thromboembolism (VTE). Anticoagulant prophylaxis is frequently recommended but underutilized partly due to the absence of studies assessing bleeding risk. Objectives To determine the rate of severe (hospitalized) bleeding from thromboprophylaxis in patients treated for MM and identify clinical risk factors for bleeding in this population. Methods Using the MarketScan database, we analyzed 6656 patients treated for MM between 2013 and 2021. Concomitant thromboprophylaxis was defined using prescription claims. Hospitalized bleeding was identified through the Cunningham algorithm. Bleeding rates were compared by thromboprophylaxis status, and Cox regression identified risk factors for bleeding. Results Anticoagulant thromboprophylaxis was used in 6.6% (436) patients treated for MM. Patients on thromboprophylaxis had a higher rate of immunomodulatory-based therapy (63.8% vs 46.7%; P < .01) and lower rate of antiplatelet use (2.1% vs 4.7%; P < .01). Bleeding occurred in 1.4% of them during median follow-up of 1.3 years. Rate of severe bleeding was not different between those on prophylaxis (7.8 per 1000 person-years) and those not on prophylaxis (10.1 per 1000 person-years). No association was identified between thromboprophylaxis and bleeding. Factors associated with increased bleeding included age (hazard ratio [HR], 1.38 per 10 years increase in age), comorbidity index (HR, 1.18 per SD increase), history of bleeding (HR, 1.54), hypertension (HR, 1.87), and renal disease (HR, 1.56). Conclusion Risk of serious bleeding from thromboprophylaxis in patients treated for MM was low, and concomitant anticoagulant therapy did not result in increased bleeding risk. Clinical risk factors for bleeding included age, comorbidity index, bleeding history, hypertension, and renal disease.
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Affiliation(s)
- Diego Adrianzen-Herrera
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Katherine Giorgio
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Rob F. Walker
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Andrew D. Sparks
- Biomedical Statistics Research Core, University of Vermont, Burlington, Vermont, USA
| | - Mansour Gergi
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Neil A. Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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Boudoulas KD, Marmagkiolis K, Iliescu C, Boudoulas H. Editorial: Calcific aortic stenosis: A complex entity with multiple coexisting disorders. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 62:18-20. [PMID: 38195344 DOI: 10.1016/j.carrev.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024]
Affiliation(s)
| | - Konstantinos Marmagkiolis
- Tampa Heart, Tampa, FL, USA; Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Cezar Iliescu
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Bertoletti L, Girard P, Élias A, Espitia O, Schmidt J, Couturaud F, Mahé I, Sanchez O. [Translation into French and republication of: "Recurrent venous thromboembolism in anticoagulated cancer patients: diagnosis and treatment"]. Rev Med Interne 2024; 45:289-299. [PMID: 38806295 DOI: 10.1016/j.revmed.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 05/30/2024]
Abstract
Patients with cancer are at significantly increased risk of venous thromboembolism (VTE), due both to the impact of malignant disease itself and to the impact of certain anticancer drugs on haemostasis. This is true both for first episode venous thromboembolism and recurrence. The diagnosis and management of VTE recurrence in patients with cancer poses particular challenges, and these are reviewed in the present article, based on a systematic review of the relevant scientific literature published over the last decade. Furthermore, it is uncertain whether diagnostic algorithms for venous thromboembolism, validated principally in untreated non-cancer patients, are also valid in anticoagulated cancer patients: the available data suggests that clinical decision rules and D-dimer testing perform less well in this clinical setting. In patients with cancer, computed tomography pulmonary angiography and venous ultrasound appear to be the most reliable diagnostic tools for diagnosis of pulmonary embolism and deep vein thrombosis respectively. Options for treatment of venous thromboembolism include low molecular weight heparins (at a therapeutic dose or an increased dose), fondaparinux or oral direct factor Xa inhibitors. The choice of treatment should take into account the nature (pulmonary embolism or VTE) and severity of the recurrent event, the associated bleeding risk, the current anticoagulant treatment (type, dose, adherence and possible drug-drug interactions) and cancer progression.
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Affiliation(s)
- L Bertoletti
- Service de médecine vasculaire et thérapeutique, CHU de Saint-Étienne, Inserm, UMR1059, équipe Dysfonction vasculaire et hémostase, université Jean-Monnet, CIC-1408, 42000 Saint-Étienne, France; F-CRIN INNOVTE network, Saint-Étienne, France.
| | - P Girard
- F-CRIN INNOVTE network, Saint-Étienne, France; Institut du thorax Curie-Montsouris, institut mutualiste Montsouris, Paris, France
| | - A Élias
- F-CRIN INNOVTE network, Saint-Étienne, France; Service de cardiologie et de médecine vasculaire, délégation recherche clinique et innovation, centre hospitalier intercommunal Toulon La Seyne-sur-Mer, Toulon, France
| | - O Espitia
- Service de médecine interne et vasculaire, Institut du thorax, Nantes université, CHU de Nantes, Inserm UMR 1087-CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - J Schmidt
- F-CRIN INNOVTE network, Saint-Étienne, France; Service d'urgence, CHU de Clermont-Ferrand, Lapsco-UMR UBP-CNRS 6024, université Clermont Auvergne, Clermont-Ferrand, France
| | - F Couturaud
- F-CRIN INNOVTE network, Saint-Étienne, France; Département de médecine interne, médecine vasculaire et pneumologie, CHU de Brest, Inserm U1304-GETBO, université de Brest, Brest, France
| | - I Mahé
- F-CRIN INNOVTE network, Saint-Étienne, France; Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France; Université Paris Cité, Inserm UMR S1140, Innovations thérapeutiques en hémostase, Paris, France
| | - O Sanchez
- F-CRIN INNOVTE network, Saint-Étienne, France; Université Paris Cité, Inserm UMR S1140, Innovations thérapeutiques en hémostase, Paris, France; Service de pneumologie et de soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France
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Sánchez Prieto I, Gutiérrez Jomarrón I, Martínez Vázquez C, Rodríguez Barquero P, Gili Herreros P, García-Suárez J. Comprehensive evaluation of genetic and acquired thrombophilia markers for an individualized prediction of clinical thrombosis in patients with lymphoma and multiple myeloma. J Thromb Thrombolysis 2024:10.1007/s11239-024-02977-0. [PMID: 38676874 DOI: 10.1007/s11239-024-02977-0] [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] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
Patients diagnosed with lymphoma or multiple myeloma are at elevated risk of venous thromboembolism (VTE). Optimum risk stratification and effective thromboprophylaxis can only be achieved through the development of a multiple-specific risk score that successfully captures all aspects of the heterogeneous prothrombotic environment existing in these patients. Our aim was to identify risk factors for thrombosis and suggest an improved tool combining clinical data, thrombo-inflammatory biomarkers and genetic (Thrombo inCode® test) variables for predicting thrombotic risk in patients with lymphoma and multiple myeloma. A prospective longitudinal study was conducted on newly-diagnosed lymphoma and multiple myeloma patients who presented at our institution between February 2020 and January 2021. The study included 47 patients with lymphoma and 16 patients with multiple myeloma. We performed a follow-up of 1 year or until September 2021. The incidence of venous thrombosis and associated risk factors were analysed, including the genetic Thrombo inCode® test. Khorana and ThroLy scores for lymphoma patients and IMPEDE VTE score for myeloma patients were calculated. At a median follow-up of 9.1 months, VTE incidence was 9.5% (6/63), with 4 and 2 patients with lymphoma and myeloma who developed the events, respectively. Univariate analysis showed that the incidence of thrombosis was significantly higher in patients with ECOG ≥ 2 and prior immobility. Median factor VIII levels were significantly higher in patients with thrombosis (with increased values in all of them). Moreover, there was a trend in genetic variant rs5985 (factor XIII) as a protective factor, and a trend to higher thrombotic risk in patients with factor V Leiden, rs2232698 variant (serpinA10), low total protein S activity, elevated D-dimer, aggressive lymphoma and treatment with dexamethasone. The results of our study demonstrate promise for the potential use of widely accessible markers to increase precision in risk prediction for VTE in patients with lymphoma and multiple myeloma, particularly ECOG ≥ 2, immobility and higher factor VIII levels, as well as lymphoma aggressiveness, treatment with dexamethasone and the haemostatic biomarkers D-dimer and total protein S activity. Additionally, genetic variants factor V Leiden, serpinA10 rs2232698 and factor XIII-A Val34Leu warrant further investigation for use in the research setting.
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Affiliation(s)
- Irene Sánchez Prieto
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - Isabel Gutiérrez Jomarrón
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Celia Martínez Vázquez
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Pedro Rodríguez Barquero
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Paula Gili Herreros
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Julio García-Suárez
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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Shyu M, Liu A, Srikureja A, Gregorian A, Srisuwananukorn A, Tremblay D, Naymagon L. Equivalent thrombotic risk with Warfarin, Dabigatran, or Enoxaparin after failure of initial direct oral anticoagulation (DOAC) therapy. J Thromb Thrombolysis 2024:10.1007/s11239-024-02978-z. [PMID: 38643437 DOI: 10.1007/s11239-024-02978-z] [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] [Accepted: 04/02/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND The direct oral anticoagulants (DOACs) are now commonly regarded as first line anticoagulants in most cases of venous thromboembolism (VTE). However, the optimal choice of subsequent anticoagulant in instances of first line DOAC failure is unclear. OBJECTIVES To describe and compare outcomes with second line anticoagulants used after DOAC failure. METHODS Patients seen at an urban hospital system for an episode of acute VTE initially treated with either apixaban or rivaroxaban who experienced a subsequent recurrent thrombosis while on anticoagulation (1st recurrent thrombosis) were included. RESULTS In total, 166 patients after apixaban or rivaroxaban failure were included. Following DOAC failure (1st recurrent thrombosis), the subsequent anticoagulant was warfarin in 60 patients (36%), dabigatran in 42 patients (25%), and enoxaparin in 64 patients (39%). Enoxaparin was preferentially prescribed in patients with a malignancy-associated etiology for 1st recurrent thrombosis (p < 0.01). The median follow-up time in our cohort was 16 months. There was no difference in 2nd recurrent thrombosis-free survival (p = 0.72) or risk for major bleeding event (p = 0.30) among patients treated with dabigatran, warfarin, or enoxaparin. CONCLUSIONS In this retrospective analysis of patients failing first line DOAC therapy, rates of 2nd recurrent thrombosis and bleeding did not differ among subsequently chosen anticoagulants. Our study provides evidence that the optimal 2nd anticoagulant is not clear, and the choice of 2nd anticoagulant should continue to balance patient preference, cost, and provider experience.
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Affiliation(s)
- Margaret Shyu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Division of Oncology, Stanford University School of Medicine, 300 Pasteur Drive MC 5151, Stanford, CA, USA.
| | - Angela Liu
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Anya Srikureja
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alison Gregorian
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Andrew Srisuwananukorn
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Douglas Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Leonard Naymagon
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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9
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Wang TF, Chen Q, Deng J, Li SL, Xu Y, Ma SX. Research progress on venous thrombosis development in patients with malignant tumors. World J Clin Cases 2024; 12:1900-1908. [PMID: 38660542 PMCID: PMC11036524 DOI: 10.12998/wjcc.v12.i11.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/04/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024] Open
Abstract
The coexistence of venous thromboembolism (VTE) within patients with cancer, known as cancer-associated thrombosis (CAT), stands as a prominent cause of mortality in this population. Over recent years, the incidence of VTE has demonstrated a steady increase across diverse tumor types, influenced by several factors such as patient management, tumor-specific risks, and treatment-related aspects. Furthermore, mutations in specific genes have been identified as potential contributors to increased CAT occurrence in particular cancer subtypes. We conducted an extensive review encompassing pivotal historical and ongoing studies on CAT. This review elucidates the risks, mechanisms, reliable markers, and risk assessment methodologies that can significantly guide effective interventions in clinical practice.
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Affiliation(s)
- Teng-Fei Wang
- Department of Vascular Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Qian Chen
- Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Jie Deng
- Department of Vascular Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Shi-Liang Li
- Department of Vascular Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Yuan Xu
- Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Si-Xing Ma
- Department of Vascular Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
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10
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Kouvela M, Livanou ME, Stefanou DT, Vathiotis IA, Sarropoulou F, Grammoustianou M, Dimakakos E, Syrigos N. Efficacy and Safety of Tinzaparin Thromboprophylaxis in Lung Cancer Patients with High Thromboembolic Risk: A Prospective, Observational, Single-Center Cohort Study. Cancers (Basel) 2024; 16:1442. [PMID: 38611118 PMCID: PMC11011428 DOI: 10.3390/cancers16071442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The aim of this study was to record and assess the efficacy and safety ofthromboprophylaxis with an intermediate dose of Tinzaparin in lung cancer patients with high thrombotic risk. METHODS This was a non-interventional, single-arm, prospective cohort study of lung cancer patients who received thromboprophylaxis with Tinzaparin 10.000 Anti-Xa IU in 0.5 mL, OD, used in current clinical practice. Enrolled ambulatory patients signed informed consent. Anti-Xa levels were tested. RESULTS In total, 140 patients were included in the study, of which 81.4% were males. The histology of the tumor was mainly adenocarcinoma. Lung cancer patients with high thrombotic risk based on tumor, patient, treatment, and laboratory-related factors were enrolled. Only one patient experienced a thrombotic event (0.7%), and 10 patients had bleeding events (7.1%), including only one major event. Anti-Xa levels measured at 10 days and 3 months did not differ significantly between patients who developed hemorrhagic events and those who did not (p = 0.26 and p = 0.32, respectively). CONCLUSION Thromboprophylaxis with an intermediate Tinzaparin dose in high thrombotic-risk lung cancer patients is a safe and effective choice for the prevention of VTE.
