1
|
Jia K, Zhang C, Li F, He B, Xie S, Du J, Feng G. A retrospective study on the effect of Chinese patent medicine combined with conventional treatment on the survival outcomes of 313 patients with stage II-III NSCLC. Aging (Albany NY) 2024; 16:6212-6228. [PMID: 38555532 PMCID: PMC11042965 DOI: 10.18632/aging.205697] [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: 10/25/2023] [Accepted: 02/23/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE We aim to explore the effect of Chinese Patent Medicine (CPM), including Huisheng oral solution (HSOS) on the 4-year survival rate of patients with stage II and III non-small cell lung cancer, and assess the association between blood coagulation indicators and survival outcomes. MATERIALS AND METHODS 313 patients diagnosed with stage II and III NSCLC were collected during 2015-2016. Kaplan-Meier method and Cox proportional hazard model were applied to analyze the factors affecting the 4-year survival rate of patients. RESULTS According to the effect of CPM, the medicine prescribed in this study could be classified into two types. The proportion of patients who received "Fuzheng Quyu" CPM for more than three months was higher than the proportion of patients who received other two types of CPM for more than three months. Medical records of 313 patients with NSCLC were analyzed. 4-year survival rate for patients received CPM more than 6 months and 3 months were higher than those received CPM less than 3 months (P = 0.028 and P = 0.021 respectively. In addition, 4-year survival rate for patients who received HSOS for more than 3 months was higher than those who received HSOS for less than 3 months (P = 0.041). Patients with elevated preoperative fibrinogen (FIB) level and those without surgery had an increased mortality risk (HR = 1.98, P < 0.01, and HR = 2.76, P < 0.01 respectively). CONCLUSION The medium and long-term use of CPM/HSOS was positively associated with higher survival rate in NSCLC patients. Patients with high-level preoperative FIB level and those without surgery might have a poor prognosis in the following years.
Collapse
Affiliation(s)
- Kegang Jia
- Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chenxu Zhang
- Chengdu Diao Pharmaceutical Group Co., Ltd., Chengdu, China
| | - Fang Li
- Chengdu Diao Pharmaceutical Group Co., Ltd., Chengdu, China
| | - Bin He
- Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shenglong Xie
- Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Du
- Chengdu Diao Pharmaceutical Group Co., Ltd., Chengdu, China
| | - Gang Feng
- Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
2
|
Zhang X, Yang Y, Wu F. A bibliometric analysis in venous thromboembolism nursing (1999-2022): Current status and future prospects. Heliyon 2024; 10:e23770. [PMID: 38192823 PMCID: PMC10772189 DOI: 10.1016/j.heliyon.2023.e23770] [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: 09/06/2023] [Revised: 11/13/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
Research on venous thromboembolism (VTE) in nursing has garnered significant attention. This study aimed to examine the characteristics of VTE nursing publications, offering valuable insights into the current state of the field and forecasting future trends. A comprehensive screening of global publications up to 2022 was conducted using the Web of Science Core Collection database to investigate VTE nursing. The search incorporated keywords such as 'venous thromboembolism', 'deep vein thrombosis', and 'pulmonary embolism' to identify relevant studies. A bibliometric analysis of these publications was performed using various visualisation tools such as VOSviewer and R software. A total of 675 papers on VTE nursing were identified, with the earliest publication dating back to 1999. The research involved 971 institutions from 43 countries, with the United States leading by contributing to 261 articles. Harvard University emerged as the most productive institution, and Heit, with 17 publications, was the most cited author. The journal Thrombosis Research published the highest number of papers (11). The frontiers of VTE nursing research are anticipated to continue focusing on topics such as epidemiology, risk factors, and VTE prevention and management.
Collapse
Affiliation(s)
- Xuan Zhang
- Department of Stomatology, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan Province, China
| | - Yuehui Yang
- Department of Stomatology, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan Province, China
| | - Fang Wu
- Department of Stomatology, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan Province, China
| |
Collapse
|
3
|
Abstract
All cancers can increase the risk of developing venous thromboembolism (VTE), and anticoagulants should be considered as an optimal treatment for patients suffering from cancer-associated VTE. However, there is still a debate about whether the new oral anticoagulant, rivaroxaban, can bring better efficacy and safety outcomes globally. Thus, this systematic review and meta-analysis was conducted to evaluate the efficacy and safety of rivaroxaban. We searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and China National Knowledge Infrastructure for relevant published papers before 1 September 2019, with no language restrictions. The primary outcomes are defined as the recurrence of VTE. The secondary outcomes are defined as clinically relevant non-major bleeding, adverse major bleeding events, and all-cause of death. The data were analyzed by Stata with risk ratio (RR) and 95% confidence interval (CI). Four trials encompassing 1996 patients were included. Rivaroxaban reduced recurrent VTE with no significant difference (RR = 0.68, 95% CI = 0.43-1.07). Similarly, there were no significant differences in adverse major bleeding events (RR = 0.86, 95% CI = 0.37-2.00), clinically relevant non-major bleeding (RR = 1.24, 95% CI = 0.73-2.12) and all-cause mortality (RR = 0.76, 95% CI = 0.40-1.44). In a selected study population of cancer patients with VTE, rivaroxaban is as good as other anticoagulants. Further, carefully designed randomized controlled trials should be performed to confirm these results.
