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Élias A, Debourdeau P, Espitia O, Sevestre MA, Girard P, Mahé I, Sanchez O. [Translation into French and republication of: "Central venous catheter associated upper extremity deep vein thrombosis in cancer patients: Diagnosis and therapeutic management"]. Rev Med Interne 2024; 45:354-365. [PMID: 38823999 DOI: 10.1016/j.revmed.2024.05.018] [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: 06/03/2024]
Abstract
Catheter-related thrombosis (CRT) is a relatively frequent and potentially fatal complication arising in patients with cancer who require a central catheter placement for intravenous treatment. In everyday practice, CRT remains a challenge for management; despite its frequency and its negative clinical impact, few data are available concerning diagnosis and treatment of CRT. In particular, no diagnostic studies or clinical trials have been published that included exclusively patients with cancer and a central venous catheter (CVC). For this reason, many questions regarding optimal management of CRT remain unanswered. Due to the paucity of high-grade evidence regarding CRT in cancer patients, guidelines are derived from upper extremity DVT studies for diagnosis, and from those for lower limb DVT for treatment. This article addresses the issues of diagnosis and management of CRT through a review of the available literature and makes a number of proposals based on the available evidence. In symptomatic patients, venous ultrasound is the most appropriate choice for first-line diagnostic imaging of CRT because it is noninvasive, and its diagnostic performance is high (which is not the case in asymptomatic patients). In the absence of direct comparative clinical trials, we suggest treating patients with CRT with a therapeutic dose of either a LMWH or a direct oral factor Xa inhibitor, with or without a loading dose. These anticoagulants should be given for a total of at least 3 months, including at least 1 month after catheter removal following initiation of therapy.
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Affiliation(s)
- A Élias
- Département de cardiologie et de médecine vasculaire, délégation recherche clinique et innovation, hôpital Sainte-Musse, centre hospitalier intercommunal de Toulon La Seyne-sur-Mer, 83000 Toulon, France; F-CRIN INNOVTE network, Saint-Étienne, France.
| | - P Debourdeau
- F-CRIN INNOVTE network, Saint-Étienne, France; Équipe mobile territoriale soins palliatifs, hôpital Joseph-Imbert, Arles, France
| | - O Espitia
- Service de médecine interne et vasculaire, Team III Vascular & Pulmonary Diseases, institut du thorax, CHU de Nantes, Nantes université, Inserm UMR 1087, CNRS UMR 6291, Nantes, France
| | - M-A Sevestre
- F-CRIN INNOVTE network, Saint-Étienne, France; Service de médecine vasculaire, EA Chimère 7516, CHU d'Amiens, 80054 Amiens, France
| | - P Girard
- F-CRIN INNOVTE network, Saint-Étienne, France; Institut du thorax Curie-Montsouris, institut mutualiste Montsouris, 75014 Paris, 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, 75015 Paris, France
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Khairani CD, Bejjani A, Assi A, Porio N, Talasaz AH, Piazza G, Cushman M, Bikdeli B. Direct oral anticoagulants for treatment of venous thrombosis: illustrated review of appropriate use. Res Pract Thromb Haemost 2024; 8:102424. [PMID: 38812988 PMCID: PMC11135034 DOI: 10.1016/j.rpth.2024.102424] [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: 02/27/2024] [Accepted: 04/04/2024] [Indexed: 05/31/2024] Open
Abstract
Direct oral anticoagulants (DOACs) have become the preferred option for treatment of venous thromboembolism due to their favorable profile compared with other agents such as vitamin K antagonists or low-molecular-weight heparin. However, findings from randomized controlled trials suggest efficacy and/or safety concerns with DOAC use in some clinical contexts. This illustrated review will summarize indications where DOACs have proven efficacy and safety, situations where they fall short, and situations where uncertainty remains compared with other treatments for venous thromboembolism.
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Affiliation(s)
- Candrika D. Khairani
- Thrombosis Research Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antoine Bejjani
- Thrombosis Research Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Assi
- Thrombosis Research Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Porio
- Thrombosis Research Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Azita H. Talasaz
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gregory Piazza
- Thrombosis Research Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Behnood Bikdeli
- Thrombosis Research Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Yale New Haven Hospital/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, USA
- Cardiovascular Research Foundation (CRF), New York, New York, USA
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Curtis K, Gough K, Krishnasamy M, Tarasenko E, Hill G, Keogh S. Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review. BMC Cancer 2024; 24:498. [PMID: 38641574 PMCID: PMC11027380 DOI: 10.1186/s12885-024-12099-8] [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: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation. METHODS A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data. RESULTS From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies. CONCLUSION Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.
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Affiliation(s)
- Kerrie Curtis
- Department of Nursing, University of Melbourne, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, Australia.
- Austin Health, Melbourne, Australia.
| | - Karla Gough
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | | | - Geoff Hill
- Royal Melbourne Hospital, Melbourne, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Wang TF, Kou R, Carrier M, Delluc A. Management of catheter-related upper extremity deep vein thrombosis in patients with cancer: a systematic review and meta-analysis. J Thromb Haemost 2024; 22:749-764. [PMID: 38065528 DOI: 10.1016/j.jtha.2023.11.017] [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: 09/21/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Patients with cancer commonly require a central venous catheter, which is associated with an increased risk of venous thromboembolism (VTE). Despite the frequent occurrence, the optimal anticoagulation management and outcomes for patients with cancer and catheter-related upper extremity deep vein thrombosis (DVT) are unclear. OBJECTIVE We performed a systematic review and meta-analysis to evaluate the rates of recurrent VTE and bleeding in patients with cancer and catheter-related upper extremity DVT. METHODS We searched MEDLINE, Embase, Scopus, and CENTRAL from inception to June 2, 2023. The primary efficacy outcome was recurrent VTE, and the primary safety outcome was major bleeding. The incidence rates (with 95% CI) of outcomes were pooled using random effects model. RESULTS We included 29 studies (N = 2,836), among which 5 were prospective. The duration of follow-up and anticoagulation varied considerably. The main long-term anticoagulant used was low molecular weight heparin, followed by direct oral anticoagulants. The pooled 3-month recurrent VTE rate from 14 studies (N = 1,128) was 0.56% (95% CI, 0.10%-3.01%; I2 = 0%). The pooled 3-month major bleeding rate from 10 studies (N = 834) was 2.34% (95% CI, 1.14%-4.76%; I2 = 0%). We were unable to pool event rates beyond 3 months, given high heterogeneity. All studies had serious risk of bias. CONCLUSIONS Our study demonstrated a relatively low rate of recurrent VTE and moderate rate of major bleeding events within the first 3 months in patients with cancer and catheter-related upper extremity DVT. However, there was significant heterogeneity in the management and reporting after 3 months.
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Affiliation(s)
- Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Roger Kou
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marc Carrier
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada. https://twitter.com/MarcCarrier1
| | - Aurélien Delluc
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada. https://twitter.com/DellucAurelien
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Espitia O, Raimbeau A, Planquette B, Katsahian S, Sanchez O, Espinasse B, Bénichou A, Murris J. A systematic review and meta-analysis of the incidence of post-thrombotic syndrome, recurrent thromboembolism, and bleeding after upper extremity vein thrombosis. J Vasc Surg Venous Lymphat Disord 2024; 12:101688. [PMID: 37717788 DOI: 10.1016/j.jvsv.2023.09.002] [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: 06/22/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Data on complications after upper extremity vein thrombosis (UEVT) are limited and heterogeneous. METHODS The aim of the present study was to evaluate the pooled proportions of venous thromboembolism (VTE) recurrence, bleeding, and post-thrombotic syndrome (PTS) in patients with UEVT. A systematic literature review was conducted of PubMed, Embase, and the Cochrane Library databases from January 2000 to April 2023 in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. All studies included patients with UEVT and were published in English. Meta-analyses of VTE recurrence, bleeding, and of PTS after UEVT were performed to compute pooled estimates and associated 95% confidence intervals (CIs). Subgroup analyses of cancer-associated UEVT and catheter-associated venous thrombosis were conducted. Patients with Paget-Schroetter syndrome or effort thrombosis were excluded. RESULTS A total of 55 studies with 15,694 patients were included. The pooled proportions for VTE recurrence, major bleeding, and PTS were 4.8% (95% CI, 3.8%-6.2%), 3.0% (95% CI, 2.2%-4.0%), and 23.8% (95% CI, 17.0%-32.3%), respectively. The pooled proportion of VTE recurrence was 2.7% (95% CI, 1.6%-4.6%) for patients treated with direct oral anticoagulants (DOACs), 1.7% (95% CI, 0.8%-3.7%) for patients treated with low-molecular-weight heparin (LMWH), and 4.4% (95% CI, 1.5%-11.8%) for vitamin K antagonists (VKAs; P = .36). The pooled proportion was 6.3% (95% CI, 4.3%-9.1%) for cancer patients compared with 3.1% (95% CI, 2.1%-4.6%) for patients without cancer (P = .01). The pooled proportion of major bleeding for patients treated with DOACs, LMWH, and VKAs, was 2.1% (95% CI, 0.9%-5.1%), 3.2% (95% CI, 1.4%-7.2%), and 3.4% (95% CI, 1.4%-8.4%), respectively (P = .72). The pooled proportion of PTS for patients treated with DOACs, LMWH, and VKAs was 11.8% (95% CI, 6.5%-20.6%), 27.9% (95% CI, 20.9%-36.2%), and 24.5% (95% CI, 17.6%-33.1%), respectively (P = .02). CONCLUSIONS The results from this study suggest that UEVT is associated with significant rates of PTS and VTE recurrence. Treatment with DOACs might be associated with lower PTS rates than treatment with other anticoagulants.
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Affiliation(s)
- Olivier Espitia
- Department of Vascular Medicine, Nantes Université, CHU Nantes, l'institut du Thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, Nantes, France; UNAV, Nantes Vascular Access Unit, Nantes Université, CHU Nantes, Nantes, France.
| | - Alizée Raimbeau
- Department of Vascular Medicine, Nantes Université, CHU Nantes, l'institut du Thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, Nantes, France; UNAV, Nantes Vascular Access Unit, Nantes Université, CHU Nantes, Nantes, France
| | - Benjamin Planquette
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Centre - Université Paris Cité, INSERM UMR S1140, Innovative Therapies in Hemostasis, Paris, France, F-CRIN INNOVTE, Université Paris Cité, St-Etienne, France
| | - Sandrine Katsahian
- INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, AP-HP, Hôpital Européen Georges Pompidou, Unité de Recherche Clinique, Service d'Informatique Médicale, Biostatistiques et Santé Publique, AP-HP Centre, Paris, France; Inserm, Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, Paris, France; HeKA, Inria, Paris, France
| | - Olivier Sanchez
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Centre - Université Paris Cité, INSERM UMR S1140, Innovative Therapies in Hemostasis, Paris, France, F-CRIN INNOVTE, Université Paris Cité, St-Etienne, France
| | | | - Antoine Bénichou
- Department of Vascular Medicine, Nantes Université, CHU Nantes, l'institut du Thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, Nantes, France; UNAV, Nantes Vascular Access Unit, Nantes Université, CHU Nantes, Nantes, France
| | - Juliette Murris
- Inserm, Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, Paris, France; HeKA, Inria, Paris, France; RWE and Data, Pierre Fabre, Boulogne-Billancourt, France
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Elias A, Debourdeau P, Espitia O, Sevestre MA, Girard P, Mahé I, Sanchez O. Central venous catheter associated upper extremity deep vein thrombosis in cancer patients: Diagnosis and therapeutic management. Arch Cardiovasc Dis 2024; 117:72-83. [PMID: 38065755 DOI: 10.1016/j.acvd.2023.11.011] [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
Catheter-related thrombosis (CRT) is a relatively frequent and potentially fatal complication arising in patients with cancer who require a central catheter placement for intravenous treatment. In everyday practice, CRT remains a challenge for management; despite its frequency and its negative clinical impact, few data are available concerning diagnosis and treatment of CRT. In particular, no diagnostic studies or clinical trials have been published that included exclusively patients with cancer and a central venous catheter (CVC). For this reason, many questions regarding optimal management of CRT remain unanswered. Due to the paucity of high-grade evidence regarding CRT in cancer patients, guidelines are derived from upper extremity DVT studies for diagnosis, and from those for lower limb DVT for treatment. This article addresses the issues of diagnosis and management of CRT through a review of the available literature and makes a number of proposals based on the available evidence. In symptomatic patients, venous ultrasound is the most appropriate choice for first-line diagnostic imaging of CRT because it is noninvasive, and its diagnostic performance is high (which is not the case in asymptomatic patients). In the absence of direct comparative clinical trials, we suggest treating patients with CRT with a therapeutic dose of either a LMWH or a direct oral factor Xa inhibitor, with or without a loading dose. These anticoagulants should be given for a total of at least three months, including at least one month after catheter removal following initiation of therapy.