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Affiliation(s)
- Marousa Kouvela
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Maria Effrosyni Livanou
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Dimitra T. Stefanou
- First Department of Internal Medicine, Laikon General Hospital, School of Medicine, National Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Ioannis A. Vathiotis
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Fotini Sarropoulou
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Maria Grammoustianou
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Evangelos Dimakakos
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
| | - Nikolaos Syrigos
- Oncology Unit, Third Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.E.L.); (I.A.V.); (F.S.); (M.G.); (E.D.); (N.S.)
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11
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Costamagna G, Navi BB, Beyeler M, Hottinger AF, Alberio L, Michel P. Ischemic Stroke in Cancer: Mechanisms, Biomarkers, and Implications for Treatment. Semin Thromb Hemost 2024; 50:342-359. [PMID: 37506734 DOI: 10.1055/s-0043-1771270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Ischemic stroke is an important cause of morbidity and mortality in cancer patients. The underlying mechanisms linking cancer and stroke are not completely understood. Long-standing and more recent evidence suggests that cancer-associated prothrombotic states, along with treatment-related vascular toxicity, such as with chemotherapy and immunotherapy, contribute to an increased risk of ischemic stroke in cancer patients. Novel biomarkers, including coagulation, platelet and endothelial markers, cell-free DNA, and extracellular vesicles are being investigated for their potential to improve risk stratification and patient selection for clinical trials and to help guide personalized antithrombotic strategies. Treatment of cancer-related stroke poses unique challenges, including the need to balance the risk of recurrent stroke and other thromboembolic events with that of bleeding associated with antithrombotic therapy. In addition, how and when to restart cancer treatment after stroke remains unclear. In this review, we summarize current knowledge on the mechanisms underlying ischemic stroke in cancer, propose an etiological classification system unique to cancer-related stroke to help guide patient characterization, provide an overview of promising biomarkers and their clinical utility, and discuss the current state of evidence-based management strategies for cancer-related stroke. Ultimately, a personalized approach to stroke prevention and treatment is required in cancer patients, considering both the underlying cancer biology and the individual patient's risk profile.
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Affiliation(s)
- Gianluca Costamagna
- Stroke Unit, Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, New York
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Morin Beyeler
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas F Hottinger
- Services of Neurology and Oncology, Lundin Family Brain Tumor Research Center, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Lorenzo Alberio
- Division of Hematology and Hematology Central Laboratory, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Patrik Michel
- Department of Clinical Neurosciences, Stroke Center, Neurology Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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12
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Chen JX, Xu LL, Cheng JP, Xu XH. Challenging anticoagulation therapy for multiple primary malignant tumors combined with thrombosis: A case report and review of literature. World J Clin Cases 2024; 12:1704-1711. [PMID: 38576733 PMCID: PMC10989423 DOI: 10.12998/wjcc.v12.i9.1704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Venous thromboembolism significantly contributes to patient deterioration and mortality. Management of its etiology and anticoagulation treatment is intricate, necessitating a comprehensive consideration of various factors, including the bleeding risk, dosage, specific anticoagulant medications, and duration of therapy. Herein, a case of lower extremity thrombosis with multiple primary malignant tumors and high risk of bleeding was reviewed to summarize the shortcomings of treatment and prudent anticoagulation experience. CASE SUMMARY An 83-year-old female patient was admitted to the hospital due to a 2-wk history of left lower extremity edema that had worsened over 2 d. Considering her medical history and relevant post-admission investigations, it was determined that the development of left lower extremity venous thrombosis and pulmonary embolism in this case could be attributed to a combination of factors, including multiple primary malignant tumors, iliac venous compression syndrome, previous novel coronavirus infection, and inadequate treatment for prior thrombotic events. However, the selection of appropriate anticoagulant medications, determination of optimal drug dosages, and establishment of an appropriate duration of anticoagulation therapy were important because of concurrent thrombocytopenia, decreased quantitative fibrinogen levels, and renal insufficiency. CONCLUSION Anticoagulant prophylaxis should be promptly initiated in cases of high-risk thrombosis. Individualized anticoagulation therapy is required for complex thrombosis.
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Affiliation(s)
- Jia-Xin Chen
- Department of Gerontology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
- Medical College, Wuhan University of Science and Technology, Wuhan 430065, Hubei Province, China
| | - Ling-Ling Xu
- Department of Gerontology, China Resources and Wisco General Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
- Medical College, Wuhan University of Science and Technology, Wuhan 430065, Hubei Province, China
| | - Jing-Ping Cheng
- Department of Gerontology, China Resources and Wisco General Hospital, Wuhan 430080, Hubei Province, China
| | - Xun-Hua Xu
- Department of Radiology, China Resources and Wisco General Hospital, Wuhan 430080, Hubei Province, China
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13
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Rautiola J, Björklund J, Zelic R, Edgren G, Bottai M, Nilsson M, Vincent PH, Fredholm H, Falconer H, Sjövall A, Nilsson PJ, Wiklund P, Aly M, Akre O. Risk of Postoperative Ischemic Stroke and Myocardial Infarction in Patients Operated for Cancer. Ann Surg Oncol 2024; 31:1739-1748. [PMID: 38091152 PMCID: PMC10838243 DOI: 10.1245/s10434-023-14688-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/13/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Risk assessment for ischemic stroke (IS) and myocardial infarction (MI) is done routinely before surgery, but the increase in risks associated with surgery is not known. The aim of this study is to assess the risk of arterial ischemic events during the first year after oncological surgery. METHODS We used Swedish healthcare databases to identify 443,300 patients who underwent cancer surgery between 1987 and 2016 and 4,127,761 matched comparison subjects. We estimated odds ratios (ORs) for myocardial infarction and ischemic stroke during the hospitalization with logistic regression and calculated 1-year cumulative incidences and hazard ratios (HRs) with 95% confidence intervals (CIs) for the outcomes after discharge. RESULTS The cumulative incidences of myocardial infarction and ischemic stroke during the first postoperative year were 1.33% and 1.25%, respectively. In the comparison cohort, the corresponding 1-year cumulative incidences were 1.04% and 1.00%. During the hospitalization, the OR for myocardial infarction was 8.81 (95% CI 8.24-9.42) and the OR for ischemic stroke was 6.71 (95% CI 6.22-7.23). After discharge, the average HR during follow-up for 365 days was 0.90 (95% CI 0.87-0.93) for myocardial infarction and 1.02 (95% CI 0.99-1.05) for ischemic stroke. CONCLUSIONS We found an overall increased risk of IS and MI during the first year after cancer surgery that was attributable to events occurring during the hospitalization period. After discharge from the hospital, the overall risk of myocardial infarction was lower among the cancer surgery patients than among matched comparison subjects.
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Affiliation(s)
- Juhana Rautiola
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Johan Björklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Renata Zelic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Gustaf Edgren
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Per Henrik Vincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Fredholm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Annika Sjövall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Per J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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14
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Gervaso L, Laffi A, Gaeta A, Gandini S, Boldrini L, Meneses-Medina MI, Rubino M, Benini L, Borghesani M, Algeri L, Curigliano G, Spada F, Cella CA, Fazio N. Venous thromboembolism in pancreatic neuroendocrine neoplasm: a cohort study. Res Pract Thromb Haemost 2024; 8:102381. [PMID: 38617046 PMCID: PMC11015488 DOI: 10.1016/j.rpth.2024.102381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Affiliation(s)
- Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
- Molecular Medicine Department, University of Pavia, Pavia, Italy
| | - Alice Laffi
- Medical Oncology and Hematology Unit, Istituto Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Aurora Gaeta
- Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Laura Boldrini
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
| | - Monica Isabel Meneses-Medina
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Manila Rubino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Lavinia Benini
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Michele Borghesani
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Laura Algeri
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Chiara Alessandra Cella
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
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15
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Chen J, Lai YL, Lee JK, Lin HW, Sun WZ, Chen YL, Cheng WF. Does the diagnostic timing of cancer-associated thromboembolism influence the survival outcome in ovarian cancer patients? J Formos Med Assoc 2024; 123:228-237. [PMID: 37596109 DOI: 10.1016/j.jfma.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/23/2023] [Accepted: 08/04/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND/PURPOSE Efforts were made to explore the influence of diagnostic timing for cancer-associated thromboembolic events on survival of ovarian cancer patients. METHODS We reviewed the medical records of 75 ovarian cancer patients with thromboembolism and evaluated the prognostic factors affecting disease-free survival and overall survival. RESULTS These 75 patients were classified into two categories by the diagnostic timing of the thromboembolism, during (33 cases) and after (42 cases) initial diagnosis of ovarian cancer groups. The diagnostic timing of thromboembolism was not related to disease-free survival or overall survival of the studied population. Advanced disease stage, clear cell histology, interval debulking surgery, no recurrence/persistence of ovarian cancer, and patients treated with anticoagulant(s) treatment >3 months were associated with the disease-free survival. Advanced disease stage, clear cell histology, body mass index (BMI) ≥24 kg/m2 at the diagnosis of ovarian cancer, and no recurrence/persistence of ovarian cancer influenced the overall survival. In the subgroup analysis, compared to the after initial ovarian cancer diagnosis group, patients with stage I/II disease, BMI <24 kg/m2 at the diagnosis of ovarian cancer, or primary debulking surgery in the during cancer diagnosis group had longer disease-free survival, and overall survival benefit was observed in cases with stage I/II disease, or primary debulking surgery. CONCLUSION The diagnostic timing of thromboembolism was not related to disease-free or overall survival of ovarian cancer patients, but associated with that of specific patient subgroups.
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Affiliation(s)
- Jung Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Yen-Ling Lai
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Jen-Kuang Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Wei Lin
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Zen Sun
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan.
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
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16
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Bertoletti L, Girard P, Elias A, Espitia O, Schmidt J, Couturaud F, Mahé I, Sanchez O. Recurrent venous thromboembolism in anticoagulated cancer patients: Diagnosis and treatment. Arch Cardiovasc Dis 2024; 117:84-93. [PMID: 38065753 DOI: 10.1016/j.acvd.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023]
Abstract
Patients with cancer are at significantly increased risk of venous thromboembolism (VTE), due both to the impact of malignant disease itself and to the impact of certain anticancer drugs on haemostasis. This is true both for first episode venous thromboembolism and recurrence. The diagnosis and management of VTE recurrence in patients with cancer poses particular challenges, and these are reviewed in the present article, based on a systematic review of the relevant scientific literature published over the last decade. Furthermore, it is uncertain whether diagnostic algorithms for venous thromboembolism, validated principally in untreated non-cancer patients, are also valid in anticoagulated cancer patients: the available data suggests that clinical decision rules and D-dimer testing perform less well in this clinical setting. In patients with cancer, computed tomography pulmonary angiography and venous ultrasound appear to be the most reliable diagnostic tools for diagnosis of pulmonary embolism and deep vein thrombosis respectively. Options for treatment of venous thromboembolism include low molecular weight heparins (at a therapeutic dose or an increased dose), fondaparinux or oral direct factor Xa inhibitors. The choice of treatment should take into account the nature (pulmonary embolism or VTE) and severity of the recurrent event, the associated bleeding risk, the current anticoagulant treatment (type, dose, adherence and possible drug-drug interactions) and cancer progression.
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Affiliation(s)
- Laurent Bertoletti
- Service de médecine vasculaire et thérapeutique, CHU de Saint-Étienne, INSERM, UMR1059, Équipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France; F-CRIN INNOVTE network, Saint-Etienne, France.
| | - Philippe Girard
- Institut du thorax Curie-Montsouris, institut mutualiste Montsouris, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Antoine Elias
- Service de cardiologie et de médecine vasculaire, délégation recherche clinique et innovation, centre hospitalier intercommunal Toulon La Seyne-sur-Mer, Toulon, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Espitia
- Service de médecine interne et vasculaire, institut du thorax, Nantes université, CHU de Nantes, Inserm UMR 1087-CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Jeannot Schmidt
- Service d'urgence, CHU de Clermont-Ferrand, LAPSCO-UMR UBP-CNRS 6024, Université Clermont Auvergne, Clermont-Ferrand, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Francis Couturaud
- Département de médecine interne, médecine vasculaire et pneumologie, CHU de Brest, Inserm U1304-GETBO, université de Brest, Brest, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Isabelle Mahé
- Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Sanchez
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; Service de pneumologie et de soins intensifs, Hôpital européen Georges-Pompidou, AP-HP, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
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17
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Kaptein FH, Guman NA, Lohle SB, Klok FA, Mairuhu AT, Kamphuisen PW, Es NV, Huisman MV. Treatment Patterns of Cancer-associated Thrombosis in the Netherlands: The Four Cities Study. TH OPEN 2024; 8:e61-e71. [PMID: 38298199 PMCID: PMC10827569 DOI: 10.1055/a-2214-8101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/17/2023] [Indexed: 02/02/2024] Open
Abstract
Background Current guidelines recommend either low-molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs) as first-line treatment in cancer-associated venous thromboembolism (VTE). Aim This study aimed to investigate treatment regimens for cancer-associated VTE over the past 5 years, explore predictors for initial treatment (LMWH vs. DOAC), and to assess the risks of recurrent VTE and bleeding. Methods This was a Dutch, multicenter, retrospective cohort study including consecutive patients with cancer-associated VTE between 2017 and 2021. Treatment predictors were assessed with multivariable logistic regression models. Six-month cumulative incidences for recurrent VTE and major bleeding (MB) were estimated with death as competing risk. Results In total, 1,215 patients were included. The majority (1,134/1,192; 95%) started VTE treatment with anticoagulation: 561 LMWH (47%), 510 DOACs (43%), 27 vitamin K antagonist (2.3%), and 36 other/unknown type (3.0%). The proportion of patients primarily treated with DOACs increased from 18% (95% confidence interval [CI] 12-25) in 2017 to 70% (95% CI 62-78) in 2021. Poor performance status (adjusted odds ratio [aOR] 0.72, 95% CI 0.53-0.99) and distant metastases (aOR 0.61, 95% CI 0.45-0.82) were associated with primary treatment with LMWH. Total 6-month cumulative incidences were 6.0% (95% CI 4.8-7.5) for recurrent VTE and 7.0% (95% CI 5.7-8.6) for MB. During follow-up, 182 patients (15%) switched from LMWH to a DOAC, and 54 patients (4.4%) vice versa, for various reasons, including patient preference, recurrent thrombosis, and/or bleeding. Conclusion DOAC use in cancer-associated VTE has increased rapidly over the past years. Changes in anticoagulation regimen were frequent over time, and were often related to recurrent thrombotic and bleeding complications, illustrating the complexity and challenges of managing cancer-associated VTE.