Collapse
Affiliation(s)
- Bo Liang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yi Liang
- Southwest Medical University, Luzhou, China
| | - Li-Zhi Zhao
- Hospital (T.C.M.) Affiliated to Southwest Medical University, Luzhou, China
| | - Yu-Xiu Zhao
- Hospital (T.C.M.) Affiliated to Southwest Medical University, Luzhou, China
| | - Ning Gu
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
4
|
Rafii H, Frère C, Benzidia I, Crichi B, Andre T, Assenat E, Bournet B, Carpentier A, Connault J, Doucet L, Durant C, Emmerich J, Gris JC, Hij A, Le Hello C, Madelaine I, Messas E, Ndour A, Villiers S, Marjanovic Z, Ait Abdallah N, Yannoutsos A, Farge D. Management of cancer-related thrombosis in the era of direct oral anticoagulants: A comprehensive review of the 2019 ITAC-CME clinical practice guidelines. On behalf of the Groupe Francophone Thrombose et Cancer (GFTC). JOURNAL DE MEDECINE VASCULAIRE 2020; 45:28-40. [PMID: 32057323 DOI: 10.1016/j.jdmv.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
Venous thromboembolism (VTE) is a common disease complication in cancer patients and the second cause of death after cancer progression. VTE management and prophylaxis are critical in cancer patients, but effective therapy can be challenging because these patients are at higher risk of VTE recurrence and bleeding under anticoagulant treatment. Numerous published studies report inconsistent implementation of existing evidence-based clinical practice guidelines (CPG), including underutilization of thromboprophylaxis, and wide variability in clinical practice patterns across different countries and various practitioners. This review aims to summarize the 2019 ITAC-CME evidence-based CPGs for treatment and prophylaxis of cancer-related VTE, which include recommendations on the use of direct oral anticoagulants specifically in cancer patients. The guidelines underscore the gravity of developing VTE in cancer and recommend the best approaches for treating and preventing cancer-associated VTE, while minimizing unnecessary or over-treatment. Greater adherence to the 2019 ITAC guidelines could substantially decrease the burden of VTE and improve survival of cancer patients.
Collapse
Affiliation(s)
- H Rafii
- Eurocord, Équipe 3 EA3518, hôpital Saint-Louis, Université de Paris, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - C Frère
- Inserm UMRS_1166, Department of Haematology, hôpital Pitié-Salpêtrière, Université de Paris, Sorbonne Paris-Cité, AP-HP, Paris, France
| | - I Benzidia
- Autoimmune and vascular disease unit, hôpital Saint-Louis, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, EA3518, AP-HP, Sorbonne Paris-Cité, Paris, France
| | - B Crichi
- Autoimmune and vascular disease unit, hôpital Saint-Louis, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, EA3518, AP-HP, Sorbonne Paris-Cité, Paris, France
| | - T Andre
- Hôpital Saint-Antoine, AP-HP, Paris, France
| | - E Assenat
- Montpellier school of Medicine, Saint-Eloi University Hospital, Montpellier, France
| | - B Bournet
- Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | | | | | - L Doucet
- Hôpital Saint-Louis, AP-HP, Paris, France
| | | | | | | | - A Hij
- Autoimmune and vascular disease unit, hôpital Saint-Louis, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, EA3518, AP-HP, Sorbonne Paris-Cité, Paris, France
| | - C Le Hello
- CHU Saint-Étienne, Saint-Étienne, France
| | | | - E Messas
- Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - A Ndour
- Hôpital Saint-Louis, AP-HP, Paris, France
| | - S Villiers
- Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - N Ait Abdallah
- Autoimmune and vascular disease unit, hôpital Saint-Louis, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, EA3518, AP-HP, Sorbonne Paris-Cité, Paris, France
| | | | - D Farge
- Internal Medicine (UF04), Équipe 3 EA 3518, Autoimmune and Vascular Disease Unit, Saint-Louis Hospital, Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, AP-HP, Sorbonne Paris-Cité, Paris, France; Department of Medicine, McGill University, Montreal, QC, Canada
| |
Collapse
|
5
|
Liang B, Zhao LZ, Liao HL, Gu N. Rivaroxaban for cancer-associated venous thromboembolism: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e18087. [PMID: 31770226 PMCID: PMC6890290 DOI: 10.1097/md.0000000000018087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND All cancers increase developing venous thromboembolism risk, and VTE is the second-leading cause of death among cancer patients. The anticoagulant drugs are considered to be the optimal treatment for patients with cancer-associated VTE. However, there is still controversy whether rivaroxaban, a new oral anticoagulant, can lead to better outcomes globally. METHODS We will search PubMed, Web of Science, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure for relevant published studies before 1 September, 2019, without any language restrictions. Only published randomized controlled trials that meet the inclusion criteria will be included. Subgroup analysis of the type of cancer, the type of VTE, cancer stage, age, sex, ethnicity, history of smoking and drinking as well as the mean, dose and duration of anticoagulants will be performed. DISCUSSION Our study aims to estimate the efficacy and safety of rivaroxaban for patients with cancer-associated VTE and to provide recommendations to key stakeholders. TRIAL REGISTRATION PROSPERO, October 23, 2019, CRD42019143265, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=143265.