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Affiliation(s)
- Antoine Elias
- Département 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-Étienne, France.
| | - Philippe Debourdeau
- Équipe Mobile Territoriale Soins Palliatifs, Hôpital Joseph-Imbert d'Arles, Arles, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Olivier Espitia
- Service de Médecine Interne et Vasculaire, Nantes Université, CHU de Nantes, Institut du thorax, Inserm UMR 1087, CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, Nantes, France
| | - Marie-Antoinette Sevestre
- Service de Médecine Vasculaire, EA Chimère 7516, CHU Amiens, 80054, Amiens, France; F-CRIN INNOVTE network, Saint-Étienne, France
| | - Philippe Girard
- Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France; F-CRIN INNOVTE network, Saint-Étienne, 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-Étienne, France
| | - Olivier Sanchez
- Service de Pneumologie et de Soins Intensifs, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Étienne, France
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Yin Q, Zheng X, Han L, Huang X, Wang Y, Song Y, Zhang Y, Bian Y. Outcome of antithrombotic therapy in cancer patients with catheter-related thrombosis: a systematic review. Front Cardiovasc Med 2023; 10:1290822. [PMID: 38162134 PMCID: PMC10756912 DOI: 10.3389/fcvm.2023.1290822] [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: 10/03/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction The guidelines' recommendations for anticoagulation in cancer patients with catheter-related thrombosis are unclear. The aim of this systematic review was to assess anticoagulation management in cancer patients with catheter-related thrombosis (CRT) based on previously published studies. Methods As of June 10, 2023,we searched databases including PubMed, Embase, and Cochrane and included 11 observational studies that met the criteria. We evaluated 770 adults with active cancer and objectively confirmed patients with CRT who were using drugs including warfarin, LMWH, and new oral anticoagulants as antithrombotic therapy. Results We extracted outcome data, including thrombosis recurrence, catheter dysfunction, major bleeding, and death, and performed a meta-analysis. Discussion In this study we found that the risk of VTE recurrence was higher with rivaroxaban, the risk of bleeding and death appeared to be greater with warfarin, and although the risk of catheter dysfunction due to LMWH is a concern, it is still a more reasonable option for cancer patients with catheter-related thrombosis. Systematic Review Registration http://www.clinicaltrials.gov, identifier (CRD42022367979).
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Affiliation(s)
- Qinan Yin
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xingyue Zheng
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lizhu Han
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuefei Huang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yueyuan Wang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yujie Song
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Zhang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Bian
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Mahé I, Meyer G, Girard P, Bertoletti L, Laporte S, Couturaud F, Mismetti P, Sanchez O. French guidelines for the treatment of cancer-associated venous thromboembolism - 2023 update. Respir Med Res 2023; 84:101056. [PMID: 37922776 DOI: 10.1016/j.resmer.2023.101056] [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: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND In recent years, knowledge about cancer associated thrombosis has evolved considerably. METHODS Practical guidelines were drafted on the initiative of the INNOVTE FCRIN Network, led by the French Speaking Society of Respiratory Diseases (SPLF), by a coordinating group, a writing group, and a review group, with the involvement of different scientific societies practicing in various settings. The method followed the "Clinical Practice Guidelines" process of the French National Authority for Health (HAS). RESULTS After a literature review, guidelines were formulated, improved, and then validated by the working groups. These guidelines addressed multiple aspects of the disease and management from the data of available clinical trials and observational studies : epidemiology, initial treatment, treatment duration, extended treatment, recurrent thrombosis, central venous catheter thrombosis, incidental thrombosis, treatment in case of thrombocytopenia. CONCLUSION These evidence-based guidelines are intended to guide the practical management of patients with cancer associated thrombosis.
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Affiliation(s)
- Isabelle Mahé
- Paris Cité University; Internal Medicine Department - Louis Mourier Hospital, Assistance Publique des Hôpitaux de Paris, Colombes; Inserm UMR_S1140, Paris; F-CRIN INNOVTE, St-Etienne.
| | - Guy Meyer
- Paris Cité University; Pulmonology and Intensive Care Department, Georges Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris; INSERM UMRS 970; INSERM CIC 1418, Paris; F-CRIN INNOVTE, St-Etienne
| | - Philippe Girard
- Curie-Montsouris Thorax Institute, Montsouris Mutualist Institute, Paris; F-CRIN INNOVTE, St-Etienne
| | - Laurent Bertoletti
- Vascular and Therapeutic Medicine Department, St-Etienne University Hospital; INSERM UMR1059, Vascular Dysfunction and Hemostasis Team, Jean-Monnet University, Saint-Etienne; INSERM, CIC-1408, Saint-Etienne; F-CRIN INNOVTE, Saint-Etienne, France
| | - Silvy Laporte
- SAINBOIS U1059 DVH team, Jean Monnet University, Lyon University, INSERM; Clinical Research, Innovation, Pharmacology Unit, Saint-Etienne University Hospital, Hôpital Nord; Saint-Etienne; F-CRIN INNOVTE, St-Etienne
| | - Francis Couturaud
- Internal Medicine and Pulmonology Department, EA3878-GETBO, CIC_INSERM1412, Western Brittany University, Brest University Hospital, F-CRIN INNOVTE, St-Etienne
| | - Patrick Mismetti
- Vascular and Therapeutic Medicine Department, St-Etienne University Hospital; INSERM UMR1059, Vascular Dysfunction and Hemostasis Team, Jean-Monnet University, Saint-Etienne; INSERM, CIC-1408, Saint-Etienne; F-CRIN INNOVTE, Saint-Etienne, France
| | - Olivier Sanchez
- Paris Cité University; Pulmonology and Intensive Care Department, Georges Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris; INSERM UMRS 1140, Paris; F-CRIN INNOVTE, St-Etienne
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Zhang X, Chen H, Jing W, Pu L, Wu Z, Su X, Chen H, Liu J, Yu H, Hu X. The clinical topography of peripherally inserted central catheter-related thrombosis in cancer patients: A prospective and longitudinal observational study based on ultrasound scans every two days. Thromb Res 2023; 229:232-242. [PMID: 37572590 DOI: 10.1016/j.thromres.2023.07.013] [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: 05/01/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
AIMS To delineate the clinical topography of peripherally inserted central catheter (PICC)-related thrombosis in cancer patients. BACKGROUND Most of the clinical features of PICC-related thrombosis are based on a single follow-up, which is insufficient to reflect the full topography of a thrombosis. DESIGN This is an observational study conducted at West China Hospital, according to the STROBE guidelines. METHODS Cancer patients scheduled for PICC placement were potentially eligible; patients with contraindications to PICC placement or existing diseases affecting blood flow were excluded; and those who later withdrew or did not reply to our contact request during the follow-up period were eliminated from this study. Ultrasound was used to detect thrombosis from the insertion site, proximal insertion site, axillary vein to the subclavian vein once every two days for two weeks post insertion. The thrombosis and its involved venous segments, onset time and symptoms and signs were recorded. RESULTS Among the 173 included patients, 126 (72.8 %) were identified as having thrombosis. Specifically, 113 and 126 patients were identified as having thrombosis within the first three days and the first week post insertion, respectively. In the 126 patients, thrombosis occurred at the insertion site (72.8 %) concurrently with thrombosis at the proximal insertion site (n = 120, 69.4 %), thrombosis in the axillary vein (n = 94, 54.3 %), and/or thrombosis in the subclavian vein (n = 41, 23.7 %). The log-rank test demonstrated that thrombosis in these four venous segments decreased significantly from the distal to the proximal central vein (log-rank test = 117.128, P < .001). Of 31 patients (17.9 %) who presented symptomatic thrombosis, only five patients experienced obvious swelling in the upper arm, and the other 26 patients exhibited atypical symptoms, such as soreness, tightness, numbness, tingling, or other discomforts in the palm, arm, armpit, and/or shoulder. In some thrombotic cases, ultrasonic assessment of PICC-related thrombosis did not parallel clinical symptoms and signs. CONCLUSION PICC-related thrombosis is common and can occur very early post insertion in cancer patients, and most thromboses present atypical symptoms. More than half of the cases with thrombosis evaluated involve multiple venous segments, and the farther the venous segments are from the central vein, the higher the incidence of thrombosis tend to be and the earlier the onset time are. RELEVANCE TO CLINICAL PRACTICE The results highlight the importance that medical staff pay particular attention to patients with catheters in the first week post insertion and be alert to thrombosis presenting atypical symptoms while keeping in mind that clinical symptoms and signs are not reliable for diagnosing thrombosis. CLINICAL REGESTRATION Clinical Trials ChiCTR1900024890.
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Affiliation(s)
- Xiaoxia Zhang
- Division of Head & Neck Tumor Multimodality Treatment, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China; West China School of Nursing, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China; Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Hongxiu Chen
- West China School of Nursing, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China; Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Wenli Jing
- Department of Ultrasound, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Lihui Pu
- Menzies Health Institute & School of Nursing and Midwifery, Griffith University, PO Box 4111, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
| | - Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Xiaotian Su
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Huirong Chen
- Division of Head & Neck Tumor Multimodality Treatment, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Juan Liu
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Huaqin Yu
- Division of Head & Neck Tumor Multimodality Treatment, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Xiuying Hu
- Department of Ultrasound, West China Hospital, Sichuan University, PO Box 610041, No.37 Guo Xue Street, Chengdu, Sichuan Province, PR China
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10
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Masini M, Toma M, Spallarossa P, Porto I, Ameri P. Direct Oral Anticoagulants for Cancer-Associated Venous Thromboembolism. Curr Oncol Rep 2023; 25:979-987. [PMID: 37278934 PMCID: PMC10474987 DOI: 10.1007/s11912-023-01428-y] [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: 05/02/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE OF REVIEW To present the randomized controlled trial (RCT) evidence and highlight the areas of uncertainty regarding direct oral anticoagulants (DOAC) for cancer-associated venous thromboembolism (CAT). RECENT FINDINGS In the last years, four RCTs have shown that rivaroxaban, edoxaban, and apixaban are at least as effective as low-molecular-weight heparin (LMWH) for the treatment of both incidental and symptomatic CAT. On the other hand, these drugs increase the risk of major gastrointestinal bleeding in patients with cancer at this site. Another two RCTs have demonstrated that apixaban and rivaroxaban also prevent CAT in subjects at intermediate-to-high risk commencing chemotherapy, albeit at the price of higher likelihood of bleeding. By contrast, data are limited about the use DOAC in individuals with intracranial tumors or concomitant thrombocytopenia. It is also possible that some anticancer agents heighten the effects of DOAC via pharmacokinetic interactions, up to making their effectiveness-safety profile unfavorable. Leveraging the results of the aforementioned RCTS, current guidelines recommend DOAC as the anticoagulants of choice for CAT treatment and, in selected cases, prevention. However, the benefit of DOAC is less defined in specific patient subgroups, in which the choice of DOAC over LMWH should be carefully pondered.