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Affiliation(s)
- Fleur H.J. Kaptein
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Noori A.M. Guman
- Department of Vascular Medicine, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands
| | - Susan B. Lohle
- Department of Vascular Medicine, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Frederikus A. Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Pieter W. Kamphuisen
- Department of Vascular Medicine, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands
| | - Nick Van Es
- Department of Vascular Medicine, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Menno V. Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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18
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Shoji M, Yamashita Y, Ishii M, Inoue H, Kato H, Fujita S, Matsui K, Tajiri K, Nameki M, Muraoka N, Nonaka A, Sugino H, Kono M, Oka T, Sueta D, Komuro I, Tsujita K. A Predictive Model for Cancer-Associated Thrombosis in Japanese Cancer Patients: Findings from the J-Khorana Registry. TH OPEN 2024; 8:e9-e18. [PMID: 38197014 PMCID: PMC10774015 DOI: 10.1055/a-2207-7715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/07/2023] [Indexed: 01/11/2024] Open
Abstract
Background Although the close relationship between cancer and venous thromboembolism (VTE) has been identified, risk stratification for VTE in Japanese patients with cancer remains unclear. Objectives This study aimed to validate the Khorana VTE risk assessment score (KRS) for VTE diagnosis and establish an optimal predictive model for VTE in Japanese patients with cancer. Methods A total of 7,955 Japanese patients with cancer were subdivided into low- (0), intermediate- (1-2), and high-score (3) groups according to the KRS. Using 37 explanatory variables, a total of 2,833 patients with cancer were divided into derivation and validation cohorts (5:5). A risk model for Japanese participants was developed using the derivation cohort data. Results The prevalence of VTE in low-, intermediate-, and high-score patients was 1.2, 2.5, and 4.3%, respectively. Logistic regression analysis demonstrated that cancer stage (III-IV) and KRS ≥ 2 were independent and significant predictors of VTE onset. The risk model for VTE assigned 1 point to body mass index ≥25 kg/m 2 and 2 points each to the prevalence of osteochondral cancer and D-dimer level ≥1.47 µg/mL. The areas under the curve of the risk model were 0.763 and 0.656 in the derivation and validation cohorts, respectively. Conclusion The KRS was useful in Japanese patients, and our new predictive model may be helpful for the diagnosis of VTE in Japanese patients with cancer.
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Affiliation(s)
- Masaaki Shoji
- Department of General Internal Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Hitoki Inoue
- Department of Cardiology, National Hospital Organization (NHO) Hokkaido Cancer Center, Hokkaido, Japan
| | - Hiroshi Kato
- Division of Onco-Cardiology, Miyagi Cancer Center, Miyagi, Japan
| | - Shin Fujita
- Department of Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Kazuhiro Matsui
- Department of Internal Medicine, Onco-Cardiology Unit, Saitama Cancer Center, Saitama, Japan
| | - Kazuko Tajiri
- Department of Cardiology, National Cancer Center Hospital East, Chiba, Japan
| | - Mizuo Nameki
- Division of Cardiology, Chiba Cancer Center, Chiba, Japan
| | - Nao Muraoka
- Division of Cardiology, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Akiko Nonaka
- Division of Onco-Cardiology, Hyogo Cancer Center, Hyogo, Japan
| | - Hiroshi Sugino
- Division of Cardiology, NHO Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Mihoko Kono
- Department of Onco-Cardiology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Toru Oka
- Department of Internal Medicine, Onco-Cardiology Unit, Saitama Cancer Center, Saitama, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Issei Komuro
- Department of Frontier Cardiovascular Science, International University of Health and Welfare, Tokyo, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
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19
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Pavlovic D, Niciforovic D, Markovic M, Papic D. Cancer-Associated Thrombosis: Epidemiology, Pathophysiological Mechanisms, Treatment, and Risk Assessment. Clin Med Insights Oncol 2023; 17:11795549231220297. [PMID: 38152726 PMCID: PMC10752082 DOI: 10.1177/11795549231220297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
Cancer patients represent a growing population with drastically difficult care and a lowered quality of life, especially due to the heightened risk of vast complications. Thus, it is well established so far that one of the most prominent complications in individuals with cancer is venous thromboembolism. Since there are various improved methods for screening and diagnosing cancer and its complications, the incidence of cancer-associated thrombosis has been on the rise in recent years. Therefore, the high mortality and morbidity rates among these patients are not a surprise. Consequently, there is an excruciating need for understanding the mechanisms behind this complex process, as well as the imperative for adequate analysis and application of the most suitable steps for cancer-associated thrombosis prevention. There are various and numerous mechanisms offering potential answers to cancer-associated thrombosis, some of which have already been elucidated in various preclinical and clinical scenarios, yet further and more elaborate studies are crucial to understanding and preventing this complex and harsh clinical entity. This article elaborates on the growing incidence, mortality, morbidity, and risk factors of cancer-associated thrombosis while emphasizing the pathophysiological mechanisms in the light of various types of cancer in patients and summarizes the most novel therapy and prevention guidelines recommendations.
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Affiliation(s)
- Dragica Pavlovic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Danijela Niciforovic
- Center for Internal Oncology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Marina Markovic
- Center for Internal Oncology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Dragana Papic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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20
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Okusaka T, Saiura A, Shimada K, Ikeda M, Ioka T, Kimura T, Hosokawa J, Takita A, Oba MS. Incidence and risk factors for venous thromboembolism in the Cancer-VTE Registry pancreatic cancer subcohort. J Gastroenterol 2023; 58:1261-1271. [PMID: 37676492 PMCID: PMC10657787 DOI: 10.1007/s00535-023-02033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND This substudy of the Cancer-VTE Registry estimated venous thromboembolism (VTE) incidence and risk factors in pancreatic cancer patients. METHODS The Cancer-VTE Registry was an observational study that collected VTE data from patients with solid tumors across Japan. We measured baseline VTE prevalence, and at 1-year follow-up, the cumulative incidence of symptomatic and composite VTE (symptomatic VTE and incidental VTE requiring treatment), bleeding, cerebral infarction/transient ischemic attack (TIA)/systemic embolic event (SEE), and all-cause death. RESULTS Of 1006 pancreatic cancer patients, 86 (8.5%) had VTE at baseline, and seven (0.7%) had symptomatic VTE. Significant risk factors of baseline VTE were Eastern Cooperative Oncology Group performance status (ECOG PS) of 1, body mass index (BMI) ≥ 25 kg/m2, history of VTE, D-dimer > 1.2 µg/mL, and hemoglobin < 10 g/dL. At 1-year follow-up, the cumulative incidence of events was higher for pancreatic cancer vs other cancers. Pancreatic cancer patients with VTE vs those without VTE had significantly higher incidences of bleeding, cerebral infarction/TIA/SEE, and all-cause death. No significant risk factors for composite VTE were identified. CONCLUSIONS The cumulative incidence of composite VTE during cancer treatment was higher in pancreatic cancer than in other cancer types. Some risk factors for VTE prevalence at cancer diagnosis were identified. Although VTE prevalence at cancer diagnosis did not predict the subsequent 1-year incidence of composite VTE, it was a significant predictor of other events such as all-cause death in pancreatic cancer patients. TRIAL REGISTRATION UMIN Clinical Trials Registry; UMIN000024942.
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Affiliation(s)
- Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazuaki Shimada
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tatsuya Ioka
- Oncology Center, Yamaguchi University Hospital, Ube, Japan
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Chuo-ku, Tokyo, Japan
| | - Jun Hosokawa
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Chuo-ku, Tokyo, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd., Shinagawa-ku, Tokyo, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, Ota-ku, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira, Japan
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21
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Wójcik-Giertuga M, Malczewska-Herman A, Kos-Kudła B. The Risk of Venous Thromboembolism in Neuroendocrine Neoplasms. Cancers (Basel) 2023; 15:5477. [PMID: 38001737 PMCID: PMC10670321 DOI: 10.3390/cancers15225477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
Neuroendocrine neoplasms (NENs) differ from other malignancies in their ability to produce hormones and biogenic amines, as well as offer a better prognosis in well-differentiated tumors. There are no definite data on the occurrence of thromboembolic events in NENs and no recommendations regarding the use of antithrombotic prophylaxis in this group. Accurate assessment of the thromboembolic risk in NENs represents an important issue, in order to reduce morbidity and mortality due to complications of VTE. The aim of this work was to review the occurrence of thromboembolic events in NENs and the use of antithrombotic prophylaxis in this group. A total of 28 studies identified on PubMed were analyzed. NENs, especially of pancreatic primary, exhibit an increased thrombotic risk. Atypical VTE locations are quite common in NENs. Hormonally active NENs are associated with a significantly increased thromboembolic risk. Further studies in NENs are needed to evaluate the parameters of coagulation and fibrinolysis as predictive biomarkers for VTE complications.
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Affiliation(s)
- Monika Wójcik-Giertuga
- Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Ceglana 35, 40-514 Katowice, Poland; (A.M.-H.); (B.K.-K.)
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22
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Yhim HY, Lee J, Kim KH, Kim SA, Lee JY, Hwang HG, Hong J, Lee JO, Bang SM. Increased risk of venous and arterial thromboembolism in patients with colorectal cancer receiving cetuximab-based combination chemotherapy: A population-based study in Korea. Thromb Res 2023; 231:50-57. [PMID: 37804738 DOI: 10.1016/j.thromres.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Limited data exist on the risk of venous and arterial thromboembolisms (VTE and ATE) in patients receiving cetuximab plus chemotherapy. We aimed to determine the thromboembolic risk of patients with recurrent/metastatic colorectal cancer (CRC) treated with cetuximab plus chemotherapy compared to chemotherapy alone. METHODS This population-based study used nationwide claims data from the Health Insurance Review and Assessment Service of South Korea from 2013 to 2020. Patients with recurrent/metastatic CRC treated with first-line oxaliplatin- or irinotecan-based doublets with or without cetuximab and no secondary prevention for VTE and ATE were included. Primary outcomes were the occurrence of any thromboembolic events, VTE, and ATE, which were determined using the cumulative incidence method incorporating death as a competing event. RESULTS We identified 19,723 patients (cetuximab plus chemotherapy, N = 7630; chemotherapy alone, N = 12,093). The cumulative incidence of any thromboembolic events in patients with cetuximab plus chemotherapy was significantly higher than in those receiving chemotherapy alone (6-month, 5.62 % vs. 3.58 %, P < 0.0001). The rates of VTE (6-month, 5.11 % vs. 3.28 %, P < 0.0001) and ATE (6-month, 0.53 % vs. 0.32 %, P = 0.0218) were also higher in patients receiving cetuximab plus chemotherapy. In multivariable analysis, cetuximab plus chemotherapy was independently associated with developing any thromboembolic events (hazard ratio [HR], 1.63; 95 % confidence interval [CI], 1.42-1.87), VTE (HR, 1.62; 95 % CI, 1.40-1.87), and ATE (HR, 1.77; 95 % CI, 1.16-2.71). CONCLUSIONS Cetuximab with irinotecan- or oxaliplatin-based doublet chemotherapy was associated with an increased risk of any thromboembolic events, VTE, and ATE; further studies are warranted to examine the underlying mechanisms.