Collapse
Affiliation(s)
- Bo Liang
- Nanjing University of Chinese Medicine, Nanjing
| | - Li-Zhi Zhao
- Hospital (T.C.M.) Affiliated to Southwest Medical University
| | - Hui-Ling Liao
- Hospital (T.C.M.) Affiliated to Southwest Medical University
- College of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou
| | - Ning Gu
- College of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
6
|
Heraudeau A, Delluc A, Le Henaff M, Lacut K, Leroyer C, Desrues B, Couturaud F, Tromeur C. Risk of venous thromboembolism in association with factor V leiden in cancer patients - The EDITH case-control study. PLoS One 2018; 13:e0194973. [PMID: 29775482 PMCID: PMC5959061 DOI: 10.1371/journal.pone.0194973] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/14/2018] [Indexed: 12/21/2022] Open
Abstract
Background Cancer and factor V Leiden mutation are both risk factors for venous thromboembolism (VTE). Cancer critically increases the thrombotic risk whereas Factor V Leiden is the most common pro-thrombotic mutation. The impact of the factor V Leiden on the risk of VTE in cancer patients remains uncertain. Objective To assess the impact of factor V Leiden mutation in cancer-associated thrombosis. Methods The EDITH hospital-based case-control study enrolled 182 patients with cancer and VTE as well as 182 control patients with cancer, matched for gender, age and cancer location, between 2000 and 2012, in the University Hospital of Brest. All cases and controls were genotyped for the factor V Leiden mutation and interviewed with a standardized questionnaire. Results Twenty one of 182 (11.5%) patients with cancer-associated thrombosis carried the factor V Leiden mutation and 4 of 182 (2.2%) controls with cancer but no venous thrombosis. In multivariate analysis including cancer stage and family history of VTE, cancer patients with factor V Leiden mutation had a seven-fold increased risk of venous thromboembolism (adjusted odds ratio [OR], 7.04; 95% CI, 2.01–24.63). Conclusion The pro-thrombotic Factor V Leiden mutation was found to be an independent additional risk factor for venous thromboembolism in cancer patients and might therefore be considered in the individual thrombotic risk assessment.
Collapse
Affiliation(s)
- Adeline Heraudeau
- Service de pneumologie, Hôpital Pontchaillou, Université de Rennes 1, Rue Henri-Le-Guilloux, France
| | - Aurélien Delluc
- Université de Brest, EA3878 (GETBO) IFR, Brest, France
- Département de médecine interne et pneumologie, CHRU de la Cavale Blanche, Boulevard Tanguy Prigent, France
| | - Mickaël Le Henaff
- Service de pneumologie, Hôpital du Scorff, Avenue de Choiseul, France
| | - Karine Lacut
- Université de Brest, EA3878 (GETBO) IFR, Brest, France
- INSERM, CIC, Brest, France
| | - Christophe Leroyer
- Université de Brest, EA3878 (GETBO) IFR, Brest, France
- Département de médecine interne et pneumologie, CHRU de la Cavale Blanche, Boulevard Tanguy Prigent, France
| | - Benoit Desrues
- Service de pneumologie, Hôpital Pontchaillou, Université de Rennes 1, Rue Henri-Le-Guilloux, France
- INSERM, ERL, Rennes, France
| | - Francis Couturaud
- Université de Brest, EA3878 (GETBO) IFR, Brest, France
- Département de médecine interne et pneumologie, CHRU de la Cavale Blanche, Boulevard Tanguy Prigent, France
- INSERM, CIC, Brest, France
| | - Cécile Tromeur
- Université de Brest, EA3878 (GETBO) IFR, Brest, France
- Département de médecine interne et pneumologie, CHRU de la Cavale Blanche, Boulevard Tanguy Prigent, France
- INSERM, CIC, Brest, France
- * E-mail:
| |
Collapse
|
7
|
Yang X, Zhang H, Kong F, Wang G, Gu Q, Zhao Z, Li T, Ren M, Li Z, Guo Y. Effect of Huisheng oral solution on coagulation function in perioperative period in patients with primary lung cancer. J Thorac Dis 2017; 9:1891-1902. [PMID: 28839987 PMCID: PMC5542976 DOI: 10.21037/jtd.2017.06.