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Affiliation(s)
- Marta Masini
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6 - 16132, Genoa, Italy
| | - Matteo Toma
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6 - 16132, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6 - 16132, Genoa, Italy.
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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11
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Giustozzi M, Franco L, Agnelli G, Verso M. Unmet clinical needs in the prevention and treatment of cancer-associated venous thromboembolism. Trends Cardiovasc Med 2023; 33:336-343. [PMID: 35150850 DOI: 10.1016/j.tcm.2022.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 12/11/2022]
Abstract
Venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, is a leading cause of morbidity and mortality in patients with cancer. Based on accumulating evidence, the prophylaxis and treatment of cancer-associated VTE have been changed over the years. Recently, the introduction in clinical practice of the direct oral anticoagulants has radically changed the management of cancer-associated VTE for their easier use and non-inferior efficacy-safety profile compared to low-molecular-weight heparins. However, the heterogeneity of the cancer population in terms of site, type and stage of the malignancy, the presence of comorbidities, and the variability in cancer treatment and prognosis represent major challenges in the management of VTE in patients with cancer. In the present review, we will discuss clinical questions that represent unsolved issues in the setting of cancer-associated VTE and provide an overview on recent evidence on this topic: primary prophylaxis in ambulatory cancer patients treated with chemotherapy and in cancer surgical patients, need of long-term anticoagulation in cancer patients, treatment of VTE in cancer patients at increased bleeding risk and in special categories such as incidental VTE, splanchnic vein thrombosis or catheter-related thrombosis.
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Affiliation(s)
- Michela Giustozzi
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Piazzale Menghini 1, Perugia 06129, Italy.
| | - Laura Franco
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Piazzale Menghini 1, Perugia 06129, Italy
| | - Giancarlo Agnelli
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Piazzale Menghini 1, Perugia 06129, Italy
| | - Melina Verso
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Piazzale Menghini 1, Perugia 06129, Italy
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12
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Ligia S, Musiu P, Serrao A, Santoro C, Taglietti A, Capriata M, Faccini A, Molinari MC, Baldacci E, Chistolini A. Low-dose apixaban or rivaroxaban as secondary prophylaxis of upper extremity deep vein thrombosis. J Thromb Thrombolysis 2023:10.1007/s11239-023-02842-6. [PMID: 37341894 DOI: 10.1007/s11239-023-02842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
Upper extremity deep vein thrombosis (UEDVT) may occur without inciting factor or may be secondary to malignancy, surgery, trauma, central venous catheter or related to thoracic outlet syndrome (TOS). International guidelines recommend anticoagulant treatment for at least three months, in particular the use of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). No data on extended anticoagulant therapy and reduced dose of DOACs have been reported in patients affected by UEDVT with persistent thrombotic risk (active cancer, major congenital thrombophilia) or without affected vein recanalization. In our retrospective observational study, including 43 patients, we treated secondary UEDVT with DOACs. In the acute phase of thrombosis (median time of 4 months), we used therapeutic dose of DOACs; the 32 patients with permanent thrombotic risk factors or without recanalization of the UEDVT were shifted to low-dose DOACs (apixaban 2.5 mg twice daily or rivaroxaban 10 mg daily). During therapy with full-dose DOACs, 1 patient presented recurrence of thrombosis; no thromboembolic events were observed during treatment with low-dose DOACs. During full-dose treatment, 3 patients presented minor hemorrhagic complications; no hemorrhagic events were observed during DOACs at low dose. We think our preliminary data could support the indication to extend the anticoagulation with dose reduction of DOACs in patients affected by UEDVT and no-transient thrombotic risk. These data should be confirmed in randomized controlled prospective study.
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Affiliation(s)
- S Ligia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - P Musiu
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Serrao
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Taglietti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - M Capriata
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Faccini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - M C Molinari
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy.
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13
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Singh O, Juneja D. Upper extremity deep vein thrombosis: An intensivist’s perspective. World J Crit Care Med 2023; 12:130-138. [PMID: 37397592 PMCID: PMC10308337 DOI: 10.5492/wjccm.v12.i3.130] [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: 12/29/2022] [Revised: 03/16/2023] [Accepted: 04/20/2023] [Indexed: 06/08/2023] Open
Abstract
Upper extremity deep vein thrombosis (UEDVT) is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients. Increasing cancer incidence, prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT. It is also associated with high rates of complications like pulmonary embolism, post-thrombotic syndrome and recurrent thrombosis. Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT; hence, a high suspicion index is required for diagnosis. Doppler ultrasound is commonly employed for diagnosis, but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients. Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies. Anticoagulant therapy alone is sufficient in most patients, and thrombolysis and surgical decompression is seldom indicated. The outcome depends on the cause and underlying comorbidities.
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Affiliation(s)
- Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
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14
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Falanga A, Ay C, Di Nisio M, Gerotziafas G, Jara-Palomares L, Langer F, Lecumberri R, Mandala M, Maraveyas A, Pabinger I, Sinn M, Syrigos K, Young A, Jordan K. Venous thromboembolism in cancer patients: ESMO Clinical Practice Guideline. Ann Oncol 2023; 34:452-467. [PMID: 36638869 DOI: 10.1016/j.annonc.2022.12.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- A Falanga
- Division of Immunohaematology and Transfusion Medicine, Haemostasis and Thrombosis Center, Department of Oncology and Haematology, Hospital Papa Giovanni XXIII, Bergamo, Italy; University of Milan Bicocca, Department of Medicine and Surgery, Monza, Italy
| | - C Ay
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - M Di Nisio
- Department of Medicine and Ageing Sciences, G. d'Annunzio University, Chieti, Italy
| | - G Gerotziafas
- Sorbonne University, INSERM UMRS-938, Team "Cancer Vessels, Biology and Therapeutics", Group "Cancer-Hemostasis-Angiogenesis", Institut Universitaire de Cancérologie, Consultation Thrombosis in Oncology (COTHON), Tenon-Saint Antoine Hospital, AP-HP, Paris, France
| | - L Jara-Palomares
- Respiratory Department, Medical Surgical Unit of Respiratory Diseases, Hospital Virgen del Rocio, Sevilla; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - F Langer
- Centre for Oncology, University Cancer Centre Hamburg (UCCH), II Medical Clinic and Polyclinic, University Medical Centre Eppendorf, Hamburg, Germany
| | - R Lecumberri
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona (Navarra); CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - M Mandala
- University of Perugia, Unit of Medical Oncology, Santa Maria Misericordia Hospital, Perugia, Italy
| | - A Maraveyas
- Queen's Centre for Oncology and Haematology, Faculty of Health Sciences, Hull York Medical School and Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - I Pabinger
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - M Sinn
- Centre for Oncology, University Cancer Centre Hamburg (UCCH), II Medical Clinic and Polyclinic, University Medical Centre Eppendorf, Hamburg, Germany
| | - K Syrigos
- Oncology Unit, 3rd Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Young
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - K Jordan
- Department of Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam, Germany; Department of Rheumatology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
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15
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Chiu J, Lazo-Langner A. Venous thromboembolism in hematopoietic stem cell transplantation: A narrative review. Thromb Res 2023; 226:141-149. [PMID: 37150028 DOI: 10.1016/j.thromres.2023.04.019] [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: 02/07/2023] [Revised: 03/28/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023]
Abstract
Venous thromboembolism (VTE) is a common complication of hematopoietic stem cell transplantation (HSCT) and its treatment has significant effects on morbidity and non-relapse mortality. There is a complex interplay on balancing the risk for thrombosis and bleeding in these patients, making treatment decisions particularly challenging. Despite this, there are currently no validated risk assessment models or guidelines to aid clinical decision making on thromboprophylaxis and VTE treatment in this population of patients. Herein, we review the many risk factors for VTE in HSCT patients, categorized into patient, disease, catheter, treatment, laboratory, and transplant-related variables. This review also discusses current thromboprophylaxis and VTE management strategies in HSCT patients, with scope into the development of risk assessment models that allow for identification of high-risk subgroups who may benefit from targeted intervention.
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Affiliation(s)
- Jodi Chiu
- Department of Medicine, Division of Hematology, Western University, London, ON, Canada
| | - Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
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16
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Cohen AT, Benson G, Bradbury CA, Choudhuri S, Hutchinson Jones N, Maraveyas A, Venugopal B, Young AM, Chapman C, McIntyre S, Burney D, Pollock KG, Morgan AR, Gabb PD, Alikhan R. A consensus viewpoint on the role of direct factor Xa inhibitors in the management of cancer-associated venous thromboembolism in the UK. Curr Med Res Opin 2023; 39:483-495. [PMID: 36629478 DOI: 10.1080/03007995.2023.2167441] [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] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Cancer patients are at high risk of venous thromboembolism (VTE), a significant cause of cancer-related death. Historically, low molecular weight heparins (LMWH) were the gold standard therapy for cancer-associated VTE, but recent evidence supports the use of direct factor Xa inhibitors in cancer-associated VTE and this is now reflected in many guidelines. However, uptake of direct factor Xa inhibitors varies and guidance on the use of direct factor Xa inhibitors in specific cancer sub-populations and clinical situations is lacking. This review presents consensus expert opinion alongside evaluation of evidence to support healthcare professionals in the use of direct factor Xa inhibitors in cancer-associated VTE. METHODS Recent guidelines, meta-analyses, reviews and clinical studies on anticoagulation therapy for cancer-associated VTE were used to direct clinically relevant topics and evidence to be systematically discussed using nominal group technique. The consensus manuscript and recommendations were developed based on these discussions. RESULTS Considerations when prescribing anticoagulant therapy for cancer-associated VTE include cancer site and stage, systemic anti-cancer therapy (including vascular access), drug-drug interactions, length of anticoagulation, quality of life and needs during palliative care. Treatment of patients with kidney or liver impairment, gastrointestinal disorders, extremes of bodyweight, elevated bleeding or recurrence risk, VTE recurrence and COVID-19 is discussed. CONCLUSION Anticoagulant therapy for cancer-associated VTE patients should be carefully selected with consideration given to the relative benefits of specific drugs when individualizing care. Direct factor Xa inhibitors are typically the treatment of choice for preventing VTE recurrence in non-cancer patients and should also be considered as such for cancer-associated VTE in most situations.