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Affiliation(s)
- Ho-Young Yhim
- Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Juhyun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyoung Ha Kim
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Sang-A Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ji Yun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hun-Gyu Hwang
- Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Republic of Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
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23
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Franchina AG, Rocchetti M, Sala E, Laricchia A, Minardi A, Spangaro A, Guazzi M, Lucreziotti S, Cereda A. Relationships, Current Issues, Safety and Efficacy of Oral Anticoagulation in Cancer Patients with Atrial Fibrillation. J Clin Med 2023; 12:6559. [PMID: 37892697 PMCID: PMC10607729 DOI: 10.3390/jcm12206559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
A relationship between malignancy and impaired hemostasis has been proven, and balancing clotting and bleeding risks can be challenging. Half of cancer patients with atrial fibrillation (AF) do not receive any oral anticoagulation (OAC). Using PubMed on the relationship between cancer and AF and their association with hemostasis, targeting studies comparing vitamin K antagonists (VKAs) and direct OAC (DOAC) strategies in AF cancer patients, three RCTs (>3000 patients) and eight observational studies (>250,000 patients) comparing different OACs were retrieved. The VKA prescribed was always warfarin. Dabigatran was the only DOAC not analyzed in the RCTs but the most used in non-randomized studies, whereas edoxaban-treated patients were the majority in the RCTs. Overall, the DOAC patients showed similar or lower rates of efficacy (thromboembolic) and safety (bleeding) outcomes compared to the VKA patients. DOACs are subject to fewer interactions with antineoplastic agents. DOACs may be preferable to VKAs as a thromboembolic prophylaxis in cancer patients with non-valvular AF.
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Affiliation(s)
- Antonio Gabriele Franchina
- Division of Cardiology, Cardio-Thoracic Department, San Carlo Borromeo Hospital (ASST Santi Paolo e Carlo), Via Pio II n.3, 20153 Milan, Italy; (M.R.); (E.S.); (A.L.); (A.M.); (A.S.); (S.L.); (A.C.)
| | - Matteo Rocchetti
- Division of Cardiology, Cardio-Thoracic Department, San Carlo Borromeo Hospital (ASST Santi Paolo e Carlo), Via Pio II n.3, 20153 Milan, Italy; (M.R.); (E.S.); (A.L.); (A.M.); (A.S.); (S.L.); (A.C.)
| | - Elena Sala
- Division of Cardiology, Cardio-Thoracic Department, San Carlo Borromeo Hospital (ASST Santi Paolo e Carlo), Via Pio II n.3, 20153 Milan, Italy; (M.R.); (E.S.); (A.L.); (A.M.); (A.S.); (S.L.); (A.C.)
| | - Alessandra Laricchia
- Division of Cardiology, Cardio-Thoracic Department, San Carlo Borromeo Hospital (ASST Santi Paolo e Carlo), Via Pio II n.3, 20153 Milan, Italy; (M.R.); (E.S.); (A.L.); (A.M.); (A.S.); (S.L.); (A.C.)
| | - Alessandro Minardi
- Division of Cardiology, Cardio-Thoracic Department, San Carlo Borromeo Hospital (ASST Santi Paolo e Carlo), Via Pio II n.3, 20153 Milan, Italy; (M.R.); (E.S.); (A.L.); (A.M.); (A.S.); (S.L.); (A.C.)
| | - Andrea Spangaro
- Division of Cardiology, Cardio-Thoracic Department, San Carlo Borromeo Hospital (ASST Santi Paolo e Carlo), Via Pio II n.3, 20153 Milan, Italy; (M.R.); (E.S.); (A.L.); (A.M.); (A.S.); (S.L.); (A.C.)
| | - Marco Guazzi
- Division of Cardiology, Cardio-Thoracic Department, San Paolo Hospital (ASST Santi Paolo e Carlo), Via Antonio di Rudinì, 8, 20142 Milan, Italy;
| | - Stefano Lucreziotti
- Division of Cardiology, Cardio-Thoracic Department, San Carlo Borromeo Hospital (ASST Santi Paolo e Carlo), Via Pio II n.3, 20153 Milan, Italy; (M.R.); (E.S.); (A.L.); (A.M.); (A.S.); (S.L.); (A.C.)
| | - Alberto Cereda
- Division of Cardiology, Cardio-Thoracic Department, San Carlo Borromeo Hospital (ASST Santi Paolo e Carlo), Via Pio II n.3, 20153 Milan, Italy; (M.R.); (E.S.); (A.L.); (A.M.); (A.S.); (S.L.); (A.C.)
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24
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Mazur R, Trna J. Principles of Palliative and Supportive Care in Pancreatic Cancer: A Review. Biomedicines 2023; 11:2690. [PMID: 37893064 PMCID: PMC10603964 DOI: 10.3390/biomedicines11102690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Pancreatic adenocarcinoma (PDAC) is well known for its poor survival time. Clinical symptoms are painless jaundice or abdominal or back pain. Less specific symptoms often appear that make diagnosis difficult, e.g., weight loss, loss of appetite, nausea and vomiting, and general weakness. Only 10-20% of patients are diagnosed at an early stage. A cure is practically only possible with a radical surgical operation. In the case of locally advanced findings, neoadjuvant therapy is administered. Among the therapeutic options offered are chemotherapy, radiotherapy (including stereotactic radiotherapy-SBRT), targeted treatment, or immunotherapy. In the case of metastatic disease, of which more than half are present at diagnosis, the goal is to relieve the patient of problems. Metastatic PDAC can cause problems arising from the localization of distant metastases, but it also locally affects the organs it infiltrates. In our review article, we focus on the largest group of patients, those with locally advanced disease and metastatic disease-symptoms related to the infiltration or destruction of the pancreatic parenchyma and the growth of the tumor into the surrounding. Therefore, we deal with biliary or duodenal obstruction, gastric outlet syndrome, bleeding and thromboembolic diseases, pain, depression, and fatigue, as well as pancreatic exocrine insufficiency and malnutrition. Metastatic spread is most often to the liver, peritoneum, or lungs. The presented overview aims to offer current therapeutic options across disciplines. In accordance with modern oncology, a multidisciplinary approach with a procedure tailored to the specific patient remains the gold standard.
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Affiliation(s)
| | - Jan Trna
- Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Zluty Kopec 7, 656 53 Brno, Czech Republic;
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25
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García Vallejo O, Aicart Bort MD, Babiano Fernández MÁ, Caballer Rodilla J, Cabrera Ferriols MÁ, Carrasco Carrasco E, Gil Gil I, Lahera García AM, Martos Cárdenas T, Piera Carbonell A. [Recommendations for thromboembolic disease in oncological processes. A view from primary care]. Semergen 2023; 49:102030. [PMID: 37487423 DOI: 10.1016/j.semerg.2023.102030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
Venous thromboembolic disease (VTE) is a frequent complication in patients diagnosed with cancer and a cause of morbidity and mortality. Approximately 20% of thromboembolic episodes develop in association with active cancer. On the other hand, it is estimated that about 2-12% of cases, the thromboembolic episode is the first manifestation of an occult cancer, diagnosed at that time or subsequently, which offers an opportunity for early diagnosis and treatment. There are multiple factors that contribute to increase the risk of VTE in oncological patients in relation to specific characteristics of the patient, the tumor and the treatments. Knowledge of these risk factors will contribute to early diagnosis when signs of VTE appear, as well as the assessment of thromboprophylaxis if indicated. The diagnosis of VTE in patients with cancer does not differ of those who do not suffer from it. Regarding the treatment of VTE in these patients, low molecular weight heparin (LMWH), direct acting anticoagulants (DACs) and antivitamin K (VKA) are the most commonly used, although the dosing regimen and length are not clear yet. The management of these patients should be interdisciplinary and early, so the primary care physician plays a key role in this process as he/she is liaise with his/her patients. It is also necessary to update knowledge in order to improve the care of these patients. For these reasons, this document has been prepared by the Working Group on Vasculopathies of the Spanish Society of Primary Care Physicians (SEMERGEN) whose objective is to present the available information regarding the management of VTE that may appear in oncological patients, as well as the assessment of thromboprophylaxis and treatment, if appropriate, from an approach focused on a primary care field.
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Affiliation(s)
- O García Vallejo
- Medicina Familiar y Comunitaria, Centro de Salud Comillas, Madrid, España.
| | | | - M Á Babiano Fernández
- Medicina Familiar y Comunitaria, Centro de Salud Argamasilla de Calatrava, Argamasilla de Calatrava, Ciudad Real, España
| | - J Caballer Rodilla
- Medicina Familiar y Comunitaria. Centro de Salud Algete, Algete, Madrid, España
| | | | - E Carrasco Carrasco
- Medicina Familiar y Comunitaria, Centro de Salud de Abarán, Abarán, Murcia, España
| | - I Gil Gil
- Medicina Familiar y Comunitaria, Centro de Salud Vielha, Vielha, Lleida, España
| | | | | | - A Piera Carbonell
- Medicina Familiar y Comunitaria, Centro de Salud Corredoria, Oviedo, Asturias, España
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26
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Napolitano M, Siragusa S. The Role of Injectables in the Treatment and Prevention of Cancer-Associated Thrombosis. Cancers (Basel) 2023; 15:4640. [PMID: 37760609 PMCID: PMC10526875 DOI: 10.3390/cancers15184640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Cancer-associated thrombosis (CAT) is a leading cause of death among patients with cancer. CAT can manifest itself as venous thromboembolism (VTE), in the form of deep vein thrombosis or pulmonary embolism, or arterial thromboembolism. The pathophysiology of CAT is complex and depends on cancer-, patient-, treatment- and biomarkers-related factors. Treatment of VTE in patients with cancer is complex and includes three major classes of anticoagulant agents: heparin and its derivatives, e.g., low molecular weight heparins, direct oral anticoagulants (DOACs), and vitamin K inhibitors. Given the tremendous heterogeneity of clinical situations in patients with cancer and the challenges of CAT, there is no single universal treatment option for patients suffering from or at risk of CAT. Initial studies suggested that patients seemed to prefer an anticoagulant that would not interfere with their cancer treatment, suggesting the primacy of cancer over VTE, and favoring efficacy and safety over convenience of route of administration. Recent studies show that when the efficacy and safety aspects are similar, patients prefer the oral route of administration. Despite this, injectables are a valid option for many patients with cancer.
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Affiliation(s)
- Mariasanta Napolitano
- Haematology Unit, Thrombosis and Haemostasis Reference Regional Center, University of Palermo, 90121 Palermo, Italy;
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27
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Castellano G, Corti C, Boldrini L, Gervaso L, Criscitiello C, Curigliano G. Risk of thromboembolic events in patients with metastatic solid tumors treated with PARP inhibitors: A systematic review and meta-analysis of phase 3 randomized controlled trials. Cancer Treat Rev 2023; 119:102601. [PMID: 37473517 DOI: 10.1016/j.ctrv.2023.102601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/15/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND SCOPE Poly(ADP-ribose) polymerase inhibitors (PARPi) have revolutionized cancer treatment in recent years. These drugs present a favorable safety profile, even though the potential risk of thromboembolic events (TEs) during their use has not been addressed yet. In addition, PARPi have been involved in an active scientific debate regarding non-oncologic indications, particularly during the Coronavirus Disease 2019 pandemic, including potential anti-thromboembolic effect. METHODS To clarify whether patients treated with PARPi for metastatic solid tumors are either at increased or decreased risk of TEs, we conducted a systematic review of the literature and meta-analysis, including all phase 3 randomized controlled trials (RCTs) which investigated PARPi in this setting. Search was conducted through Medline, EMBASE, Pubmed, SCOPUS and Google Scholar in February 2023, including the proceedings of the principal oncology meetings of the last 10 years, with no time restriction. For each included study, frequencies of TEs in experimental and control arm were collected. RESULTS Our search identified 2,369 reports, of which 20 were lastly selected. A total of 4,946 patients were included, across 12 different RCTs. The meta-analysis did not demonstrate either an increased or a reduced risk in TEs in patients treated with PARPi for metastatic disease (OR 1.50, range: 1.00-2.24; 95% CI; P = 0.050), with low heterogeneity and low publication bias. CONCLUSION Although our research did not confirm either increased or decreased risk of TEs for PARPi use, no safety alerts emerged. Thromboembolic risk assessment models should always be integrated in daily clinical routine, to identify high-risk patients.
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Affiliation(s)
- Grazia Castellano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy
| | - Chiara Corti
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy.
| | - Laura Boldrini
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy
| | - Lorenzo Gervaso
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy; Molecular Medicine Program, University of Pavia, Pavia, Italy
| | - Carmen Criscitiello
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy
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28
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Larsen TL, Svalastoga M, Brekke J, Enden T, Frøen H, Garresori H, Jacobsen EM, Paulsen PQ, Porojnicu AC, Ree AH, Torfoss D, Velle EO, Wik HS, Ghanima W, Sandset PM, Dahm AEA. Arterial events in cancer patients treated with apixaban for venous thrombosis. Thromb Res 2023; 228:128-133. [PMID: 37327527 DOI: 10.1016/j.thromres.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/20/2023] [Accepted: 05/17/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION In a recent interventional study of cancer patients with newly diagnosed venous thrombosis (VT), we found a high risk of arterial thrombotic events (AT) during treatment with therapeutic doses of apixaban. METHODS Total 298 cancer patients with VT received apixaban as treatment and secondary prophylaxis for up to 36 months. AT was registered as a serious adverse event, and this is a post hoc analysis of risk factors for AT. Clinical risk factors and concomitant medication were assessed through odds ratios (OR) with 95 % confidence interval using multivariate logistic regression. Biomarkers were assessed by non-parametric testing. RESULTS AT occurred in 16/298 patients (5.4 %, 95 % confidence interval (CI) 3.1-8.6 %). Median leucocyte count at baseline was higher in patients with AT compared with patients without AT (11 vs. 6.8·109/L, p < 0.01). Clinical factors associated with AT were pancreatic cancer (OR 13.7, 95 % CI 4.3-43.1), ovarian cancer (OR 19.3, 95 % CI 2.3-164.4), BMI <25 percentile (OR 3.1, 95 % CI 1.1-8.8) and previous VT (OR 4.4, 95 % CI 1.4-13.7). Pancreatic cancer had a cumulative incidence of AT of 36 % compared with 0.8 % for all other cancers at 6 months (p < 0.01). Non-steroidal anti-inflammatory drugs (OR 4.9, 95 % CI 1.0-26) and antiplatelet treatment (OR 3.8, 95 % CI 1.2-12.2) were associated with AT. CONCLUSION In cancer patients with apixaban treated VT, pancreatic cancer was strongly associated with AT. In addition, ovarian cancer, BMI < 25 percentile, previous VT, antiplatelet treatment, non-steroidal anti-inflammatory drug use and high leucocyte count at baseline were associated with AT. The CAP study is registered with the unique identifier NCT02581176 in ClinicalTrials.gov.