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 06/01/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The incidence of venous thromboembolism (VTE) is about 4-10% in lung cancer patients. Huisheng oral solution (HSOS) has been previously demonstrated to inhibit carageenan induced acute thrombosis in rats, reduce the incidence of thrombosis in the lungs and mesentery of tumor-bearing mice and inhibit tumor cell metastasis. The purpose of this study was to assess the anticoagulant effect of HSOS in lung cancer patients in the perioperative period. METHODS This study was a multicenter, randomized, single-blind, blank-controlled clinical trial. A total of patients at five hospitals in Hebei Province, China were included. The patients were randomly divided into study group or control group according to random number table. The primary outcome was the blood test indices in both groups. The study group was given oral HSOS (20 mL, bid) from admission until 24 h before surgery. If no active bleeding was observed, the patients were given oral HSOS (20 mL, tid) from 24 h to 24 d postoperatively. The patients in the study group did not receive any other anticoagulation therapy during the study period and the control group only underwent surgery. The study protocol was approved by the local ethics committee of principal investigator hospital. Blood samples were taken at admission (before therapy), 24 h, 72 h, 10 d (before discharge) and 24 d (first visit after discharge) after surgery. Routine blood tests [red blood cell (RBC) count, white blood cell (WBC) count, hemoglobin (HGB), and platelet (PLT) count] and coagulation function test [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), and plasma D-dimer] were performed. The changes in outcome measures over time were analyzed by repeated measures analysis of variance to compare the differences between groups and between different time points and assess the impact of tumor stage and mode of surgery on them. All tests were two-tailed, and P values <0.05 were considered statistically significant. RESULTS The results differed between different tumor stage groups. In stage III-IV group, there was no significant difference in various indices between the study group and control group. In stage I-II group, there was significant difference in hemoglobin (P=0.004), platelet count (P=0.007), fibrinogen (P=0.046), and plasma D-dimer (24 d: P=0.032) between two groups. Fibrinogen reach the peak 72 h after surgery, and other indices reach the peak 7-10 d postoperatively and declined one month after surgery, and the decline tendency was different between two groups. In addition, no adverse drug reaction was observed in both the study group and control group. CONCLUSIONS HSOS (20 mL, tid) is of good safety profile and does not increase the risk of bleeding. With its unique characteristic of convenience for being taken, HSOS (20 mL, tid) could be a proper treatment for lung cancer patients in the perioperative period.
Collapse
Affiliation(s)
| | - Helin Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Fanyi Kong
- Cangzhou Central Hospital, Cangzhou 061001, China
| | - Guochen Wang
- North China University of Science and Technology Affiliated Hospital, Tangshan 063000, China
| | - Qianyu Gu
- Fourth Hospital of Hebei Medical University, Tumor Hospital of Hebei Province, Shijiazhuang 050000, China
| | - Zheng Zhao
- Handan Central Hospital, Handan 056001, China
| | - Tiezhi Li
- The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Mingming Ren
- Cangzhou Central Hospital, Cangzhou 061001, China
| | - Zuosheng Li
- North China University of Science and Technology Affiliated Hospital, Tangshan 063000, China
| | - Yang Guo
- Fourth Hospital of Hebei Medical University, Tumor Hospital of Hebei Province, Shijiazhuang 050000, China
| |
Collapse
|
8
|
Zhou Q, Liu J, Yang X, Zhang H, Kong F, Wang G, Meng X, Chen Z, Liu L, Li L, Wu X, Guo Y. [Experts Consensus on Huisheng Oral Solution for Lung Cancer
Anticoagulation Treatment at Perioperation Period (2016 version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:721-724. [PMID: 27866513 PMCID: PMC5999641 DOI: 10.3779/j.issn.1009-3419.2016.11.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Junfeng Liu
- Forth Hospital of Hebei Medical University/Tumor Hospital of Hebei Province, Shijiazhuang 050011, China
| | | | - Helin Zhang
- The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Fanyi Kong
- Cangzhou Central Hospital, Cangzhou 061001,
China
| | - Guochen Wang
- North China University of Science and Technology Affiliated Hospital, Tangshan 063000, China
| | - Xianli Meng
- Forth Hospital of Hebei Medical University/Tumor Hospital of Hebei Province, Shijiazhuang 050011, China
| | - Zhiquan Chen
- North China University of Science and Technology Affiliated Hospital, Tangshan 063000, China
| | - Lijun Liu
- Hebei General Hospital, Shijiazhuang 050055, China