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Affiliation(s)
- Alexander T Cohen
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Gary Benson
- Northern Ireland Haemophilia Comprehensive Care Centre and Thrombosis Unit, Belfast, UK
| | | | | | | | | | - Balaji Venugopal
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Annie M Young
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | | | | | | | | | - Peter D Gabb
- Health Economics and Outcomes Research Ltd., Cardiff, UK
| | - Raza Alikhan
- Haemophilia and Thrombosis Centre, University Hospital of Wales, Cardiff, UK
- Cardiff University School of Medicine, Cardiff, UK
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17
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Huang W, Chen Y, Liu Z, Huang Y, Hu Y. Treatment of pacemaker-induced superior vena cava syndrome by direct oral anticoagulant. Thromb J 2023; 21:19. [PMID: 36782246 PMCID: PMC9926563 DOI: 10.1186/s12959-023-00459-6] [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: 08/07/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The use of cardiac implantable electronic devices has grown substantially over the past two decades, lead-related vascular issues are commonly encountered in clinical practice. Superior vena cava (SVC) syndrome due to pacemaker leads is an uncommon complication. Anticoagulation remains the mainstay of therapy to restore some degree of patency and relieve swelling. However, there are limited clinical trials on direct oral anticoagulants (DOACs). CASE PRESENTATION We report a case of an 80-year-old man who developed SVC syndrome after transvenous pacemaker implantation with symptoms of obstruction that were significantly relieved after four months of DOACs. His symptoms had completely resolved nine months later. CONCLUSIONS DOACs are effective in the treatment of SVC syndrome after pacemaker implantation, representing an important new approach. It is a very good choice for patients who do not want to undergo interventional therapy.
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Affiliation(s)
- Weijun Huang
- grid.284723.80000 0000 8877 7471Department of Cardiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Shunde, Foshan, China
| | - Yingwen Chen
- grid.284723.80000 0000 8877 7471Department of Cardiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Shunde, Foshan, China
| | - Ziwei Liu
- grid.284723.80000 0000 8877 7471Department of Radiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Shunde, Foshan, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Shunde, Foshan, China.
| | - Yunzhao Hu
- Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Shunde, Foshan, China.
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18
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Xu J, Wang G, Chen X, Shen Y, Wang X, Wang H. Efficacy and safety of rivaroxaban for the treatment of PICC-related upper extremity deep vein thrombosis in cancer patients: a retrospective study. Thromb J 2023; 21:15. [PMID: 36726149 PMCID: PMC9890768 DOI: 10.1186/s12959-023-00456-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The optimal duration and choice of anticoagulant for the treatment of Peripherally inserted central catheters (PICC)-related upper extremity deep vein thrombosis (UEDVT) in cancer patients are still undetermined. OBJECTIVES The aim of this study was to assess the efficacy and safety of rivaroxaban for the treatment of PICC-related UEDVT in cancer patients. METHODS We conducted a retrospective cohort study including consecutive cancer patients for the management of acute symptomatic PICC-related UEDVT. The efficacy outcome of the study was the 180-day recurrence of any venous thromboembolism (VTE), while the safety outcome was the 180-day incidence of all bleeding events. The Kaplan‒Meier method was used to estimate the overall incidence. Hazard ratios (HRs) were obtained with a Cox proportional hazards model to estimate the risk of the outcome events. RESULTS A total of 217 patients were included in the final analysis with a median age of 56 years old, 41.5% of whom had metastases. After the initial 3-5 days of nadroparin, patients received sequential anticoagulation, either with nadroparin (118 patients) or with rivaroxaban (99 patients). Four patients with recurrent VTE were observed (nadroparin, n = 2; rivaroxaban, n = 2). The 180-day cumulative VTE recurrence rates were 1.7% and 2.0% (p = 0.777) in patients receiving nadroparin and rivaroxaban, respectively. The overall bleeding rate at 180 days was 8.8%. Although no major bleeding events were observed, nineteen patients with clinically relevant nonmajor bleeding (CRNMB) were observed. The 180-day cumulative rate of CRNMB was 5.1% for nadroparin and 13.1% for rivaroxaban (HR = 3.303, 95% CI 1.149-9.497, p = 0.027). CONCLUSION Our study supported the efficacy of rivaroxaban for treating PICC-related UEDVT in cancer patients. However, data on anticoagulation therapy for PICC-related UEDVT presented with a low risk of VTE recurrence and a relatively high risk of CRNMB bleeding events. Considering the risk-benefit ratio, further well-designed trials are required to optimize the drug selection and duration for the treatment of PICC-related UEDVT in cancer patients.
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Affiliation(s)
- Jiaxuan Xu
- grid.412474.00000 0001 0027 0586Department of Critical Care Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Guodong Wang
- grid.412474.00000 0001 0027 0586Department of Critical Care Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaojie Chen
- grid.412474.00000 0001 0027 0586Department of Critical Care Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yanfen Shen
- grid.412474.00000 0001 0027 0586Department of Critical Care Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Xinpeng Wang
- grid.412474.00000 0001 0027 0586Department of Critical Care Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongzhi Wang
- grid.412474.00000 0001 0027 0586Department of Critical Care Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
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Guan Z, Wang R, Hussain RH, Fredenburgh JC, Jaffer IH, Weitz JI. Rivaroxaban and apixaban are less effective than enoxaparin for the prevention of catheter-induced clotting in vitro. JOURNAL OF THROMBOSIS AND HAEMOSTASIS : JTH 2023; 21:76-82. [PMID: 36695399 DOI: 10.1016/j.jtha.2022.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/17/2022] [Accepted: 10/29/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Central venous catheters are prone to clotting, particularly in patients with cancer. Although low-molecular-weight heparin and direct oral anticoagulants, such as apixaban and rivaroxaban, have been evaluated for the prevention of catheter thrombosis, their efficacy remains uncertain. OBJECTIVES Compare apixaban and rivaroxaban with enoxaparin for the prevention of catheter-induced clotting in vitro. METHODS To address this uncertainty, we used a well-established microplate-based assay to compare the effects of enoxaparin, apixaban, and rivaroxaban on catheter-induced thrombosis and thrombin generation in human plasma. RESULTS Consistent with our previous findings, catheter segments shortened the clotting time and promoted thrombin generation. When compared at concentrations with similar anti-factor Xa activity as enoxaparin, apixaban and rivaroxaban were >20-fold less potent than enoxaparin for the prevention of catheter-induced clotting and thrombin generation. CONCLUSION The prevention of catheter thrombosis in patients with cancer is challenging. Clinical trials are needed to compare the efficacy of low-molecular-weight heparin with that of direct oral anticoagulants both for the prevention and treatment of catheter thrombosis.
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Affiliation(s)
- Zeyu Guan
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Roxanna Wang
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rawaa H Hussain
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James C Fredenburgh
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Iqbal H Jaffer
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada.
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Wang TF. The 5 most frequently asked questions about factor Xa inhibitors. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:515-521. [PMID: 36485108 PMCID: PMC9821165 DOI: 10.1182/hematology.2022000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Direct oral anticoagulants (DOACs) are commonly used oral factor Xa inhibitors in recent years. However, in some special clinical situations, the appropriate use of these anticoagulants may be of concern. In this article, we address the 5 commonly asked questions regarding their use for the treatment of venous thromboembolism, including in the setting of obesity, renal impairment, gastrointestinal (GI) malignancy, catheter-related thrombosis, and drug-drug interactions. Data on the use of DOACs in the presence of significant obesity or renal failure are mainly observational. Some DOACs are shown to have an increased risk of bleeding in patients with unresected luminal GI malignancy but not others, so selection of appropriate patients is the key. Furthermore, literature on the use of DOACs for catheter-related thrombosis or when drug-drug interactions are of concern is limited, and more research is welcome.
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Affiliation(s)
- Tzu-Fei Wang
- Correspondence Tzu-Fei Wang, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 201A, Ottawa, ON K1H 8L6, Canada; e-mail:
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21
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Zalunardo B, Panzavolta C, Bigolin P, Visonà A. Multidisciplinary Care for the Prevention and Treatment of Venous Thromboembolism in Patients with Cancer-Associated Thrombosis (CAT): Impact of Educational Interventions on CAT-Related Events and on Patients' and Clinicians' Awareness. Life (Basel) 2022; 12:life12101594. [PMID: 36295029 PMCID: PMC9605479 DOI: 10.3390/life12101594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/20/2022] [Accepted: 10/05/2022] [Indexed: 05/27/2023] Open
Abstract
Cancer is a leading cause of death. Venous thromboembolism (VTE) is an often-overlooked cause of morbidity and mortality in cancer patients that can be readily prevented and treated. Actions are needed to reduce the morbidity and mortality of patients with cancer-associated thrombosis (CAT). There is a need to increase awareness of the impact of CAT on cancer patients' morbidity and mortality, on their quality of life and to understand the importance of more effective preventions and treatments of VTE in cancer patients. Moreover, it is of great importance to systematically assess the risk of VTE in regard to patients, cancer and treatment-related factors. Unfortunately, there are unmet clinical needs in the prevention and treatment of cancer-associated VTE. In this review, we discuss an action plan to ensure an increased awareness of and education on the issues that need to be addressed in order to improve the provision of appropriate prevention, early diagnosis and effective and safe treatment of VTE to all cancer patients and, ultimately, to reduce morbidity and mortality.
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22
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Matzdorff A. Venous Thromboembolism in Women with Cancer with an Additional Focus on Breast and Gynecological Cancers. Hamostaseologie 2022; 42:309-319. [DOI: 10.1055/a-1913-2873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractCancer-associated venous thromboembolism (VTE) is common in women with cancer. Many clinical practice guidelines provide guidance for prevention and treatment; however, there are no specific recommendations for women. This is unfortunate because the proportion of women with breast- and gynecological cancers is high among patients with cancer-associated VTE. Thromboembolism often heralds cancer progression and poor prognosis and should—besides adequate anticoagulant management—also prompt reassessment and, if necessary, changes in cancer treatment. Recently, the new class of direct-acting oral anticoagulants (DOACs) has started to replace low-molecular-weight heparin as standard thromboprophylaxis and therapy in cancer patients. They are very effective, but they also carry a relevant risk of bleeding. Therefore, despite their ease of use, not every tumor patient qualifies for a DOAC, and this is especially true for gynecological tumor patients. Each prescription must be weighed individually. This review addresses specific aspects of VTE prophylaxis and management in women with cancer. Every physician who treats breast and gynecological cancers should be familiar with prophylaxis, diagnosis, and therapy of cancer-associated VTE. At the same time, patients should be informed by their physician what symptoms to look for and whom to contact if these symptoms occur, even outside of office hours and on weekends.
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Affiliation(s)
- Axel Matzdorff
- Department of Internal Medicine II, Asklepios Clinic Uckermark, Schwedt, Germany
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23
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Catheter-related thrombosis (CRT) in patients with solid tumors: a narrative review and clinical guidance for daily care. Support Care Cancer 2022; 30:8577-8588. [PMID: 35932317 DOI: 10.1007/s00520-022-07297-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
Central venous access devices (CVADs) including central venous catheters and peripherally inserted central catheters (PICCs) are essential in the treatment of cancer. Catheter-related thrombosis (CRT) is the most frequent non-infectious complication associated with the use of central lines. The development of CRT may cause to delays in oncologic treatment and increase morbidity leading to potentially life-threatening complications. Several local and systemic risk factors are associated with the development of CRT and should be taken into account to prevent CRT by standardizing appropriate catheter placement and maintenance. The use of primary pharmacological thromboprophylaxis in order to avoid CRT is not routinely recommended, although it can be considered in selected cases. Recommendations for the management of established CRT are based on the extrapolation of anticoagulation for lower limb venous thrombosis. The present review summarizes the current evidence and recommendations for the prevention and management of CRT and identifies areas that require further research.