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Affiliation(s)
- Trine-Lise Larsen
- Faculty of Medicine, University of Oslo, Postboks 1078, Blindern, 0316 Oslo, Norway; Department of Hematology, Akershus University Hospital, P.O. BOX 1000, N-1478 Lørenskog, Norway.
| | - Marte Svalastoga
- Faculty of Medicine, University of Oslo, Postboks 1078, Blindern, 0316 Oslo, Norway.
| | - Jorunn Brekke
- Department of Oncology, Haukeland University Hospital, P.O. BOX 1400, N-5021 Bergen, Norway.
| | - Tone Enden
- Tidsskriftet, den norske legeforening, Postboks 1152, Sentrum, 0107 Oslo, Norway.
| | - Hege Frøen
- Department of Haematology, Oslo University Hospital, P.O. BOX 4950, Nydalen, N-0424 Oslo, Norway
| | - Herish Garresori
- Department of Oncology, Stavanger University Hospital, P.O. BOX 8100, N-4068 Stavanger, Norway.
| | - Eva Marie Jacobsen
- Department of Haematology, Oslo University Hospital, P.O. BOX 4950, Nydalen, N-0424 Oslo, Norway.
| | - Petter Quist Paulsen
- Department of Hematology, St. Olav's University Hospital, P.O. BOX 3250, Torgarden, N-7006 Trondheim, Norway.
| | - Alina Carmen Porojnicu
- Department of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, P.O. BOX 800, N-3004 Drammen, Norway.
| | - Anne Hansen Ree
- Faculty of Medicine, University of Oslo, Postboks 1078, Blindern, 0316 Oslo, Norway; Department of Oncology, Akershus University Hospital, P.O. BOX 1000, N-1478 Lørenskog, Norway.
| | - Dag Torfoss
- Department of Oncology, Oslo University Hospital, P.O. BOX 4950 Nydalen, N-0424 Oslo, Norway
| | - Elin Osvik Velle
- Department of Medicine, Volda Hospital, Møre and Romsdal Hospital, P.O. BOX b 113, 6101 Volda, Norway.
| | - Hilde Skuterud Wik
- Department of Haematology, Oslo University Hospital, P.O. BOX 4950, Nydalen, N-0424 Oslo, Norway.
| | - Waleed Ghanima
- Faculty of Medicine, University of Oslo, Postboks 1078, Blindern, 0316 Oslo, Norway; Clinic of Internal Medicine, Østfold Hospital, P.O. BOX 300, N-1714 Grålum, Norway.
| | - Per Morten Sandset
- Faculty of Medicine, University of Oslo, Postboks 1078, Blindern, 0316 Oslo, Norway; Department of Haematology, Oslo University Hospital, P.O. BOX 4950, Nydalen, N-0424 Oslo, Norway.
| | - Anders Erik Astrup Dahm
- Faculty of Medicine, University of Oslo, Postboks 1078, Blindern, 0316 Oslo, Norway; Department of Hematology, Akershus University Hospital, P.O. BOX 1000, N-1478 Lørenskog, Norway
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Baloch MF, Adepoju AV, Falki V, Hajjaj M, Habet T, Habet K, Mahrosh A, Kundu S, Kataria J, Mathew M, Saka T, Al-Tawil M. Comparative Efficacy of Oral Apixaban and Subcutaneous Low Molecular Weight Heparins in the Treatment of Cancer-Associated Thromboembolism: A Meta-Analysis. Cureus 2023; 15:e43447. [PMID: 37711939 PMCID: PMC10498340 DOI: 10.7759/cureus.43447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/13/2023] [Indexed: 09/16/2023] Open
Abstract
Cancer patients' risk of developing venous thromboembolism (VTE) is four to seven times higher than the general population. Cancer-associated VTE (CA-VTE), is a leading cause of morbidity and mortality in cancer patients. Low Molecular Weight Heparin (LMWH) has historically been the mainstay treatment of CA-VTE; however, complications such as bleeding and recurrent VTE make it challenging to manage these patients. Recent randomized controlled trials (RCTs) have proven that direct oral anticoagulants (DOACs) are as efficacious as LMWHs in treating CA-VTE. We conducted a systematic review and meta-analysis to ascertain the efficacy and safety of LMWH and Apixaban for the treatment of CA-VTE. A systematic review was conducted using Medline, Embase, and Scopus, databases for all cohort studies, case-control studies, and RCTs in English comparing cancer patients undergoing treatment with Apixaban or LMWH to treat CA-VTE from inception-May 2023. The Review Manager program, version 5.4.1, was used for statistical analysis and the Mantel-Haenszel fixed-effects models to calculate the risk ratio (RR) and 95% confidence intervals (CIs) and the inverse variance approach to get the weighted mean difference for the continuous outcomes. Q-test for heterogeneity was used to examine statistical heterogeneity and an I2 statistics value >50% was defined as significant heterogeneity. A total of four studies were included, and the total number of patients was 1,632 across all studies. The Apixaban group was associated with a statistically significant increase in minor bleeding (RR 1.57; 95% CI (1.12, 2.21); p=0.009; I2=0%), but not for major and total bleeding. The Apixaban group showed a statistically significant lower risk of recurrent VTE when compared to the LMWH group (RR: 0.61; 95% CI (0.41, 0.92); p=0.02; I2 = 7%), and there was no statistically significant difference in terms of mortality between the two groups (RR: 0.89; 95% CI (0.73, 1.09); I2=0). Our findings suggest that Apixaban may be a favorable anticoagulant option for managing cancer-associated thromboembolism, as it demonstrated a lower risk of recurrent VTE. The risk of bleeding with DOAC in gastrointestinal cancers warrants further investigation.
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Affiliation(s)
- Maryam F Baloch
- Department of Community Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Vaibhavkumar Falki
- School of Medicine, Corewell Health University Hospital, Grand Rapids, USA
| | - Mohsin Hajjaj
- Department of Internal Medicine, Jinnah Hospital Lahore, Lahore, PAK
| | - Tatiana Habet
- School of Medicine, Universidad de Ciencias Médicas, San Jose, CRI
| | - Karina Habet
- School of Medicine, American University of Antigua, Antigua, ATG
| | - Amtul Mahrosh
- School of Medicine, Dr. VRK Womens Medical College, Hyderabad, IND
| | - Sumana Kundu
- Department of Research, R.G. Kar Medical College and Hospital, Kolkata, IND
| | - Janvi Kataria
- School of Medicine, DY Patil University, Mumbai, IND
| | - Midhun Mathew
- Department of Internal Medicine, Pennsylvania Hospital, Philadelphia, USA
| | - Tugba Saka
- School of Medicine, Istinye University, Istanbul, TUR
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30
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Jin J, Qi X, Zhang H, Li M, Li S, Shen G. Lung cancer presenting with acute myocardial infarction and pulmonary embolism within 1 month. SAGE Open Med Case Rep 2023; 11:2050313X231181979. [PMID: 37434900 PMCID: PMC10331209 DOI: 10.1177/2050313x231181979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/29/2023] [Indexed: 07/13/2023] Open
Abstract
Acute myocardial infarction and pulmonary embolism can have life-threatening consequences such as congestive heart and respiratory failure, respectively. Cancer patients are at great risk of both acute myocardial infarction and pulmonary embolism complications because the malignancy sparks the patient's blood hypercoagulable state. Nevertheless, the literature currently offers only a few reports on acute myocardial infarction associated with pulmonary embolism, and two of them occurred in the same cancer patient. Here, we present a case of a 60-year-old woman who had been diagnosed with lung cancer. She was admitted to the emergency department twice. She was diagnosed with acute myocardial infarction at her first admission, when she experienced sudden-onset chest pain. Electrocardiography showed ST-segment elevation in leads V1-V3 with inverted T wave and pathological Q wave, suggesting an acute myocardial infarction. Coronary angiography revealed a thrombus in the left anterior descending coronary artery, and thrombus aspiration was performed. After 1 month, she had an attack of pulmonary embolism with syncope upon the second admission. A computed tomographic pulmonary angiography showed branches of right and left pulmonary embolism. Anticoagulation and antiplatelet measures were taken. In this article, we discuss the relationship between cancer and thrombosis with a special focus on the conservative management strategy regarding anticoagulant and antiplatelet therapy in our case.
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Affiliation(s)
- Jiacheng Jin
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xin Qi
- Department of Cardiology, Affiliated Hospital of Jilin Medical College, Jilin, China
| | - Hongyu Zhang
- Department of Cardiology, Jilin Central General Hospital, Jilin, China
| | - Min Li
- Department of Cardiology, Jilin Central General Hospital, Jilin, China
| | - Shuangbin Li
- Department of Cardiology, Jilin Central General Hospital, Jilin, China
| | - Guangyin Shen
- Department of Cardiology, Jilin Central General Hospital, Jilin, China
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31
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Yoshikawa T, Sano T, Terashima M, Yamaguchi K, Bando E, Kawabata R, Yabusaki H, Shinohara H, Oba MS, Kimura T, Takita A, Sasako M. Incidence and risk factors for venous thromboembolism in the Cancer-VTE Registry stomach cancer subcohort. Gastric Cancer 2023; 26:493-503. [PMID: 37004667 PMCID: PMC10284943 DOI: 10.1007/s10120-023-01378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/26/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND The Cancer-VTE Registry was a large-scale, multicenter, prospective registry designed to investigate real-world data on venous thromboembolism (VTE) incidence and risk factors in adult Japanese patients with solid tumors. This pre-specified subgroup analysis aimed to estimate the incidence of VTE, including VTE types other than symptomatic VTE, and identify risk factors of VTE in stomach cancer from the Cancer-VTE Registry. METHODS Stage II-IV stomach cancer patients who planned to initiate cancer therapy and underwent VTE screening within 2 months before registration were enrolled. RESULTS Of 1,896 patients enrolled, 131 (6.9%) had VTE at baseline, but 96.2% were asymptomatic. Female sex, age ≥ 65 years, VTE history, and D-dimer > 1.2 μg/mL were independent risk factors of VTE at baseline. Notably, patients with D-dimer > 1.2 µg/mL at the time of cancer diagnosis had an approximately 20-fold risk of VTE. During follow-up, event incidences were symptomatic VTE, 0.3%; incidental VTE requiring treatment, 1.1%; composite VTE, 1.4%; bleeding, 1.6%; cerebral infarction/transient ischemic attack/systemic embolic events, 0.7%; and all-cause death, 15.0%. The incidence of all-cause death was higher in patients with VTE vs without VTE at baseline (adjusted hazard ratio 1.67; 95% confidence interval 1.21-2.32; p = 0.002). CONCLUSIONS VTE prevalence at the time of cancer diagnosis was not negligible and was extremely high when the patients had high D-dimer. VTE screening by D-dimer before starting cancer treatment is advisable, even for asymptomatic patients, regardless of whether the patient is undergoing surgery or chemotherapy. TRIAL REGISTRATION UMIN000024942.
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Affiliation(s)
- Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Kensei Yamaguchi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ryohei Kawabata
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
- Department of Surgery, Sakai City Medical Center, Sakai, Japan
| | - Hiroshi Yabusaki
- Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hisashi Shinohara
- Department of Gastroenterological Surgery, Division of Upper GI, Hyogo Medical University, Nishinomiya, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research and Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Mitsuru Sasako
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
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32
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Kimyaghalam A, Singer K, Kania T, Malekpour F. An unexpected recurrence of rectal squamous cell cancer presenting as deep vein thrombosis. J Vasc Surg Cases Innov Tech 2023; 9:101142. [PMID: 37235170 PMCID: PMC10205761 DOI: 10.1016/j.jvscit.2023.101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 05/28/2023] Open
Abstract
Tumor thrombus is an uncommon oncologic complication and is exceedingly rare in the setting of colorectal cancer. We present the case of a 71-year-old woman with a significant oncologic history, including rectal squamous cell cancer, who presented with left lower extremity deep vein thrombosis. She underwent left lower extremity venography and thrombectomy of the left common iliac vein. Pathologic examination revealed fragments of squamous cell carcinoma embedded in an organizing thrombus. A covered stent was placed in the common iliac vein across the internal iliac vein origin. Positron emission tomography-computed tomography confirmed mediastinal and retroperitoneal lymphadenopathy, which was managed with adjuvant carboplatin and paclitaxel chemotherapy.