| | - Lu Li
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiongzhi Wu
- Cancer Hospital/Institute, Tianjin Medical University, Tianjin 300040, China
| | - Yang Guo
- Forth Hospital of Hebei Medical University/Tumor Hospital of Hebei Province, Shijiazhuang 050011, China
| |
Collapse
|
9
|
Qureshi W, Ali Z, Amjad W, Alirhayim Z, Farooq H, Qadir S, Khalid F, Al-Mallah MH. Venous Thromboembolism in Cancer: An Update of Treatment and Prevention in the Era of Newer Anticoagulants. Front Cardiovasc Med 2016; 3:24. [PMID: 27517038 PMCID: PMC4963402 DOI: 10.3389/fcvm.2016.00024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/06/2016] [Indexed: 12/23/2022] Open
Abstract
Cancer patients are at major risk of developing venous thromboembolism (VTE), resulting in increased morbidity and economic burden. While a number of theories try to explain its pathophysiology, its risk stratification can be broadly done in cancer-related, treatment–related, and patient-related factors. Studies report the prophylactic use of thrombolytic agents to be safe and effective in decreasing VTE-related mortality/morbidity especially in postoperative cancer patients. Recent data also suggest the prophylactic use of low molecular weight Heparins (LMWHs) and Warfarin to be effective in reducing VTEs related to long-term central venous catheter use. In a double-blind, multicenter trial, a new ultra-LMWH Semuloparin has shown to be efficacious in preventing chemotherapy-associated VTE’s along with other drugs, such as Certoparin and Nadoparin. LMWHs are reported to be very useful in preventing recurrent VTEs in advanced cancers and should be preferred over full dose Warfarin. However, their long-term safety beyond 6 months has not been established yet. Furthermore, this paper discusses the safety and efficacy of different drugs used in the treatment and prevention of recurrent VTEs, including Bemiparin, Semuloparin, oral direct thrombin inhibitors, parenteral and direct oral factor Xa inhibitors.
Collapse
Affiliation(s)
- Waqas Qureshi
- Department of Internal Medicine, Division of Cardiovascular Epidemiology and Cardiology, Wake Forest University , Winston Salem, NC , USA
| | - Zeeshan Ali
- Department of Internal Medicine, University of Maryland , Baltimore, MD , USA
| | - Waseem Amjad
- Allama Iqbal Medical College , Lahore , Pakistan
| | - Zaid Alirhayim
- Department of Internal Medicine, Henry Ford Hospital, Wayne State University , Detroit, MI , USA
| | - Hina Farooq
- Rawalpindi Medical College , Rawalpindi , Pakistan
| | | | - Fatima Khalid
- Department of Internal Medicine, Division of Nephrology and Hypertension, Wake Forest University , Winston Salem, NC , USA
| | | |
Collapse
|
10
|
Sun YH, Cui L, Chen J, Wang M, Liu JJ, Liu XX, Huang XE. Analysis of Relationships Between Prethrombotic States and Cervical Cancer. Asian Pac J Cancer Prev 2016; 16:6163-6. [PMID: 26320513 DOI: 10.7314/apjcp.2015.16.14.6163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To analyze the relationship between a prethrombotic state and the occurrence of thrombosis, as well as survival time for patients with cervical cancer. METHODS Patients with first diagnosis of cervical cancer were subgrouped according to FIGO staging, and two D-dimer levels were assessed. According to the results, patients are divided into an observation group (abnormal) and control group (normal). RESULTS For 106 patients with cervical cancer, 38 with abnormal D-dimer, the abnormal rate is 35.9%, of which stage I accounted for 6.5%, stageII 38.5%, stage III 50%, and stage IV 61.1% (p=0.013); The level of D-dimers in stageI wass 0.87±0.68ug/ ml, while in stage II it was 1.50±1.35ug/ml, stage III 2.60±1.86ug/ml and stage IV 18.6±53.4ug/ml (P=0.031); after follow-up of patients for 2-30 months, the mortality of observation group is 21.1%, while for control group it was 2.94% (p <0.01). In the observation group, survival time was 15.1±5.8 months, while for control group it was 21.0±5.4 months, the difference between two groups being highly significant (p=0.000). CONCLUSION There is a direct correlation between prethrombotic state and the grade malignancy of cervical cancer. The level is positively correlated with clinical stage, and is inversely related to survival time, so that a prethrombotic state could be used to predict the prognosis for patients with cervical cancer.