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Porfidia A, Cammà G, Coletta N, Bigossi M, Giarretta I, Lupascu A, Scaletta G, Porceddu E, Tondi P, Scambia G, Ferrandina G, Pola R. A Single Center Retrospective Cohort Study Comparing Different Anticoagulants for the Treatment of Catheter-Related Thrombosis of the Upper Extremities in Women With Gynecologic and Breast Cancer. Front Cardiovasc Med 2022; 9:880698. [PMID: 35837602 PMCID: PMC9273836 DOI: 10.3389/fcvm.2022.880698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCatheter-related thrombosis (CRT) of the upper extremities is a frequent complication among cancer patients that carry a central venous catheter (CVC) and may lead to pulmonary embolism (PE) and loss of CVC function. Despite its clinical impact, no anticoagulant treatment scheme has been rigorously evaluated in these patients. In addition, there is no proven evidence that direct oral anticoagulants (DOACs) are efficacious and safe in this setting because cancer patients with CRT of the upper extremities were not included in the clinical trials that led to the approval of DOACs for the treatment of cancer-associated venous thromboembolism (VTE).MethodsWe performed a single center retrospective cohort study on women with gynecologic or breast cancer treated with either low-molecular-weight heparin, fondaparinux, or DOACs for CRT of the upper extremities. Only patients who received anticoagulation at the proper therapeutic dose and for at least 3 months were included in the analysis. Effectiveness was evaluated in terms of preservation of line function, residual thrombosis, and recurrence of VTE (including PE). Safety was evaluated in terms of death, major bleeding (MB), and clinically relevant non-major bleeding (CRNMB).ResultsWe identified 74 women who fulfilled the criteria to be included in the analysis. Of these, 31 (41.9%) had been treated with fondaparinux, 21 (28.4%) with enoxaparin, and 22 (29.7%) with the DOAC edoxaban. We found no differences between patients treated with the three different therapeutic approaches, in terms of preservation of line function, incidence of residual thrombosis, and VTE recurrence (including PE). Safety was similar as well, with no MBs recorded in any treatment group.ConclusionThese results, although retrospective and based on a relatively small sample size, indicate that, in women with gynecologic or breast cancer, CRT of the upper extremities may be treated with similar effectiveness and safety with fondaparinux, enoxaparin, and edoxaban. Further studies are needed to substantiate these findings.
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Affiliation(s)
- Angelo Porfidia
- Section of Internal Medicine and Thromboembolic Diseases, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Cammà
- Section of Internal Medicine and Thromboembolic Diseases, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Coletta
- Section of Internal Medicine and Thromboembolic Diseases, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Margherita Bigossi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Population Health and Genomics, School of Medicine, Pat Macpherson Centre for Pharmacogenomics and Pharmacogenetics, University of Dundee, Dundee, United Kingdom
| | - Igor Giarretta
- Section of Internal Medicine and Thromboembolic Diseases, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Andrea Lupascu
- Section of Internal Medicine and Thromboembolic Diseases, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Scaletta
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrica Porceddu
- Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Angiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paolo Tondi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Division of Angiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Pola
- Section of Internal Medicine and Thromboembolic Diseases, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Roberto Pola
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Best practice & research: Clinical hematology review on thrombosis and bleeding in hematological malignancy. Best Pract Res Clin Haematol 2022; 35:101353. [DOI: 10.1016/j.beha.2022.101353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 01/19/2023]
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Valeriani E, Di Nisio M, Porceddu E, Agostini F, Pola R, Spoto S, Donadini MP, Ageno W, Porfidia A. Anticoagulant treatment for upper extremity deep vein thrombosis: A systematic review and meta-analysis. J Thromb Haemost 2022; 20:661-670. [PMID: 34846783 DOI: 10.1111/jth.15614] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Data on anticoagulant treatment for upper extremity deep vein thrombosis (UEDVT) are largely derived from studies on usual site venous thromboembolism (VTE). OBJECTIVES The objective of this meta-analysis was to evaluate the efficacy and safety of anticoagulant therapy for UEDVT. PATIENTS/METHODS A systematic search of MEDLINE and EMBASE was conducted for studies including patients with UEDVT. Primary outcomes were recurrent VTE and major bleeding. Secondary outcomes included clinically-relevant non-major bleeding and all-cause mortality. Summary estimates with 95% confidence intervals (CIs) were calculated by random-effect meta-analysis. RESULTS A total of 1473 patients from 11 prospective and nine retrospective studies were included. Sixty percent of patients had an indwelling catheter and 56.1% had cancer. Anticoagulant treatment consisted of direct oral anticoagulants, low molecular weight heparin followed by vitamin K antagonists, and low molecular weight heparin alone in 45.1%, 35.0%, and 19.9% of patients, respectively. During a median follow-up of 13 months, recurrent VTE occurred in 3% of patients (95% CI: 2-4; 21/1334 patients), major bleeding in 3% (95% CI: 2%-5%; 29/1235 patients), clinically-relevant non-major bleeding in 4% (95% CI: 3-6; 40/1075 patients), and all-cause mortality in 9% (95% CI: 5-15; 108/1084 patients). Rates of these outcomes were not significantly different between patients with or without cancer, patients with or without an indwelling catheter, and among those receiving different anticoagulant treatments. CONCLUSIONS In patients with UEDVT, anticoagulant treatment is associated with a low risk of recurrent VTE and a nonnegligible risk of major bleeding.
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Affiliation(s)
- Emanuele Valeriani
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Enrica Porceddu
- Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Fabiana Agostini
- Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Roberto Pola
- Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Walter Ageno
- Department of Clinical Medicine, University of Insubria, Varese, Italy
| | - Angelo Porfidia
- Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
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Ageno W. Treatment of Atypical Clots. Hamostaseologie 2022; 42:10-18. [PMID: 35196729 DOI: 10.1055/a-1669-3336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The term unusual site thrombosis refers to the occurrence of venous thromboembolism outside of the lower limbs and the pulmonary arteries. Unusual site thrombosis can virtually affect any venous segment, with the most common and/or clinically relevant sites including the upper limbs veins, the retinal veins, the splanchnic veins and the cerebral veins. Clinical features are obviously heterogeneous, while many predisposing factors are common, though with different prevalence among the various disorders. Antithrombotic therapy is prescribed to most patients, but the type, intensity, and duration of treatment vary both within and among patient groups. Increasing evidence is supporting the use of the direct oral anticoagulants in patients with upper limb deep vein thrombosis, cerebral vein thrombosis, and with splanchnic vein thrombosis. This article will review available evidence on the treatment of venous thrombosis occurring in unusual sites.
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Affiliation(s)
- Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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29
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Turrian U, Lapebie FX, Bura-Rivière A. Duration of anticoagulation for upper extremity deep vein thrombosis associated with cancer and central venous catheter: Outcome of a cohort study. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:11-18. [PMID: 35393086 DOI: 10.1016/j.jdmv.2022.01.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In cancer patients with catheter-associated upper extremity deep vein thrombosis, 3 months of anticoagulation is recommended. The main objective of this study was to compare the incidence of thrombosis recurrence in these patients in case of continuation or discontinuation of anticoagulation, at the end of 3 months and after catheter has been removed. The secondary objectives were the incidence of major bleeding and death. MATERIAL AND METHODS We conducted a retrospective cohort study including patients with a cancer and a catheter-associated upper extremity deep vein thrombosis. RESULTS About 60 patients included, 44 stopped anticoagulation after the first 3 months and 16 continued it. The median time between catheter insertion and deep vein thrombosis was 26±83 days. Three recurrences occurred during the one-year follow-up: 2 in the group who stopped anticoagulation, with a cumulative incidence at 1 year of 4,8% (95%IC 1.2-18.1) and 1 in the group who continued anticoagulation, with a cumulative incidence at 1 year of 14.3% (95%IC 2.1-66.6). No major bleeding event occurred in anticoagulation discontinued group. The group who stopped anticoagulation was significantly associated with a lower risk of death (HR 0.21-95%IC 0.09-0.48, P<0.001). CONCLUSION The risk of recurrence in cancer patients with a catheter-associated upper extremity deep vein thrombosis was low and statistically comparable between the group who stopped anticoagulation and the group who continued it. These results suggest that anticoagulation after the first 3 months deserves to be considered when catheter is removed.
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Affiliation(s)
- U Turrian
- Vascular medicine department, Toulouse university hospital, Toulouse, France.
| | - F X Lapebie
- Vascular medicine department, Toulouse university hospital, Toulouse, France
| | - A Bura-Rivière
- Vascular medicine department, Toulouse university hospital, Toulouse, France
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A prospective cohort study of catheter-related thrombosis in cancer patients treated with 1 month of anticoagulation after catheter removal. Blood Coagul Fibrinolysis 2022; 33:171-175. [PMID: 34980834 DOI: 10.1097/mbc.0000000000001122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The duration of anticoagulation in patients with catheter-related thrombosis (CRT) is not standardized. This is a multiinstitutional prospective pilot study in patients with cancer and upper extremity CRT. Patients received therapeutic enoxaparin for 1 month after catheter removal. Incidence of recurrent thrombosis, hemorrhage, and postthrombotic syndrome (PTS) using the modified Villalta scale, and functional limitation using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were assessed at months 1, 3, and 6 after catheter removal. Clopper-Pearson exact 95% confidence intervals (CI), Pearson correlations, and Skillings-Mack, and Wilcoxon signed ranks tests were done. Twenty-seven patients from three institutions were enrolled. Feasibility outcomes were not met. Seventy percent (n = 19) of the cohort had hematologic malignancies. Excluding two patients who were still on enoxaparin at study withdrawal, the median total duration of therapeutic enoxaparin was 32 [interquartile range (IQR) 30-52] days in the remaining 25 patients. During the 6 months after catheter removal, the incidence of recurrent thrombosis was 0% (n = 0/20, 95% CI 0-17%) and major hemorrhage was 5% (n = 1/20, 95% CI 0.13-25%). One patient (5%, 95% CI 0.13-25%) had PTS in the affected arm at any visit, and none had severe PTS. Higher PTS scores were associated with higher DASH scores. DASH scores at month 6 were significantly lower compared with month 1 (P = 0.0066). No deaths occurred. A multicenter pilot study of treatment with anticoagulation for 1 month after catheter removal did not meet feasibility outcomes but we found no recurrent thrombosis and a low incidence of PTS.