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Affiliation(s)
| | | | | | - Fatemeh Malekpour
- Correspondence: Fatemeh Malekpour, MD, Division of Vascular Surgery, Department of Surgery, Staten Island University Hospital, 501 Seaview Ave, Unit 302, Staten Island, NY 10305
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33
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Hamana T, Otake H, Kuramitsu S, Shinozaki T, Ohya M, Horie K, Kawamoto H, Yamanaka F, Natsuaki M, Shiomi H, Nakazawa G, Ando K, Kadota K, Saito S, Kimura T. Association between cancer history and second-generation drug-eluting stent thrombosis: insights from the REAL-ST registry. Thromb J 2023; 21:60. [PMID: 37226249 DOI: 10.1186/s12959-023-00503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 05/17/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Cancer-associated thrombosis is a frequent complication of cancer; however, little evidence is available regarding the association between cancer history and coronary artery stent thrombosis (ST). We aimed to investigate the relationship between cancer history and second-generation drug-eluting stent thrombosis (G2-ST). METHODS From the REAL-ST (Retrospective Multicenter Registry of ST After First- and Second-Generation Drug-Eluting Stent Implantation) registry, this study evaluated 1265 patients (G2- ST cases, n = 253; controls, n = 1012) with cancer-related information available. RESULTS The prevalence of patients with cancer history was higher (12.3% vs. 8.5%, p = 0.065), and that of currently diagnosed and currently treated cancer was significantly higher in ST cases than controls (3.6% vs. 1.4%, p = 0.021; 3.2% vs. 1.3%, p = 0.037, respectively). Multivariable logistic regression analysis revealed that cancer history was associated with late ST (odds ratio [OR]: 2.80, 95% confidence intervals [CI]: 0.92-8.55, p = 0.071) and very late ST (OR: 2.40, 95% CI: 1.02-5.65, p = 0.046), but not with early ST (OR: 1.01, 95% CI: 0.51-2.00, p = 0.97). During the median follow-up period of 872 days after the index ST events, patients with cancer history showed a higher mortality than those without, among both ST cases (hazard ratio [HR]: 1.93, 95% CI: 1.06-3.51, p = 0.031) and controls (HR: 1.93, 95% CI: 1.09-3.40, p = 0.023). CONCLUSION A post hoc analysis of REAL-ST registry revealed that patients with G2-ST had a higher prevalence of currently diagnosed and currently treated cancer. Notably, cancer history was associated with the occurrence of late and very late ST, but not with early ST.
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Affiliation(s)
- Tomoyo Hamana
- Division of Cardiology, Department of Internal Medicine, Kobe University Graduates School of Medicine, Kobe, Japan
| | - Hiromasa Otake
- Division of Cardiology, Department of Internal Medicine, Kobe University Graduates School of Medicine, Kobe, Japan
| | - Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu, 802-8555, Japan.
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Japan
| | | | - Futoshi Yamanaka
- Division of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu, 802-8555, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shigeru Saito
- Division of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
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Clasen SC, Fung C, Sesso HD, Travis LB. Cardiovascular Risks in Testicular Cancer: Assessment, Prevention, and Treatment. Curr Oncol Rep 2023; 25:445-454. [PMID: 36867377 DOI: 10.1007/s11912-023-01375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Testicular cancer (TC) is the leading cancer in men between 18 and 39 years of age. Current treatment involves tumor resection followed by surveillance and/or one or more lines of cisplatin-based chemotherapy (CBCT) and/or bone marrow transplant (BMT). Ten years after treatment, CBCT has been associated with significant atherosclerotic cardiovascular disease (CVD) including myocardial infarction (MI), stroke, and heightened rates of hypertension, dyslipidemia, diabetes mellitus, and metabolic syndrome (MetS). Additionally, low testosterone levels and hypogonadism contribute to MetS and may further drive CVD. RECENT FINDINGS CVD in TCS has been associated with worse physical functioning accompanied by role limitations, decreased energy, and decreased overall health. Exercise may play a role in ameliorating these effects. Systematic CVD screening practices are needed at TC diagnosis and in survivorship. We encourage a multidisciplinary partnership between primary care physicians, cardiologists, cardio-oncologists, medical oncologists, and survivorship providers to address these needs.
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Affiliation(s)
- Suparna C Clasen
- Division of Cardiovascular Medicine, Department of Medicine, Indiana University School of Medicine, Indiana University, 1800 N. Capitol Ave., E308, Indianapolis, IN, 46202, USA.
| | - Chunkit Fung
- Division of Hematology and Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Howard D Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lois B Travis
- Division of Hematology-Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Epidemiology, Fairbanks School of Public Health, Indianapolis, IN, USA
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35
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Li HY, Wang J, Wang T, Wang HS. Management of venous thromboembolism in pediatric patients: Quality assessment of clinical practice guidelines and variations in recommendations. Thromb Res 2023; 226:107-116. [PMID: 37141795 DOI: 10.1016/j.thromres.2023.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION We performed a quality assessment and comparison of clinical practice guidelines (CPGs) for the prevention and treatment of venous thromboembolism (VTE) in pediatric patients and to provide a clinical reference. MATERIALS AND METHODS Electronic databases, guideline development organizations, and professional societies were searched to identify CPGs for VTE in pediatric patients between January 1, 2012, and April 7, 2022. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate quality. Recommendations for preventing and treating VTE in pediatric patients were extracted via descriptive synthesis. RESULTS Six CPGs were included. The median scores (interquartile range [IQR]) for each AGREE II domain were as follows: scope and purpose, 88.89 % (IQR: 8.33 %); stakeholder involvement, 88.89 % (25 %); rigor of development, 67.71 % (24.47 %); clarity and presentation, 88.89 % (0 %); applicability, 50 % (42.71 %); and editorial independence, 66.67 % (50.00 %). In total, 268 key recommendations were extracted, and traditional anticoagulants (heparin and warfarin) remain the standard treatment. However, in recent years direct oral anticoagulants (DOACs) have shown similar efficacy and safety results for the treatment of VTE in children to those reported in adults; therefore, this practice is recommended in recent guidelines. CONCLUSIONS Variability exists in the development and reporting of CPGs for VTE in pediatric patients. There may be changes to the recommendations for the prevention and treatment of VTE in pediatrics in the future due to the efficacy of DOACs in children, and recommendations should be revised periodically as new evidence emerges.
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Affiliation(s)
- Hong-Yan Li
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Jing Wang
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Tao Wang
- Department of Vascular Surgery, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Hai-Shan Wang
- Department of Intensive Care Unit, Yantai YEDA Hospital, Yantai, Shandong, China.
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36
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Naftali J, Barnea R, Eliahou R, Tolkovsky A, Pardo K, Zukerman M, Soback N, Adi M, Leader A, Bloch S, Saliba W, Auriel E. Cerebral Microinfarcts Are Common in Undiagnosed Lung Cancer Patients: A Population-Based Study. Acta Neurol Scand 2023. [DOI: 10.1155/2023/9240247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Background. Cerebral microinfarcts (CMI) represent covert brain ischemia and were associated with stroke risk and cognitive impairment. Magnetic resonance imaging diffusion-weighted imaging (DWI) hyperintensities have been suggested to represent acute CMI. The relationship between malignancy and CMI is unknown. Aims. We aimed to examine whether CMI is more common in patients with undiagnosed lung cancer, and therefore might serve as a prediction marker for cognitive impairment or cancer-related stroke. Methods. We used the computerized database of Clalit Health Services (the largest healthcare provider in Israel) to identify adults diagnosed with lung cancer who had an MRI brain scan for any indication prior to cancer diagnosis. We analyzed DWI sequences, in order to evaluate CMI incidence in this population, and compared it to control groups of patients with other undiagnosed malignancies and patients without known cancer. Results. Altogether, we reviewed 1822 MRI brain scans, of which 497 scans were taken in patients with undiagnosed lung cancer, 543 scans of noncancer patients, and 793 scans of patients with other undiagnosed malignancies. In the lung cancer group, we found 24 CMI, compared with 4 in the noncancer group (
) and 8 in the other cancer group (
). Conclusions. CMI is common in undiagnosed lung cancer patients compare to other undiagnosed cancer types or noncancer patients. At the time of lung cancer diagnosis patients may be at risk for future stroke or cognitive decline.
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Affiliation(s)
- Jonathan Naftali
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ruth Eliahou
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Rabin Medical Center, Petach Tikva, Israel
| | - Assaf Tolkovsky
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Keshet Pardo
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Michal Zukerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Noa Soback
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Meital Adi
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Kaplan Medical Center, Rehovot, Israel
| | - Avi Leader
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Sivan Bloch
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Lady Davis Carmel Medical Center, Israel
| | - Walid Saliba
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Watson NW, Shatzel JJ, Al-Samkari H. Cyclin-dependent kinase 4/6 inhibitor-associated thromboembolism: a critical evaluation of the current evidence. J Thromb Haemost 2023; 21:758-770. [PMID: 36696184 PMCID: PMC10065951 DOI: 10.1016/j.jtha.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 01/09/2023]
Abstract
Cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors are an essential treatment modality for hormone receptor-positive breast cancer. As the rates of breast cancer continue to rise globally and the indications for CDK 4/6 inhibitors now extend beyond metastatic disease, more patients than ever are receiving these agents. Thrombosis is an emerging clinical concern with this class of agents, particularly venous thromboembolism. Although venous thromboembolism initially emerged as an adverse effect of interest in early trials, more recent studies have demonstrated even higher incidences of thrombosis in real-world clinical practice. In this review, we summarize the evidence to date that has informed the thrombosis risk for these agents both in clinical trials and real-world studies. We review data describing the venous and arterial thromboembolic risks in clinical trials of CDK 4/6 inhibitors as well as the now rather extensive real-world evidence available, including a comparison of risk for each of the 3 agents approved for use in breast cancer: palcociclib, ribociclib, and abemaciclib. As the role of prophylactic anticoagulation continues to remain unknown in women receiving CDK 4/6 inhibitors, future efforts directed at carefully investigating the risks and benefits of thromboprophylaxis may lead to improved outcomes in these patients.
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Affiliation(s)
| | - Joseph J Shatzel
- Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon, USA; Division of Biomedical Engineering, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Hanny Al-Samkari
- Harvard Medical School, Boston, Massachusetts, USA; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Tabassum H, Chakraborty R, Chatterjee NS. A review of venous thromboembolism in India. Indian J Med Res 2023; 157:281-292. [PMID: 37282391 PMCID: PMC10438400 DOI: 10.4103/ijmr.ijmr_1538_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Indexed: 06/08/2023] Open
Abstract
Venous thromboembolism (VTE), which entails the formation of a thrombus (blood clot) in a vein, has a significant disease burden worldwide. While VTE has traditionally been considered to predominantly affect Caucasian populations, recent studies have indicated a gradual shift in the disease burden towards Asian populations, with added significance of it being a key driver of post-operative mortality. It is imperative to develop a sound understanding of the various factors that affect VTE in stratified local populations. However, there is a glaring paucity of quality data on VTE and its ramifications among Indians - both in terms of quality of life and cost of healthcare. This review aims to throw light on the disease burden, epidemiology, risk factors, environmental factors, food and nutrition that plays a key role in VTE. We also explored the association of VTE with coronavirus disease 2019 to grasp the interplay between the two most significant public health crises of our time. It is vital to place a special emphasis on future research on VTE in India to plug the gaps, which exist in our current knowledge of the disease, particularly with respect to Indian population.
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Affiliation(s)
- Heena Tabassum
- Division of Biomedical Sciences, Indian Council of Medical Research, Jamia Hamdard, New Delhi, India
| | - Rohan Chakraborty
- Department of Toxicology, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, India
| | - Nabendu Sekhar Chatterjee
- Division of Biomedical Sciences, Indian Council of Medical Research, Jamia Hamdard, New Delhi, India
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Qin Y, Zhang L, Liang X, Sun X, Wang N, Yuan M, Wang Q, Wu D. Venous and Arterial Thromboembolism in Patients with Metastatic Lung Cancer. Clin Appl Thromb Hemost 2023; 29:10760296231159121. [PMID: 36814378 PMCID: PMC9950605 DOI: 10.1177/10760296231159121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide with an increasing incidence in many countries. There were few studies on arterial and venous thromboembolism (ATE/VTE) in patients with metastatic lung cancer. Our study focused on the clinical characteristics of stage IV lung cancer patients with ATE or VTE to further explore the risk factors and prognosis. Patients diagnosed with metastatic lung cancer were enrolled from January 2011 to June 2019 at a tertiary hospital in Jiangyin, China. Log-rank test was used to reveal the survival for patients with ATE or VTE. Univariable analysis and multivariable logistic regression were used to study the risk factors for ATE. A total of 587 patients were enrolled in our study, including 52 patients with VTE and 48 with ATE. ATE occurred earlier than VTE. Patients with ATE had a worse prognosis. Multivariable logistic regression revealed that older age and a history of hypertension were independent risk factors for ATE. Patients with metastatic lung cancer were at high risk of VTE and ATE. ATE occurred earlier and was associated with a worse prognosis. Attention should be paid to metastatic lung cancer patients who may develop thromboembolism, especially ATE.
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Affiliation(s)
- Ya Qin
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China,Qiong Wang, Department of Oncology,
Jiangyin People's Hospital, 163# Shoushan Road, Jiangyin, Jiangsu, China.
| | - Lingfei Zhang
- Department of Cardiology, Jiangyin Hospital of Traditional Chinese
Medicine, Wuxi, 214400, Jiangsu, China
| | - Xiao Liang
- Department of Medical Oncology, the First Affiliated Hospital of
Nanjing Medical University, Nanjing, 210000, Jiangsu, China
| | - Xia Sun
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China
| | - Nanyao Wang
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China
| | - Ming Yuan
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China
| | - Qiong Wang
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China
| | - Dan Wu
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China,Dan Wu, Department of Oncology, Jiangyin
People's Hospital, 163# Shoushan Road, Jiangyin, Jiangsu, China.