Collapse
Affiliation(s)
- You-Hong Sun
- Department of Gynaecology, Taizhou Second People's Hospital, the Affiliated Hospital of Yangzhou University, Taizhou, China E-mail :
| | | | | | | | | | | | | |
Collapse
|
11
|
Cui L, Sun YH, Chen J, Wang L, Liu JJ, Zhou XR, Ding J, Liu XX, Huang XE. Analysis of Prethrombotic States in Patients with Malignant Tumors. Asian Pac J Cancer Prev 2016. [PMID: 26225697 DOI: 10.7314/apjcp.2015.16.13.5477] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the incidence and risk factors for a prethrombotic state in patients with malignant tumors. MATERIALS AND METHODS Plasma d-dimer (D-D) in patients with malignant tumors was measured. Abnormal rates of D-D and possible risk factors like gender, age, type of tumor, and staging of tumor were analyzed. RESULTS Of 1,453 patients, 629 demonstrated plasma D-D abnormality (43.3%). The D-D abnormal rate of male patients (n=851, 43.5%) was not statistically significantly different from that for female patients (n=602, 43.0%) (p>0.05). D-D abnormal rate increased with age and was statistically significant among different age groups (p<0.05). Regarding staging of tumor, D-D abnormal rate in patients with phase I was 2.0%, 6.2% in phase II, 47.6% in phase III and 83.1% in phase IV, with statistically significant differences between phase III and II, as well as phase III and IV (p<0.01). CONCLUSIONS A prethrombotic state was closely related to malignancy of tumors. The risk factors for a prethrombotic state include age and tumor stage.
Collapse
Affiliation(s)
- Lin Cui
- Department of Oncology, Taizhou Second People's Hospital, the Affiliated Hospital of Yangzhou University, Taizhou, China E-mail :
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Rickles FR, Brenner B, Falanga A. The International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC) at the Peak of Adolescence - 15 Years and Counting. Thromb Res 2016; 140 Suppl 1:S99-102. [PMID: 27067988 DOI: 10.1016/s0049-3848(16)30107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Frederick R Rickles
- The Departments of Medicine, Pediatrics and Pharmacology and Physiology, The Dr. Cyrus & Myrtle Katzen Cancer Research Center, The George Washington University and the Veterans Administration Medical Center, Washington, DC, USA.
| | - Benjamin Brenner
- Thrombosis and Hemostasis Unit, Department of Hematology, Rambam Health Care Campus, Haifa, Israel
| | - Anna Falanga
- Division of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
13
|
Riess H, Habbel P, Jühling A, Sinn M, Pelzer U. Primary prevention and treatment of venous thromboembolic events in patients with gastrointestinal cancers - Review. World J Gastrointest Oncol 2016; 8:258-270. [PMID: 26989461 PMCID: PMC4789611 DOI: 10.4251/wjgo.v8.i3.258] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/08/2015] [Accepted: 01/04/2016] [Indexed: 02/05/2023] Open
Abstract
Venous thromboembolism event (VTE) is a common and morbid complication in cancer patients. Patients with gastrointestinal cancers often suffer from symptomatic or incidental splanchnic vein thrombosis, impaired liver function and/or thrombocytopenia. These characteristics require a thorough risk/benefit evaluation for individual patients. Considering the risk factors for the development of VTE and bleeding events in addition to recent study results may be helpful for correct initiation of primary pharmacological prevention and treatment of cancer-associated thrombosis (CAT), preferably with low molecular weight heparins (LMWH). Whereas thromboprophylaxis is most often recommended in hospitalized surgical and non-surgical patients with malignancy, there is less agreement as to its duration. With regard to ambulatory cancer patients, the lack of robust data results in low grade recommendations against routine use of anticoagulant drugs. Anticoagulation with LMWH for the first months is the evidence-based treatment for acute CAT, but duration of secondary prevention and the drug of choice are unclear. Based on published guidelines and literature, this review will focus on prevention and treatment strategies of VTE in patients with gastrointestinal cancers.
Collapse
|
14
|
Large Cohort Study of Central Venous Catheter Thrombosis during Intravenous Antibiotic Therapy. Antimicrob Agents Chemother 2015; 60:36-43. [PMID: 26459894 DOI: 10.1128/aac.00700-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/30/2015] [Indexed: 11/20/2022] Open
Abstract
The frequency and risk factors for central venous catheter-related thrombosis (CRT) during prolonged intravenous (i.v.) antibiotic therapy have rarely been reported. The primary objective of this study was to evaluate the frequency, incidence, and risk factors for CRT among patients being treated with prolonged i.v. antibiotic therapy. The secondary objective was to describe the clinical manifestations, diagnostic evaluation, and clinical management. This cohort study was conducted between August 2004 and May 2010 in a French referral center for osteoarticular infections. All patients treated for bone and joint infections with i.v. antimicrobial therapy through a central venous catheter (CVC) for ≥2 weeks were included. Risk factors were identified using nonparametric tests and logistic regression. A case-control study investigated the role of vancomycin and catheter malposition. A total of 892 patients matched the inclusion criteria. CRT developed in 16 infections occurring in 16 patients (incidence, 0.39/1,000 catheter days). The median time to a CRT was 29 days (range, 12 to 48 days). Local clinical signs, fever, and secondary complications of CRT were present in 15, 8, and 4 patients, respectively. The median C-reactive protein level was 95 mg/liter. The treatment combined catheter removal and a median of 3 months (1.5 to 6 months) of anticoagulation therapy. The outcome was good in all patients, with no recurrence of CRT. Three risk factors were identified by multivariate analysis: male sex (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.1 to 26.6), catheter malposition (OR, 5.3; 95% CI, 1.6 to 17.9), and use of vancomycin (OR, 22.9; 95% CI, 2.8 to 188). Catheter-related thrombosis is a rare but severe complication in patients treated with prolonged antimicrobial therapy. Vancomycin use was the most important risk factor identified.