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Salgado M, Brozos-Vázquez E, Campos B, González-Villarroel P, Pérez ME, Vázquez-Tuñas ML, Arias D. Venous Thromboembolism In Cancer Patients: "From Evidence to Care". Clin Appl Thromb Hemost 2022; 28:10760296221098717. [PMID: 35538861 PMCID: PMC9102132 DOI: 10.1177/10760296221098717] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This article seeks to review the current status of treatment and prevention of venous thromboembolic disease (VTE) in cancer patients after the addition of direct oral anticoagulants (DOAC) to the therapeutic arsenal available. The suitability of DOAC use in complex clinical situations, poorly represented in clinical trials, is controversial and difficult for care activity, making the recommendations in clinical practice guidelines the focus of special attention in this area. Recently, several randomized trials have compared low molecular weight heparin (LMWH) to DOAC for the management of CAT. Potential drug interactions with DOACs or the increased risk of bleeding in intraluminal tumors require special precautions, as do metastatic or primary brain disease and comorbid conditions, such as renal or liver failure, which are not suitably represented in pivotal studies. Furthermore, few data are available for situations involving elevated bleeding risk, with thrombocytopenia levels below the inclusion criterion of clinical trials, or recurrence during active anticoagulant therapy. Similarly, it is less clear that patients and physicians accept the presumption that oral DOAC administration is more convenient than subcutaneous LMWH, particularly when drug absorption may be compromised. The non-inclusion or under-representation of patients at higher risk for complications with anticoagulation in randomized clinical trials, makes their use complex in certain situations in health care. This paper provides a practical review of current clinical guideline recommendations regarding LMWH and/ or DOAC to treat and prevent CAT, as well as the most controversial clinical conditions for their use.
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Affiliation(s)
- Mercedes Salgado
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Elena Brozos-Vázquez
- Medical Oncology Department, 59535Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Begoña Campos
- Medical Oncology Department, 309716Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | - María Eva Pérez
- Medical Oncology Department, 16811Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - David Arias
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
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Carrier M, Blais N, Crowther M, Kavan P, Le Gal G, Moodley O, Shivakumar S, Suryanarayan D, Tagalakis V, Wu C, Lee AYY. Treatment Algorithm in Cancer-Associated Thrombosis: Updated Canadian Expert Consensus. Curr Oncol 2021; 28:5434-5451. [PMID: 34940092 DOI: 10.3390/curroncol28060453] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with cancer-associated thrombosis (CAT) are at high risk of recurrent venous thromboembolism (VTE) and major bleeding complications. Risks vary significantly between individuals based on cancer status, treatment, and other characteristics. To facilitate the evidence-based management of anticoagulant therapy in this patient population, a committee of 11 Canadian clinical experts updated a consensus-based algorithm for the acute and extended treatment of symptomatic and incidental CAT that was developed in 2018. Following a systematic review of the literature, updates to the algorithm were discussed during an online teleconference, and the algorithm was subsequently refined based on feedback from committee members. Clinicians using this treatment algorithm should consider bleeding risk, type of cancer, and drug-drug interactions, as well as patient and clinician preferences, in tailoring anticoagulation for patients with CAT. Anticoagulant therapy should be adapted as the patient's cancer status and management change over time.
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Affiliation(s)
- Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Normand Blais
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC H2L 4M1, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, ON L8N 4A6, Canada
| | - Petr Kavan
- Department of Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Otto Moodley
- Department of Hematology, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Sudeep Shivakumar
- Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, NS B3H 3A7, Canada
| | - Deepa Suryanarayan
- Department of Medicine, University of Calgary, Foothills Hospital, Calgary, AB T2N 2T9, Canada
| | - Vicky Tagalakis
- Department of Medicine, Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC H3T 1E2, Canada
| | - Cynthia Wu
- Department of Medicine, University of Alberta, Edmonton, AB T5J 2J7, Canada
| | - Agnes Y Y Lee
- Department of Medicine, University of British Columbia, British Columbia Cancer Agency, Vancouver, BC V5Z 4E6, Canada
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Debourdeau P, Lamblin A, Debourdeau T, Marcy PY, Vazquez L. Venous thromboembolism associated with central venous catheters in patients with cancer: From pathophysiology to thromboprophylaxis, areas for future studies. J Thromb Haemost 2021; 19:2659-2673. [PMID: 34363736 DOI: 10.1111/jth.15487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022]
Abstract
Symptomatic catheter related thrombosis (CRT) occurs in 4%-8% of cancer patients. The mean incidence of CRT, detected either by echography or Doppler ranges between 12 and 14% with a high negative predictive value of about 95%, allowing the subsequent occurrence of CRT (symptomatic and asymptomatic) to be safely excluded. Despite its frequency and its medico-economic consequences, no thromboprophylaxis has been validated to date. In most patients, CRT occurs immediately after catheter insertion, most often within the first week and almost all within the first month after insertion. Meta analyses show a reduction of asymptomatic and symptomatic CRT incidence by about 55%-60% using either vitamin K antagonists or low molecular weight heparins without an increased risk of major bleeding. This pharmacological prophylaxis is only effective when started before the central venous catheter insertion at prophylactic doses and thereafter continued at subtherapeutic doses. Since no population at high risk of CRT has been identified, this review focuses on pathophysiology, epidemiology and clinical supportive data that could lead to a new CRT prophylaxis strategy.
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Affiliation(s)
| | | | | | - Pierre Yves Marcy
- Department of Diagnosis & Interventional Imaging, Polyclinics Les Fleurs, Ollioules, France
| | - Léa Vazquez
- Supportive Care Unit, Sainte Catherine Institute, Avignon, France
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34
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Marin A, Bull L, Kinzie M, Andresen M. Central catheter-associated deep vein thrombosis in cancer: clinical course, prophylaxis, treatment. BMJ Support Palliat Care 2021; 11:371-380. [PMID: 34413028 PMCID: PMC8606430 DOI: 10.1136/bmjspcare-2019-002106] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Abstract
The adequate handling of central venous catheters is a key element in the management of patients with cancer. Catheter-associated deep vein thrombosis is frequently observed in patients with malignant diseases; however, despite being a common complication among these patients, objective information concerning its epidemiology, clinical course, prophylaxis and treatment strategies is very limited. The reported incidence of catheter-related thrombosis (CRT) is highly variable, depending on symptomatic events, or if patients are screened for asymptomatic thrombosis. Several factors have been identified as potential predisposing factors for CRT, both technical and pathological aspects. The anticoagulant of choice is still unclear; while low-molecular-weight heparin is most commonly used, recent studies assessing the role of direct oral anticoagulants in the treatment of CRT show promise as an alternative, but the evidence remains insufficient and the decision must be made on a case-by-case basis.
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Affiliation(s)
- Arnaldo Marin
- Department of Basic and Clinical Oncology, University of Chile Faculty of Medicine, Santiago, 8380453, Chile
| | - Leonardo Bull
- School of Medicine, University of Chile, Santiago, 8380453, Chile
| | - Matthew Kinzie
- Neurosciences, University of Texas Health, Houston, Texas, USA
| | - Max Andresen
- Intensive Care Department, Facultad de Medicina . Pontificia Universidad Catolica de Chile, Santiago, 8330077, Chile
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Potere N, Candeloro M, Porreca E, DI Nisio M. Management of upper extremity deep vein thrombosis: an updated review of the literature. Minerva Med 2021; 112:746-754. [PMID: 33969964 DOI: 10.23736/s0026-4806.21.07578-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Upper extremity deep vein thrombosis (UEDVT) represents about 5-10% of all cases of deep vein thrombosis (DVT) with a steadily increasing incidence mostly due to the high prevalence of cancer and frequent use of intravascular devices such as central venous catheters and pacemaker. In primary UEDVT, the venous outflow obstruction and subsequent thrombosis are related to congenital or acquired anatomical abnormalities, whereas secondary UEDVT is often associated with malignancy or indwelling lines. A considerable proportion of patients with UEDVT develops serious complications such as recurrent thrombosis, post-thrombotic syndrome, and pulmonary embolism, therefore timely diagnosis and adequate treatment are of crucial importance. Despite sharing many similarities with lower extremity DVT, UEDVT has distinctive features requiring specific diagnostic and therapeutic approaches. The present review discusses the latest evidence on the epidemiology, diagnosis, and treatment of UEDVT, and provides management indications which may help guide clinical decision making.
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Affiliation(s)
- Nicola Potere
- Department of Innovative Technologies in Medicine and Dentistry, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Matteo Candeloro
- Department of Medicine and Ageing Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Ettore Porreca
- Department of Innovative Technologies in Medicine and Dentistry, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marcello DI Nisio
- Department of Medicine and Ageing Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy -
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36
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Yuen HLA, Tran H, Chunilal S. Upper Extremity Deep Vein Thrombosis: Current Knowledge and Future Directions. Semin Thromb Hemost 2021; 47:677-691. [PMID: 33971684 DOI: 10.1055/s-0041-1725116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Upper extremity deep vein thrombosis (UEDVT) has been increasing in incidence due to the escalating use of central venous catheters such as peripherally inserted central catheters. UEDVT can be primary idiopathic or secondary to pacemaker leads, intravascular catheters or cancer. In comparison to conventional venous thromboembolism such as lower limb deep vein thrombosis or pulmonary embolism the risk factors, investigations, and management are not well defined. We review current evidence in primary and secondary UEDVT, highlighting areas in need of further research. We also explore the entity of venous thoracic outlet syndrome, which is said to be a risk factor for recurrent primary UEDVT and is the rationale behind surgical interventions.
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Affiliation(s)
- Hiu Lam Agnes Yuen
- Monash Haematology, Monash Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Huyen Tran
- Department of Medicine, Monash University, Melbourne, Australia
| | - Sanjeev Chunilal
- Monash Haematology, Monash Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
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Mahé I, Meyer G, Girard P, Bertoletti L, Laporte S, Couturaud F, Mismetti P, Sanchez O. [Treatment of cancer associated thrombosis. 2019 update of the French guidelines]. Rev Mal Respir 2021; 38:427-437. [PMID: 33858733 DOI: 10.1016/j.rmr.2021.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- I Mahé
- Service de Médecine Interne-Hôpital Louis Mourier, Assistance publique des Hôpitaux de Paris, Colombes, Université de Paris, Inserm UMR_S1140, Paris, F-CRIN INNOVTE, St-Etienne, France
| | - G Meyer
- Service de Pneumologie et de soins intensifs, Hôpital Européen Georges-Pompidou, Assistance publique des Hôpitaux de Paris, Inserm UMRS 970, Université de Paris, Inserm CIC 1418, Paris, F-CRIN INNOVTE, St-Etienne, France
| | - P Girard
- Institut du Thorax Curie-Montsouris, l'Institut mutualiste Montsouris, Paris, F-CRIN INNOVTE, St-Etienne, France
| | - L Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Inserm UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, Inserm, CIC-1408, Saint-Etienne, F-CRIN INNOVTE, Saint-Etienne, France
| | - S Laporte
- SAINBOIS U1059 équipe DVH, Université Jean-Monnet, Université de Lyon, Inserm, Unité de recherche clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, F-CRIN INNOVTE, St-Etienne, France
| | - F Couturaud
- Département de médecine interne et pneumologie, EA3878-GETBO, CIC_INSERM1412, université de Bretagne occidentale, centre hospitalo-universitaire de Brest, F-CRIN INNOVTE, St-Etienne, France
| | - P Mismetti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Inserm UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, Inserm, CIC-1408, Saint-Etienne, F-CRIN INNOVTE, Saint-Etienne, France
| | - O Sanchez
- Service de Pneumologie et de soins intensifs, Hôpital européen Georges-Pompidou, Assistance publique des Hôpitaux de Paris, Université de Paris, Inserm UMRS 1140, Paris, F-CRIN INNOVTE, St-Etienne, France.