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Nielsen AC, Nicolajsen CW, Eldrup N. Abdominal Aortic Aneurysm Repair in Patients with Concomitant Cancer: A Literature Review. Vascular 2023:17085381231159151. [PMID: 36812403 DOI: 10.1177/17085381231159151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES Abdominal aortic aneurysmal (AAA) repair in patients with concomitant cancer is controversial due to increased comorbidity and reduced life expectancy in this specific patient group. This literature review aims to investigate the evidence supporting one treatment modality over another (endovascular aortic repair (EVAR) or open repair (OR)), as well as treatment strategy (staged AAA-, cancer first or simultaneous procedures) in patients with AAA and concomitant cancer. METHODS Literature review, including studies published from 2000 to 2021 on surgical treatment in patients with AAA and concomitant cancer and related outcomes (30-day morbidity/complications as well as 30-day and 3-year mortality). RESULTS 24 studies comprising 560 patients undergoing surgical treatment of AAA and concomitant cancer were included. Of these, 220 cases were treated with EVAR and 340 with OR. Simultaneous procedures were performed in 190 cases, 370 received staged procedures. The 30-day mortality for EVAR versus OR was 1% and 8%, corresponding to a relative risk (RR) of 0.11 (95% CI: 0.03-0.46, p = 0.002). No difference in mortality was observed between staged versus simultaneous procedure nor between AAA-first versus cancer-first strategy, RR 0.59 (95% CI: 0.29-1.1, p = 0.13) and 0.88 (95% CI 0.34-2.31, p = 0.80), respectively. Overall, 3-year mortality was 21% for EVAR and 39% for OR from 2000-2021, while the mortality up to 3 years after EVAR within recent years (2015-2021) was 16%. CONCLUSION This review supports EVAR treatment as first choice if suitable. No consensus was established on treating either the aneurysm or the cancer first or simultaneously. Long-term mortality after EVAR was comparable to non-cancer patients within recent years.
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Affiliation(s)
- Anne C Nielsen
- Department of Vascular Surgery, 53165Viborg Regional Hospital, Viborg, Denmark
| | - Chalotte W Nicolajsen
- Department of Vascular Surgery, 53165Viborg Regional Hospital, Viborg, Denmark
- Department of Cardiology, Thrombosis Research Unit, 53141Aalborg University Hospital, Aalborg, Denmark
| | - Nikolaj Eldrup
- Department of Vascular Surgery, 53146Rigshospitalet, Copenhagen, Denmark
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Comparison of the efficacy and safety of rivaroxaban and low-molecular-weight heparin in Chinese lung cancer patients with nonhigh-risk pulmonary embolism. Thromb J 2023; 21:16. [PMID: 36732741 PMCID: PMC9893535 DOI: 10.1186/s12959-023-00453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Data that guide selection of differing anticoagulant regimens for specific cancer-associated venous thromboembolism (VTE) are lacking. We aimed to compare the efficacy and safety of rivaroxaban and low-molecular-weight heparin (LMWH) against nonhigh-risk pulmonary embolism (PE) in Chinese lung cancer patients. METHODS Four hundred forty-six Chinese lung cancer patients with nonhigh-risk PE who initiated treatment with rivaroxaban or LMWH were identified from Zhongshan Hospital database from 2016 to 2020. The primary outcomes were the composite event of VTE recurrence or major bleeding, and all-cause mortality. The secondary outcomes were VTE recurrence, major bleeding and clinically relevant non-major bleeding (CRNMB). Propensity score matching was used to balance baseline covariates. We conducted sensitivity analysis by stabilized inverse probability of treatment weighting and competing risk analysis by a Fine and Gray subdistribution hazard model. RESULTS In propensity score-matched cohorts, rivaroxaban was similar to LMWH in the risks of the composite outcome (hazard ratio (HR), 0.73; 95% confidence interval (CI), 0.45-1.21; P = 0.22), VTE recurrence (HR, 0.69; 95% CI, 0.36-1.34; P = 0.28), major bleeding (HR, 0.79; 95% CI, 0.37-1.68; P = 0.54) and CRNMB (HR, 1.13; 95% CI, 0.62-2.09; P = 0.69). All-cause mortality was significantly lower in rivaroxaban group than LMWH group (HR, 0.52; 95% CI, 0.36-0.75; P < 0.001). The primary and secondary outcomes favored rivaroxaban over LMWH in all the subgroups expect for central PE and intermediate-risk PE. The sensitivity analysis yielded similar results, and competing risk analysis was in accordance with the primary findings. CONCLUSIONS Rivaroxaban might be a promising alternative to LMWH as initial treatment for nonhigh-risk PE in lung cancer patients.
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Gon Y, Sasaki T, Kawano T, Okazaki S, Todo K, Takeda T, Matsumura Y, Mochizuki H. Impact of stroke on survival in patients with cancer. Thromb Res 2023; 222:109-112. [PMID: 36640565 DOI: 10.1016/j.thromres.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/11/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Yasufumi Gon
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Tsutomu Sasaki
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomohiro Kawano
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shuhei Okazaki
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenichi Todo
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshihiro Takeda
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Matsumura
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
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Cella CA, Knoedler M, Hall M, Arcopinto M, Bagnardi V, Gervaso L, Pellicori S, Spada F, Zampino MG, Ravenda PS, Frassoni S, Passaro A, Milano M, Laffi A, Fazio N, Lordick F. Validation of the ONKOTEV Risk Prediction Model for Venous Thromboembolism in Outpatients With Cancer. JAMA Netw Open 2023; 6:e230010. [PMID: 36795409 PMCID: PMC9936336 DOI: 10.1001/jamanetworkopen.2023.0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
IMPORTANCE The assessment of the risk of venous thromboembolism (VTE) among outpatients with cancer represents an unsolved topic. Current international guidelines recommend primary prophylaxis for patients at intermediate to high risk of VTE, indicated by a Khorana score of 2 or more. A previous prospective study developed the ONKOTEV score, a 4-variable risk assessment model (RAM) consisting of a Khorana score of more than 2, metastatic disease, vascular or lymphatic compression, and previous VTE event. OBJECTIVE To validate the ONKOTEV score as a novel RAM to assess the risk of VTE among outpatients with cancer. DESIGN, SETTING, AND PARTICIPANTS ONKOTEV-2 is a noninterventional prognostic study conducted in 3 European centers located in Italy, Germany, and the United Kingdom among a prospective cohort of 425 ambulatory patients with a histologically confirmed diagnosis of a solid tumor who were receiving active treatments. The total study duration was 52 months, with an accrual period of 28 months (from May 1, 2015, to September 30, 2017) and an overall follow up-period of 24 months (data were censored September 30, 2019). Statistical analysis was performed in October 2019. EXPOSURES The ONKOTEV score was calculated for each patient at baseline by collecting clinical, laboratory, and imaging data from tests performed for routine practice. Each patient was then observed to detect any thromboembolic event throughout the study period. MAIN OUTCOMES AND MEASURES The primary outcome of the study was the incidence of VTE, including deep vein thrombosis and pulmonary embolism. RESULTS A total of 425 patients (242 women [56.9%]; median age, 61 years [range, 20-92 years]) were included in the validation cohort of the study. The cumulative incidences for the risk of developing VTE at 6 months were 2.6% (95% CI, 0.7%-6.9%), 9.1% (95% CI, 5.8%-13.2%), 32.3% (95% CI, 21.0%-44.1%), and 19.3% (95% CI, 2.5%-48.0%), respectively, among 425 patients with an ONKOTEV score of 0, 1, 2, and greater than 2 (P < .001). The time-dependent area under the curve at 3, 6, and 12 months was 70.1% (95% CI, 62.1%-78.7%), 72.9% (95% CI, 65.6%-79.1%), and 72.2% (95% CI, 65.2%-77.3%), respectively. CONCLUSIONS AND RELEVANCE This study suggests that, because the ONKOTEV score has been validated in this independent study population as a novel predictive RAM for cancer-associated thrombosis, it can be adopted into practice and into clinical interventional trials as a decision-making tool for primary prophylaxis.
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Affiliation(s)
- Chiara A Cella
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Maren Knoedler
- University Cancer Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Center for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
| | - Michele Arcopinto
- Department of Translational Medical Sciences, "Federico II" University Hospital and School of Medicine, Naples, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
- Molecular Medicine Department, University of Pavia, Pavia, Italy
| | | | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria G Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Paola S Ravenda
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Monica Milano
- Division of Medical Senology, European Institute of Oncology IRCCS, Milan, Italy
| | - Alice Laffi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Florian Lordick
- University Cancer Center Leipzig, University Hospital Leipzig, Leipzig, Germany
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Khorana AA, Palaia J, Rosenblatt L, Pisupati R, Huang N, Nguyen C, Barron J, Gallagher K, Bond TC. Venous thromboembolism incidence and risk factors associated with immune checkpoint inhibitors among patients with advanced non-small cell lung cancer. J Immunother Cancer 2023; 11:jitc-2022-006072. [PMID: 36657815 PMCID: PMC9853260 DOI: 10.1136/jitc-2022-006072] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in patients with lung cancer. Systemic therapies, such as chemotherapy (chemo), are associated with increased risk of VTE. Immune checkpoint inhibitors (ICIs) are a new standard of care for the treatment of lung cancer, but their association with VTE is not fully understood. We evaluated the incidence of VTE and risk factors for patients with advanced non-small cell lung cancer (aNSCLC) treated with first-line ICI-based, chemo-based, or ICI+chemo regimens. METHODS This retrospective cohort study used HealthCore Integrated Research Environment - Oncology data, an integrated database of administrative claims, coupled with clinical data from a cancer-care quality program. Patients with first-line treatment of stage IV non-small cell lung cancer from July 2014 to August 2020 were grouped based on three treatment types: ICI-based, chemo-based, or ICI+chemo. Patients with VTE before initiation of systemic treatment were excluded. Newly diagnosed VTE events were identified via inpatient and outpatient diagnosis codes. Cox proportional hazards models were used to investigate the factors associated with VTE risk. RESULTS Among 2299 eligible patients (ICI-based, n=605; chemo-based, n=1092; ICI+chemo, n=602) with a median follow-up of 9.1 months, the VTE incidence rates (95% CI) per 100 person-years were 17.8 (95% CI 16.0 to 19.5) overall, 13.5 (95% CI 10.6 to 16.5) for ICI-based, 18.0 (95% CI 15.5 to 20.5) for chemo-based, and 22.4 (95% CI 20.2 to 24.5) for ICI+chemo. The 6-month cumulative incidence of VTE was 8.1% for ICI-based, 10.9% for chemo-based, and 12.8% for ICI+chemo. Pulmonary embolism was most common, accounting for 63% of the VTE events. After controlling for baseline patient characteristics, the risk of VTE was 26% lower for ICI-based regimens than for chemo-based regimens (HR 0.74, p=0.03). There was no meaningful difference in the risk between ICI+chemo and chemo-based regimens (HR 1.12, p=0.36). Previous radiation and severe obesity (body mass index ≥40) were associated with VTE. CONCLUSIONS VTE incidence rate per 100 person-years was common across regimens in patients with aNSCLC, but numerically lower for patients receiving ICI-based regimens compared with those receiving chemo-based and ICI+chemo regimens. VTE is a common complication of lung cancer, and there is a continued need for awareness of VTE as a comorbidity in this population.
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Affiliation(s)
- Alok A Khorana
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennell Palaia
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Lisa Rosenblatt
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Radhika Pisupati
- US Medical Oncology, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Ning Huang
- Worldwide Patient Safety: Medical Safety Assessment, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Chi Nguyen
- Health Economics and Outcomes Research, HealthCore Inc, Wilmington, Delaware, USA
| | - John Barron
- Health Economics and Outcomes Research, HealthCore Inc, Wilmington, Delaware, USA
| | - Kerrin Gallagher
- Health Economics and Outcomes Research, HealthCore Inc, Wilmington, Delaware, USA
| | - T Christopher Bond
- Worldwide Patient Safety: Epidemiology, Bristol Myers Squibb, Princeton, New Jersey, USA
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Wang J, Tan J, Hua L, Sheng Q, Huang X, Liu P. Genetic Predisposition of Both Waist Circumference and Hip Circumference Increased the Risk of Venous Thromboembolism. Thromb Haemost 2023; 123:347-361. [PMID: 36384228 PMCID: PMC9981277 DOI: 10.1055/a-1980-8852] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obesity, especially abdominal obesity, is an independent indicator of increased cardiovascular risk. Observational studies have shown an observational association between obesity and venous thromboembolism (VTE). As a type of VTE, pulmonary embolism (PE) is also associated with obesity. However, it is unclear whether the observed associations are causal or caused by confounding bias or reverse causality. METHODS We performed a two-sample test by obtaining the exposure dataset of waist circumference (WC) and hip circumference (HC) from the Neale Laboratory Consortium's genome-wide association study summary data and the summary-level outcome data of VTE and PE from FinnGen Biobank of European ancestry to determine the causal effect of WC and HC on VTE and PE. RESULTS All three Mendelian randomization methods displayed a positive association between WC/HC and VTE/PE. WC and HC were positively associated with VTE (odds ratio [OR] = 1.803 per 1 standard deviation [SD] increase in WC, 95% confidence interval [CI] = 1.393-2.333; p < 0.001; OR = 1.479 per 1 SD increase in HC, 95% CI = 1.219-1.796; p < 0.001, respectively). Furthermore, we found a causal association between genetically predicted WC/HC and a higher risk of PE (OR = 1.929 per 1 SD increase in WC, 95% CI = 1.339-2.778, p < 0.001; OR = 1.431 per 1 SD increase in HC, 95% CI =1.095-1.869; p = 0.009, respectively). CONCLUSION There is a significant causal relationship between WC/HC and VTE/PE, which is consistent with observational studies. Taking measures to reduce WC/HC of obesity may help reduce the incidence of VTE/PE.