Collapse
|
15
|
Sousa B, Furlanetto J, Hutka M, Gouveia P, Wuerstlein R, Mariz JM, Pinto D, Cardoso F. Central venous access in oncology: ESMO Clinical Practice Guidelines. Ann Oncol 2015; 26 Suppl 5:v152-68. [PMID: 26314776 DOI: 10.1093/annonc/mdv296] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- B Sousa
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | | | - M Hutka
- St George's University Hospitals, NHS Foundation Trust, London, UK
| | - P Gouveia
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | - R Wuerstlein
- CCC of LMU, Breast Center, University Hospital Munich, Munich, Germany
| | - J M Mariz
- Department of Haematology, Instituto Português de Oncologia do Porto- Francisco Gentil, Oporto, Portugal
| | - D Pinto
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| |
Collapse
|
16
|
Abstract
Venous thromboembolism (VTE) is a common complication in patients with cancer. VTE is a main cause of morbidity and mortality in patients with cancer and has a significant impact on their quality of life. Preventing VTE in cancer patients reduces both morbidity and mortality. The level of evidence for antithrombotic prophylaxis of VTE in patients with cancer varies for hospitalized and ambulatory patients. Hospitalized patients with active cancer (for both medical or surgical indication) and reduced mobility should receive thromboprophylaxis throughout hospital stay. Prophylaxis of VTE is not routinely recommended for outpatients with cancer on chemotherapy. For these patients, current guidelines suggest that clinicians should consider antithrombotic prophylaxis on a case-by-case basis in highly selected outpatients. Different strategies for identification of high-risk outpatients with cancer who could benefit of thromboprophylaxis are under consideration. The new oral anticoagulants could have a role for VTE prevention in ambulatory patients with cancer who are on chemotherapy, as they are administered at a fixed dose without routine laboratory monitoring and may have fewer drug interactions with anticancer agents.
Collapse
Affiliation(s)
- Melina Verso
- Division of Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
| | - Giancarlo Agnelli
- Division of Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy
| |
Collapse
|
17
|
Farge-Bancel D, Bounameaux H, Brenner B, Büller HR, Kakkar A, Pabinger I, Streiff M, Debourdeau P. Implementing thrombosis guidelines in cancer patients: a review. Rambam Maimonides Med J 2014; 5:e0041. [PMID: 25386357 PMCID: PMC4222430 DOI: 10.5041/rmmj.10175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However, a lack of consensus among various national and international clinical practice guidelines has contributed to knowledge and practice gaps among practitioners, and inconsistent approaches to venous thromboembolism. The 2013 international guidelines for thrombosis in cancer have sought to address these gaps by critically re-evaluating the evidence coming from clinical trials and synthesizing a number of guidelines documents. An individualized approach to prophylaxis is recommended for all patients.
Collapse
Affiliation(s)
- Dominique Farge-Bancel
- Assistance Publique-Hôpitaux de Paris, Internal Medicine and Vascular Disease Unit, Saint-Louis Hospital; Sorbonne Paris Cité, Paris 7 Diderot University, Paris, France
| | - Henri Bounameaux
- Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Harry R Büller
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands
| | - Ajay Kakkar
- Thrombosis Research Institute and Queen Mary University of London, London, UK
| | - Ingrid Pabinger
- Division of Hematology and Hemostaseology, Department of Internal Medicine, Medical University Vienna, Vienna, Austria
| | - Michael Streiff
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | |
Collapse
|
18
|
Frere C, Debourdeau P, Hij A, Cajfinger F, Onan MN, Panicot-Dubois L, Dubois C, Farge D. Therapy for Cancer-Related Thromboembolism. Semin Oncol 2014; 41:319-38. [DOI: 10.1053/j.seminoncol.2014.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Runkle M, Parikh PP, Falls G. Management of upper extremity deep venous thrombosis in a hospice patient. J Palliat Med 2014; 17:342-5. [PMID: 24617317 DOI: 10.1089/jpm.2013.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In this case report, upper extremity deep venous thrombosis (UEDVT) is discussed with special attention to the diagnosis, treatment, and prevention in palliative care patients. METHODS A 43-year-old female with a history of metastatic breast cancer presented with a UEDVT. Standard anticoagulation was unsuccessful, so after a complete discussion about the treatment options, alternative therapy was used for clot lysis. CONCLUSION Aggressive treatment of UEDVT in a palliative care setting has the potential for improving the quality of life, yet because of the increased risk of complications and philosophy of palliative medicine, the treatment strategy for each patient should be carefully considered.