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38
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Xiong W. Current status of treatment of cancer-associated venous thromboembolism. Thromb J 2021; 19:21. [PMID: 33789658 PMCID: PMC8010277 DOI: 10.1186/s12959-021-00274-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with cancer are prone to develop venous thromboembolism (VTE) that is the second leading cause of mortality among them. Cancer patients with VTE may encounter higher rates of VTE recurrence and bleeding complications than patients without cancer. Treatment of established VTE is often complex in patients with cancer. Treatment of cancer-associated VTE basically comprises initial treatment, long-term treatment, treatment within 6 months, treatment beyond 6 months, treatment of recurrent VTE, and treatment in special situations. Decision of antithrombotic therapy, selection of anticoagulants, duration of anticoagulation, decision of adjuvant therapy, and adjustment of regimen in special situations are the major problems in the treatment of cancer-associated VTE. Therapeutic anticoagulation is the key of the key in the treatment of cancer-associated VTE. In addition to the efficacy and safety of low-molecular-weight heparin (LMWH) that has been fully demonstrated, direct oral anticoagulants (DOACs) are increasingly showing its advantages along with the accompanying concern in the treatment of cancer-associated VTE. The latest ASCO, ITAC and NCCN guidelines agree with each other on most aspects with respect to the treatment of cancer-associated VTE, whereas differ on a few issues. Encompassing recent randomized controlled trials, clinical trials, and meta-analyses, as well as the comparison of the latest authoritative guidelines including the NCCN, ASCO, and ITAC guidelines in this field, the objective of this review is to present current overview and recommendations for the treatment of cancer-associated VTE.
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Affiliation(s)
- Wei Xiong
- Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
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Treatment of venous thromboembolism in cancer patients: The dark side of the moon. Cancer Treat Rev 2021; 96:102190. [PMID: 33812338 DOI: 10.1016/j.ctrv.2021.102190] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 02/08/2023]
Abstract
Venous thromboembolism (VTE) is a common complication in patients with cancer. The risk of emergent VTE is four- to seven-fold higher in cancer patients compared to non-cancer patients. Although the therapeutic armamentarium for cancer-associated VTE has been recently implemented, anticoagulant treatment remains challenging because of the increased risk of recurrent VTE and bleeding. Several international societies and expert panels released clinical practice guidelines on VTE treatment which are mostly focused on the general cancer population. Nevertheless, recommendations for the management of VTE in patients with peculiar clinical presentations are inconsistent and remain elusive due to the lack of pertinent evidence. The challenging clinical scenarios include, among others, patients with thrombocytopenia, renal impairment, gastrointestinal cancer, primary or metastatic brain cancer, distal thrombosis of the lower extremities, catheter-related VTE, splanchnic thrombosis, incidental VTE, extreme body weight, recurrent VTE during treatment, as well as the optimal duration of anticoagulant treatment in patients with active disease who have received 3 to 6 months of anticoagulation. Herein, we present a critical overview on VTE management in these challenging clinical settings, discuss potential approaches, and include some calls to action for future clinical research.
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Abstract
This review aims to describe the epidemiology, pathophysiology, risk factors, presentation, complications, evaluation/diagnosis, and treatment of upper extremity deep vein thrombosis (UEDVT). Upper extremity deep vein thrombosis (UEDVT) accounts for 6% of cases of deep vein thrombosis (DVT). It can lead to swelling and discomfort in that extremity and can be complicated by pulmonary embolism, post-thrombotic syndrome, and recurrence of DVT. Evaluation can begin with a dichotomized Constans score and fibrin degradation product testing. Diagnosis is typically made with compression ultrasound. Anticoagulation is the mainstay of therapy. Primary UEDVT is known as Paget Schroetter Syndrome (PSS) which occurs due to venous thoracic outlet syndrome (vTOS). Anticoagulation, thrombolysis, and decompression of the venous thoracic outlet are used for treatment but the optimal strategy remains to be elucidated. Secondary UEDVT are most commonly caused by indwelling catheters and malignancy. There is an ongoing realization that UEDVT are more than simply 'leg clots in the arm.' Given the increasing incidence, research needs to be done to further our understanding of this disease state, its evaluation, and its treatment.
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Affiliation(s)
- Oneib Khan
- Lankenau Medical Center - Internal Medicine, Wynnewood, PA, USA
| | - Ashley Marmaro
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - David A Cohen
- Mainline Healthcare Internal Medicine at Lankenau Medical Center, Sidney Kimmel Medical College, Wynnewood, PA, USA
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Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA, Leavitt AD, Lee AYY, Macbeth F, Morgan RL, Noble S, Sexton EA, Stenehjem D, Wiercioch W, Kahale LA, Alonso-Coello P. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv 2021; 5:927-974. [PMID: 33570602 PMCID: PMC7903232 DOI: 10.1182/bloodadvances.2020003442] [Citation(s) in RCA: 384] [Impact Index Per Article: 128.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common complication among patients with cancer. Patients with cancer and VTE are at a markedly increased risk for morbidity and mortality. OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the prevention and treatment of VTE in patients with cancer. METHODS ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The guideline development process was supported by updated or new systematic evidence reviews. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess evidence and make recommendations. RESULTS Recommendations address mechanical and pharmacological prophylaxis in hospitalized medical patients with cancer, those undergoing a surgical procedure, and ambulatory patients receiving cancer chemotherapy. The recommendations also address the use of anticoagulation for the initial, short-term, and long-term treatment of VTE in patients with cancer. CONCLUSIONS Strong recommendations include not using thromboprophylaxis in ambulatory patients receiving cancer chemotherapy at low risk of VTE and to use low-molecular-weight heparin (LMWH) for initial treatment of VTE in patients with cancer. Conditional recommendations include using thromboprophylaxis in hospitalized medical patients with cancer, LMWH or fondaparinux for surgical patients with cancer, LMWH or direct oral anticoagulants (DOAC) in ambulatory patients with cancer receiving systemic therapy at high risk of VTE and LMWH or DOAC for initial treatment of VTE, DOAC for the short-term treatment of VTE, and LMWH or DOAC for the long-term treatment of VTE in patients with cancer.
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Affiliation(s)
- Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Marcello Di Nisio
- Department of Medicine and Aging Sciences, University G. D'Annunzio, Chieti, Italy
| | - Lisa K Hicks
- Division of Hematology/Oncology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Alok A Khorana
- Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, OH
| | - Andrew D Leavitt
- Department of Laboratory Medicine and
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Agnes Y Y Lee
- Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Medical Oncology, BC Cancer, Vancouver site, Provincial Health Services Authority, Vancouver, BC, Canada
| | | | - Rebecca L Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Simon Noble
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | | | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lara A Kahale
- American University of Beirut (AUB) Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Center, American University of Beirut, Beirut, Lebanon; and
| | - Pablo Alonso-Coello
- Cochrane Iberoamérica, Biomedical Research Institute Sant Pau-CIBERESP, Barcelona, Spain
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42
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Riva N, Ageno W. Direct oral anticoagulants for unusual-site venous thromboembolism. Res Pract Thromb Haemost 2021; 5:265-277. [PMID: 33733025 PMCID: PMC7938617 DOI: 10.1002/rth2.12480] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022] Open
Abstract
Direct oral anticoagulants (DOACs) are currently the preferred oral anticoagulant treatment for most of the patients with deep vein thrombosis of the lower extremities and/or pulmonary embolism. DOACs have several advantages over vitamin K antagonists, such as availability of fixed dosages, fewer drug interactions, faster onset of action, shorter half-life, and lower risk of major and intracranial bleeding. Although the evidence on the use of DOACs in patients with unusual-site venous thromboembolism (VTE) is limited to a few, small randomized controlled trials, these drugs are increasingly used in clinical practice, and several observational cohort studies have been published recently. This narrative review will describe the latest evidence for the use of the DOACs in patients with thrombosis in atypical locations (splanchnic, cerebral, upper extremity, ovarian, and renal vein thrombosis) and will provide some practical advice for their use in patients with unusual-site VTE.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, Faculty of Medicine and SurgeryUniversity of MaltaMsidaMalta
| | - Walter Ageno
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
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Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, Ten Cate-Hoek AJ, Elalamy I, Enzmann FK, Geroulakos G, Gottsäter A, Hunt BJ, Mansilha A, Nicolaides AN, Sandset PM, Stansby G, Esvs Guidelines Committee, de Borst GJ, Bastos Gonçalves F, Chakfé N, Hinchliffe R, Kolh P, Koncar I, Lindholt JS, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, De Maeseneer MG, Comerota AJ, Gloviczki P, Kruip MJHA, Monreal M, Prandoni P, Vega de Ceniga M. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg 2020; 61:9-82. [PMID: 33334670 DOI: 10.1016/j.ejvs.2020.09.023] [Citation(s) in RCA: 265] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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44
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Wang TF, Billett HH, Connors JM, Soff GA. Approach to Cancer-Associated Thrombosis: Challenging Situations and Knowledge Gaps. Oncologist 2020; 26:e17-e23. [PMID: 33275323 DOI: 10.1002/onco.13570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Malignancy is a significant risk factor for venous thromboembolism (VTE). It is estimated that up to 20% of patients with cancer may develop VTE at some time in their cancer journey. Cancer-associated VTE can lead to hospitalizations, morbidity, delayed cancer treatment, and mortality. The optimal prevention and management of cancer-associated thrombosis (CAT) is of utmost importance. Direct oral anticoagulants have been recommended as first-line therapy for VTE treatment in the general population and their efficacy has recently been demonstrated in the cancer population, leading to increased use. However, patients with cancer have unique challenges and comorbidities that can lead to increased risks and concerns with anticoagulation. Herein we will discuss commonly encountered challenges in patients with CAT, review available literature, and provide practice suggestions. IMPLICATIONS FOR PRACTICE: This article aims to specifically address cancer-associated thrombosis issues for which there is limited or absent evidence to guide best practice, for circumstances that pose unique challenges for clinicians, and for directions when the literature is conflicting. It reviews pertinent data for each selected topic and provides guidance for patient management based on the best available evidence and experiences from the panel.
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Affiliation(s)
- Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Henny H Billett
- Division of Hematology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Jean M Connors
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerald A Soff
- Hematology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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45
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Riess H, Verhamme P, Weitz JI, Young A, Bauersachs R, Beyer-Westendorf J, Crowther M, Maraveyas A. Treatment of cancer-associated thrombosis: The evolution of anticoagulant choice and clinical insights into practical management. Crit Rev Oncol Hematol 2020; 157:103125. [PMID: 33254037 DOI: 10.1016/j.critrevonc.2020.103125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/30/2020] [Accepted: 10/02/2020] [Indexed: 12/21/2022] Open
Abstract
Low-molecular-weight heparin (LMWH) therapy is recommended over vitamin K antagonists (VKAs) for the treatment of cancer-associated thrombosis (CAT) and extended therapy is recommended in those with active cancer to prevent recurrent thrombosis. However, the inconvenience of daily subcutaneous injections and the cost of LMWH therapy hinder long-term use. Observational data demonstrate that persistence with LMWH therapy is low in clinical practice and that many patients are switched to oral alternatives - namely VKAs and direct oral anticoagulants (DOACs). Recently, the efficacy and safety of apixaban, edoxaban, and rivaroxaban versus LMWH therapy for the treatment of CAT have been demonstrated in randomized trials. This review provides a critical evaluation of studies with DOACs in this setting and an update on the guidance regarding anticoagulant use for the treatment of CAT. In recognition of the heterogeneity of patients with cancer and the challenges of CAT, patient cases with expert clinical perspectives are presented.