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Affiliation(s)
- Jiayu Wang
- Department of Cardiology, The Second Hospital of Shandong University, Jinan, China
| | - Jiangshan Tan
- Key Laboratory of Pulmonary Vascular Medicine, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Hua
- Key Laboratory of Pulmonary Vascular Medicine, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiping Sheng
- Department of Cardiology, The Second Hospital of Shandong University, Jinan, China
| | - Xianwei Huang
- Department of Emergency, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ping Liu
- Department of Cardiology, The Second Hospital of Shandong University, Jinan, China,Address for correspondence Ping Liu Department of Cardiology, The Second Hospital of Shandong UniversityNo.247, Beiyuan Road, Jinan, Shandong 250033China
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Xu Q, Lei H, Li X, Li F, Shi H, Wang G, Sun A, Wang Y, Peng B. Machine learning predicts cancer-associated venous thromboembolism using clinically available variables in gastric cancer patients. Heliyon 2023; 9:e12681. [PMID: 36632097 PMCID: PMC9826862 DOI: 10.1016/j.heliyon.2022.e12681] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
Stomach cancer (GC) has one of the highest rates of thrombosis among cancers and can lead to considerable morbidity, mortality, and additional costs. However, to date, there is no suitable venous thromboembolism (VTE) prediction model for gastric cancer patients to predict risk. Therefore, there is an urgent need to establish a clinical prediction model for VTE in gastric cancer patients. We collected data on 3092 patients between January 1, 2018 and December 31, 2021. And after feature selection, 11 variables are reserved as predictors to build the model. Five machine learning (ML) algorithms are used to build different VTE predictive models. The accuracy, sensitivity, specificity, and AUC of these five models were compared with traditional logistic regression (LR) to recommend the best VTE prediction model. RF and XGB models have selected the essential characters in the model: Clinical stage, Blood Transfusion History, D-Dimer, AGE, and FDP. The model has an AUC of 0.825, an accuracy of 0.799, a sensitivity of 0.710, and a specificity of 0.802 in the validation set. The model has good performance and high application value in clinical practice, and can identify high-risk groups of gastric cancer patients and prevent venous thromboembolism.
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Affiliation(s)
- Qianjie Xu
- Department of Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Haike Lei
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Xiaosheng Li
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Fang Li
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Hao Shi
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Guixue Wang
- MOE Key Lab for Biorheological Science and Technology, State and Local Joint Engineering Laboratory for Vascular Implants, College of Bioengineering Chongqing University, Chongqing, 400030, China
| | - Anlong Sun
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, 400030, China,Corresponding author.
| | - Ying Wang
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, 400030, China,Corresponding author.
| | - Bin Peng
- Department of Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, 400016, China,Corresponding author.
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Onder AH, Keskin AS, Onder KD, Kizilates F, Heybeli C. Factors associated with development of an acute ischemic event during hospitalization for COVID-19 in cancer and non-cancer patients. Ann Saudi Med 2023; 43:1-9. [PMID: 36739498 PMCID: PMC9899339 DOI: 10.5144/0256-4947.2023.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19 and solid cancer are both associated with an increased risk of thromboembolism. OBJECTIVES Assess whether solid cancer is a risk factor for acute ischemic event development among patients with COVID-19. DESIGN Retrospective cohort SETTING: A tertiary training and research hospital PATIENTS AND METHODS: Patients who were hospitalized for COVID-19 for ≥3 days between 15 March 2020 and 30 March 2021 at Antalya Training and Research Hospital, Antalya, Turkiye. were included in the study. Independent predictors of the development of acute ischemic events during hospitalization were determined using multivariable logistic regression analysis. MAIN OUTCOME MEASURES Risk factors for acute ischemic event development. SAMPLE SIZE 538 patients. RESULTS Patients diagnosed with solid cancer comprised 11.3% of the cohort (n=61). Forty-one (7.6%) developed an acute ischemic event at a median of 3 (range, 1-15) days after hospitalization. The presence of a solid cancer (OR 3.80, 95% CI 1.20-12.03, P=.023) along with length of hospital stay (OR 1.05 per day, 95% CI 1.01-1.09, P=.025) were independent predictors of acute ischemic event development during the course of COVID-19. Mortality was reported in 200 (37%) patients at a median of 5 (range, 3-10) days after hospitalization. The presence of solid tumor increased mortality 5.83 times (95% CI 3.19-10.63, P<.001) while this ratio was 4.59 (95% CI 2.29-9.23, P<.001) for patients who experienced an acute ischemic event. CONCLUSION Patients with active cancer carry a significant risk for acute ischemic event development during the course of COVID-19 and such patients may require particular attention in terms of anticoagulation therapy. LIMITATIONS Retrospective design and small sample size. CONFLICT OF INTEREST None.
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Affiliation(s)
- Arif Hakan Onder
- From the Department of Medical Oncology, Antalya Training and Research Hospital, Antalya, Turkiye
| | - Aysegul Seremet Keskin
- From the Department of Infectious Disease and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkiye
| | - Kubra Demir Onder
- From the Department of Infectious Disease and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkiye
| | - Filiz Kizilates
- From the Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkiye
| | - Cihan Heybeli
- From the Division of Nephrology, Mus State Hospital, Mus, Turkiye
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Overvad TF, Skjøth F, Piazza G, Noble S, Ording AG, Larsen TB, Nielsen PB. The Khorana score and venous and arterial thrombosis in patients with cancer treated with immune checkpoint inhibitors: A Danish cohort study. J Thromb Haemost 2022; 20:2921-2929. [PMID: 36112135 PMCID: PMC9828438 DOI: 10.1111/jth.15883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Thrombosis is common among patients with cancer. Primary thromboprophylaxis guided by the Khorana score is endorsed by guidelines but recommendations rely mainly on data from patients treated with chemotherapy. OBJECTIVES To explore if the Khorana score could risk stratify patients with cancer treated with immune checkpoint inhibitors according to risk of venous and arterial thrombosis. PATIENTS/METHODS The study population and Khorana score were defined using administrative Danish health registries. The primary outcome was 6-month risk of venous thromboembolism after initiation of checkpoint inhibitor treatment. Secondary outcomes were arterial thrombosis and any thromboembolic event. Death was considered a competing risk event. RESULTS Among 3946 patients with cancer initiating checkpoint inhibitor treatment without other indications for anticoagulation, the overall 6-month incidence of venous thromboembolism was 2.6% (95% confidence interval [CI]: 2.1-3.1). Risks were 2.1% (95% CI: 1.5-3.0), 2.6% (95% CI: 2.0-3.4), and 3.7% (95% CI: 2.1-5.9) in low (score 0), intermediate (score 1-2), and high risk (score ≥3) Khorana categories, respectively. Among patients eligible for primary thromboprophylaxis according to guidelines (Khorana score ≥2), risk of venous thromboembolism was 4.1% (95% CI: 3.1-5.4). Higher Khorana risk category was also associated with higher 6-month risk of both arterial thrombosis and any thromboembolic events. CONCLUSIONS The Khorana score was able to risk stratify patients with cancer treated with immune checkpoint inhibitors according to 6-month risk of thromboembolic events. Risks of venous thromboembolism were lower than in randomized thromboprophylaxis trials, thus questioning the absolute benefit of routine primary thromboprophylaxis in an unselected population of patients treated with immune checkpoint inhibitors.
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Affiliation(s)
- Thure F. Overvad
- Department of Clinical PharmacologyAalborg University HospitalAalborgDenmark
- Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Unit of Clinical BiostatisticsAalborg University HospitalAalborgDenmark
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Simon Noble
- Marie Curie Palliative Care Research CentreCardiff UniversityCardiffUK
| | - Anne G. Ording
- Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Department of CardiologyAalborg University HospitalAalborgDenmark
| | - Torben B. Larsen
- Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Department of CardiologyAalborg University HospitalAalborgDenmark
| | - Peter B. Nielsen
- Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Department of CardiologyAalborg University HospitalAalborgDenmark
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Song H, Park JY, Song JM, Yoon Y, Kim YW. Menstrual and Reproductive Factors for Gastric Cancer in Postmenopausal Women: The 2007-2020 Korea National Health and Nutrition Examination Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14468. [PMID: 36361346 PMCID: PMC9656237 DOI: 10.3390/ijerph192114468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Globally, the incidence of gastric cancer is lower in women than in men. It is thought that menstrual and reproductive factors may be related to their lower incidence of gastric cancer. This cross-sectional study examined menstrual, reproductive, and other factors in 20,784 postmenopausal women from the 2007-2020 Korea National Health and Nutrition Examination Survey (KNHANES). A univariate logistic regression analysis was performed, and then a multivariate logistic regression analysis for significant factors in the univariate analysis was conducted. In the multivariate logistic regression analysis, the age at menarche (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.00-1.06, p = 0.035) and myocardial infarction (OR 2.43, 95% CI 1.05-5.62, p = 0.026) showed a significant association with increased incidence of gastric cancer. The age at menopause (OR 0.97, 95% CI 0.95-1.00, p = 0.03), the age at the first childbirth (OR 0.93, CI 0.89-0.97, p = 0.007), and the experience of alcohol consumption (OR 0.68, 95% CI 0.5-0.91, p = 0.003) showed a significant association with a decreased incidence of gastric cancer. Late menarche, early menopause, early aged first childbirth, and myocardial infarction are estimated to be risk factors for gastric cancer in postmenopausal Korean women.
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Affiliation(s)
- Heekyoung Song
- Department of Obstetrics and Gynecology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea
| | - Jung Yoon Park
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea
| | - Ju Myung Song
- Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea
| | - Youngjae Yoon
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea
| | - Yong-Wook Kim
- Department of Obstetrics and Gynecology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea
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50
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Parrini I, Lucà F, Rao CM, Parise G, Micali LR, Musumeci G, La Meir M, Colivicchi F, Gulizia MM, Gelsomino S. Superiority of Direct Oral Anticoagulants over Vitamin K Antagonists in Oncological Patients with Atrial Fibrillation: Analysis of Efficacy and Safety Outcomes. J Clin Med 2022; 11:jcm11195712. [PMID: 36233581 PMCID: PMC9572823 DOI: 10.3390/jcm11195712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/31/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background and aim. Cancer and atrial fibrillation (AF) may be associated, and anticoagulation, either with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs), is necessary to prevent thromboembolic events by reducing the risk of bleeding. The log incidence rate ratio (IRR) and 95% confidence interval were used as index statistics. Higgin’s I2 test was adopted to assess statistical inconsistencies by considering interstudy variations, defined by values ranging from 0 to 100%. I2 values of less than 40% are associated with very low heterogeneity among the studies; values between 40% and 75% indicate moderate heterogeneity, and those greater than 75% suggest severe heterogeneity. The aim of this meta-analysis was to compare the safety and efficacy of VKAs and DOACs in oncologic patients with AF. Methods. A meta-analysis was conducted comparing VKAs to DOACs in terms of thromboembolic events and bleeding. A meta-regression was conducted to investigate the differences in efficacy and safety between four different DOACs. Moreover, a sub-analysis on active-cancer-only patients was conducted. Results. A total of eight papers were included. The log incidence rate ratio (IRR) for thromboembolic events between the two groups was −0.69 (p < 0.005). The meta-regression did not reveal significant differences between the types of DOACs (p > 0.9). The Log IRR was −0.38 (p = 0.008) for ischemic stroke, −0.43 (p = 0.02) for myocardial infarction, −0.39 (p = 0.45) for arterial embolism, and −1.04 (p = 0.003) for venous thromboembolism. The log IRR for bleeding events was −0.43 (p < 0.005), and the meta-regression revealed no statistical difference (p = 0.7). The log IRR of hemorrhagic stroke, major bleeding, and clinically relevant non-major bleeding between the VKA and DOAC groups was −0.51 (p < 0.0001), −0.45 (p = 0.03), and 0.0045 (p = 0.97), respectively. Similar results were found in active-cancer patients for all the endpoints except for clinically-relevant non-major bleedings. Conclusions. DOACs showed better efficacy and safety outcomes than VKAs. No difference was found between types of DOACs.
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Affiliation(s)
- Iris Parrini
- Division of Cardiology, Mauriziano Hospital, 10128 Turin, Italy
- Correspondence:
| | - Fabiana Lucà
- Grande Ospedale Metropolitano, 89124 Reggio Calabria, Italy
| | | | - Gianmarco Parise
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Linda Renata Micali
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute, Maastricht University, 6211 LK Maastricht, The Netherlands
| | | | - Mark La Meir
- University Hospital Brussels, 1050 Brussels, Belgium
| | | | - Michele Massimo Gulizia
- Cardiology Division, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, 95126 Catania, Italy
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute, Maastricht University, 6211 LK Maastricht, The Netherlands
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