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Affiliation(s)
- Hanno Riess
- Department of Haematology and Oncology, Charite - Universitatmedizin Berlin, Germany.
| | - Peter Verhamme
- Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium
| | - Jeffrey I Weitz
- McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Annie Young
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Jan Beyer-Westendorf
- Thrombosis Research Unit, Department of Medicine I, Division Hematology, University Hospital "Carl Gustav Carus" Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany; King's Thrombosis Service, Department of Haematology, King's College London, London, United Kingdom
| | - Mark Crowther
- McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Anthony Maraveyas
- Hull York Medical School and Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
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Papakonstantinou PE, Tsioufis C, Konstantinidis D, Iliakis P, Leontsinis I, Tousoulis D. Anticoagulation in Deep Venous Thrombosis: Current Trends in the Era of Non- Vitamin K Antagonists Oral Anticoagulants. Curr Pharm Des 2020; 26:2692-2702. [DOI: 10.2174/1381612826666200420150517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022]
Abstract
:
Anticoagulation therapy is the cornerstone of treatment in acute vein thrombosis (DVT) and it aims to
reduce symptoms, thrombus extension, DVT recurrences, and mortality. The treatment for DVT depends on its
anatomical extent, among other factors. Anticoagulation therapy for proximal DVT is clearly recommended (at
least for 3 months), while AT for isolated distal DVT should be considered, especially in the presence of high
thromboembolic risk factors. The optimal anticoagulant and duration of therapy are determined by the clinical
assessment, taking into account the thromboembolic and bleeding risk in each patient in a case-by-case decision
making. Non-Vitamin K antagonists oral anticoagulants (NOACs) were a revolution in the anticoagulation management
of DVT. Nowadays, NOACs are considered as first-line therapy in the anticoagulation therapy for DVT
and are recommended as the preferred anticoagulant agents by most scientific societies. NOACs offer a simple
route of administration (oral agents), a rapid onset-offset of their action along with a good efficacy and safety
profile in comparison with Vitamin K Antagonists (VKAs). However, there are issues about their efficacy and
safety profile in specific populations with high thromboembolic and bleeding risks, such as renal failure patients,
active-cancer patients, and pregnant women, in which VKAs and heparins were the standard care of treatment.
Since the available data are promising for the use of NOACs in end-stage chronic kidney disease and cancer
patients, several ongoing randomized trials are currently trying to solve that issues and give evidence about the
safety and efficacy of NOACs in these populations.
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Affiliation(s)
- Panteleimon E. Papakonstantinou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Panagiotis Iliakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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47
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Bosch FTM, Nisio MD, Büller HR, van Es N. Diagnostic and Therapeutic Management of Upper Extremity Deep Vein Thrombosis. J Clin Med 2020; 9:jcm9072069. [PMID: 32630244 PMCID: PMC7408847 DOI: 10.3390/jcm9072069] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/21/2022] Open
Abstract
Upper extremity deep vein thrombosis (UEDVT) accounts for 5% of all deep vein thromboses (DVTs). UEDVT may be complicated by post thrombotic syndrome and pulmonary embolism, and early recognition and prompt start of anticoagulant treatment are key. Primary UEDVT, also known as Paget-von Schrötter syndrome, is associated with repeated or sudden physical activity of the upper arm and venous outflow obstruction due to anatomical variations. Secondary UEDVT is often associated with malignancy or use of intravenous devices, such as central venous catheters or pacemaker leads. Although the diagnosis and treatment of UEDVT have many similarities with DVT of the lower extremities, knowledge of specific aspects regarding UEDVT is important to guide optimal management. In this review, we will discuss the epidemiology, diagnosis, and treatment of UEDVT based on the current literature.
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Affiliation(s)
- Floris T. M. Bosch
- Department of Internal Medicine, Tergooi Hospitals, 1213 XZ Hilversum, The Netherlands
- Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (H.R.B.); (N.v.E.)
- Correspondence: ; Tel.: +31-20-566-8791
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, Gabriele D′Annunzio University, Via dei Vestini 31, 66100 Chieti, Italy;
| | - Harry R. Büller
- Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (H.R.B.); (N.v.E.)
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (H.R.B.); (N.v.E.)
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48
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Houghton DE, Casanegra AI, Peterson LG, Cochuyt J, Hodge DO, Vlazny D, McBane RD, Froehling D, Wysokinski WE. Treatment of upper extremity deep vein thrombosis with apixaban and rivaroxaban. Am J Hematol 2020; 95:817-823. [PMID: 32267011 DOI: 10.1002/ajh.25820] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 11/07/2022]
Abstract
Randomized controlled trials leading to the approval of apixaban and rivaroxaban for venous thromboembolism (VTE) did not include patients with upper extremity deep vein thrombosis (UE-DVT). We sought to evaluate the safety and effectiveness of rivaroxaban and apixaban for the treatment of acute UE-DVT. Consecutive patients with VTE enrolled into the Mayo Clinic VTE Registry, between March 1, 2013 and December 31, 2019, were followed prospectively. Clinical, demographic and imaging data were collected at the time of study recruitment. Patients with a diagnosis of acute UE-DVT who received rivaroxaban, apixaban, LMWH or warfarin were included. Recurrent VTE, major bleeding, clinical-relevant non-major bleeding (CRNMB), and death were assessed at 3-month intervals. During the study period, 210 patients with acute UE-DVT were included; 63 were treated with apixaban, 39 with rivaroxaban, and 108 with LWMH and/or warfarin. Overall 51% had catheter-associated UE-DVT, 60% had a diagnosis of malignancy, and 14% had concurrent pulmonary embolism. Malignancy was more common in patients treated with LMWH/warfarin (67% vs 52%, P = .03). At 3 months of follow up, one (0.9%) recurrent VTE occurred in a patient treated with LMWH/warfarin and one (1.0%) patient treated with apixaban or rivaroxaban (P = .97). Major bleeding occurred in three patients treated with LMWH/warfarin, and in none of those treated with apixaban or rivaroxaban (P = .09). Clinical-relevant non-major bleeding occurred in one patient (0.9%) treated with LWMH/warfarin and two patients (2.0%) treated with apixaban or rivaroxaban (P = .53). Treatment of UE-DVT with apixaban or rivaroxaban appears to be as safe and effective as LMWH/warfarin.
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Affiliation(s)
- Damon E. Houghton
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - Ana I. Casanegra
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - Lisa G. Peterson
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - Jordan Cochuyt
- Department of Health Sciences ResearchMayo Clinic Jacksonville Florida USA
| | - David O. Hodge
- Department of Health Sciences ResearchMayo Clinic Jacksonville Florida USA
| | - Danielle Vlazny
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - Robert D. McBane
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - David Froehling
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
| | - Waldemar E. Wysokinski
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota USA
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49
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Wojtukiewicz MZ, Skalij P, Tokajuk P, Politynska B, Wojtukiewicz AM, Tucker SC, Honn KV. Direct Oral Anticoagulants in Cancer Patients. Time for a Change in Paradigm. Cancers (Basel) 2020; 12:cancers12051144. [PMID: 32370207 PMCID: PMC7281117 DOI: 10.3390/cancers12051144] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/31/2022] Open
Abstract
Thrombosis is a more common occurrence in cancer patients compared to the general population and is one of the main causes of death in these patients. Low molecular weight heparin (LMWH) has been the recognized standard treatment for more than a decade, both in cancer-related thrombosis and in its prevention. Direct oral anticoagulants (DOACs) are a new option for anticoagulation therapy. Recently published results of large randomized clinical trials have confirmed that DOAC may be a reasonable alternative to LMWH in cancer patients. The following review summarizes the current evidence on the safety and efficacy of DOAC in the treatment and prevention of cancer-related thrombosis. It also draws attention to the limitations of this group of drugs, knowledge of which will facilitate the selection of optimal therapy.
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Affiliation(s)
- Marek Z. Wojtukiewicz
- Department of Oncology, Medical University of Białystok, 12 Ogrodowa St., 15-027 Białystok, Poland; (P.S.); (P.T.)
- Department of Clinical Oncology, Comprehensive Cancer Center, 12 OgrodowaSt., 15-369 Białystok, Poland
- Correspondence:
| | - Piotr Skalij
- Department of Oncology, Medical University of Białystok, 12 Ogrodowa St., 15-027 Białystok, Poland; (P.S.); (P.T.)
- Department of Clinical Oncology, Comprehensive Cancer Center, 12 OgrodowaSt., 15-369 Białystok, Poland
| | - Piotr Tokajuk
- Department of Oncology, Medical University of Białystok, 12 Ogrodowa St., 15-027 Białystok, Poland; (P.S.); (P.T.)
- Department of Clinical Oncology, Comprehensive Cancer Center, 12 OgrodowaSt., 15-369 Białystok, Poland
| | - Barbara Politynska
- Department of Philosophy and Human Psychology, Medical University of Białystok, 37 Szpitalna St., 15-295 Białystok, Poland; (B.P.); (A.M.W.)
- Robinson College, University of Cambridge, Cambridge CB3 9AN, UK
| | - Anna M. Wojtukiewicz
- Department of Philosophy and Human Psychology, Medical University of Białystok, 37 Szpitalna St., 15-295 Białystok, Poland; (B.P.); (A.M.W.)
| | - Stephanie C. Tucker
- Bioactive Lipids Research Program, Department of Pathology-School of Medicine, Detroit, MI 48202, USA; (S.C.T.); (K.V.H.)
| | - Kenneth V. Honn
- Bioactive Lipids Research Program, Department of Pathology-School of Medicine, Detroit, MI 48202, USA; (S.C.T.); (K.V.H.)
- Department of Chemistry, Wayne State University, Detroit, MI 48202, USA
- Department of Oncology, Karmanos Cancer Institute, Detroit, MI 48202, USA
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50
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Muñoz Martín AJ, Gallardo Díaz E, García Escobar I, Macías Montero R, Martínez-Marín V, Pachón Olmos V, Pérez Segura P, Quintanar Verdúguez T, Salgado Fernández M. SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019). Clin Transl Oncol 2020; 22:171-186. [PMID: 31981080 DOI: 10.1007/s12094-019-02263-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 12/12/2022]
Abstract
In 2011, the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of venous thromboembolism (VTE) and cancer. This guideline was updated in 2014, and since then, multiple studies and clinical trials have changed the landscape of the treatment and prophylaxis of VTE in cancer patients. To incorporate the most recent evidence, including data from direct oral anticoagulants (DOACs) randomized clinical trials, SEOM presents a new update of the guideline.
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Affiliation(s)
- A J Muñoz Martín
- Medical Oncology Department, Instituto de Investigación Sanitaria Gregorio Marañón, C/ Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - E Gallardo Díaz
- Medical Oncology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - I García Escobar
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - R Macías Montero
- Medical Oncology Department, Complejo H. Universitario, Badajoz, Spain
| | - V Martínez-Marín
- Medical Oncology Department, Hospital Universitario la Paz, Madrid, Spain
| | - V Pachón Olmos
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Madrid, Spain
| | - P Pérez Segura
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - M Salgado Fernández
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
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