Collapse
Affiliation(s)
- Mary Runkle
- 1 Boonshoft School of Medicine, Wright State University , Dayton, Ohio
| | | | | |
Collapse
|
20
|
Honecker F, Koychev D, Luhmann AD, Langer F, Dieckmann KP, Bokemeyer C, Oechsle K. Venous thromboembolic events in germ cell cancer patients undergoing platinum-based chemotherapy. ACTA ACUST UNITED AC 2013; 36:663-8. [PMID: 24192771 DOI: 10.1159/000355652] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Germ cell tumor (GCT) patients are at risk of venous thromboembolic events (VTEEs). A higher incidence of VTEEs has been reported in GCT patients undergoing cisplatin-based chemotherapy. PATIENTS AND METHODS A retrospective analysis of the incidence of and risk factors for VTEEs in 193 GCT patients receiving platinum-based chemotherapy in Hamburg, Germany, between 2000 and 2009 was performed. RESULTS VTEEs occurred in 22 patients (11%). In only 4 patients, the VTEEs occurred during cisplatin-based chemotherapy, while 18 patients (81%) experienced VTEEs prior to initiation of chemotherapy. Pure seminoma, 'intermediate risk' (International Germ Cell Cancer Collaborative Group (IGCCCG)), retroperitoneal or supraclavicular lymph node metastases, elevated lactate dehydrogenase (LDH) levels, a central venous catheter (CVC), arterial hypertension, application of granulocyte colony-stimulating factor (G-CSF) and of ≥ 3 cycles of cisplatin-based chemotherapy could be identified as risk factors. 2 risk groups could be described: (i) VTEEs manifesting before chemotherapy in patients with seminoma, retroperitoneal tumor masses, and elevated LDH levels, and (ii) VTEEs occurring during chemotherapy applied via CVC in patients with supraclavicular lymph node metastases. CONCLUSIONS The incidence of VTEEs in GCT patients was 11%, but in the majority of patients, the VTEEs occurred before the initiation of platinum-based chemotherapy. Supraclavicular lymph node metastases and use of a CVC are risk factors for VTEEs during chemotherapy.
Collapse
Affiliation(s)
- Friedemann Honecker
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | |
Collapse
|
21
|
Gaddh M, Antun A, Yamada K, Gupta P, Tran H, El Rassi F, Kim HS, Khoury HJ. Venous access catheter-related thrombosis in patients with cancer. Leuk Lymphoma 2013; 55:501-8. [PMID: 23772637 DOI: 10.3109/10428194.2013.813503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with cancer are at high risk for developing venous thromboembolism (VTE), and the presence of a central venous catheter (CVC) further increases this risk. CVC-related VTE has serious implications related to the loss of vascular access, development of pulmonary embolism, recurrent VTE, infections and post-thrombotic syndrome. The pathogenesis of CVC-related VTE is complex and multifactorial, with risk factors associated with the catheter, the vessel selected for insertion and the underlying cancer as well as the anti-cancer therapy. Clinical presentation of CVC-related VTEs is often non-specific, and ultrasonography is the most commonly used radiological diagnostic test. Management of CVC-related VTE in patients with cancer requires a balance between the need for venous access, the risk of VTE recurrence and the risk of bleeding from treatment-induced thrombocytopenia. Effective VTE prophylaxis methods have yet to be defined. Ongoing studies are evaluating the role of newer oral antithrombotic agents and alternative interventional strategies for the prevention and treatment of CVC-related VTE in patients with cancer.
Collapse
Affiliation(s)
- Manila Gaddh
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University , Atlanta, GA , USA
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Application des recommandations dans le traitement de la maladie thromboembolique veineuse chez les patients atteints de cancer : étude rétrospective sur 145 cas. ACTA ACUST UNITED AC 2013; 38:185-92. [DOI: 10.1016/j.jmv.2013.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 03/14/2013] [Indexed: 02/06/2023]
|
23
|
Thrombosis, cancer and renal insufficiency: low molecular weight heparin at the crossroads. Support Care Cancer 2012; 20:3033-42. [DOI: 10.1007/s00520-012-1590-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 08/30/2012] [Indexed: 02/04/2023]
|
24
|
Abstract
There is a bidirectional connection between tumors and thrombosis. On one hand, thromboembolic events are more frequent in cases of malignancies, on the other hand, proliferation of tumor cells, progression of the malignant process and metastasis formation are facilitated by the activation of the hemostatic system. Thromboembolic events are associated with a worse prognosis in case of patients with malignant diseases. Thromboembolism is the second most frequent cause of death in patients with malignant tumors. Mortality is twice as high in patients with thromboembolism compared to those without it. The incidence of thromboembolism shows an increasing tendency. There has been a 28% increase among hospitalized cancer patients between 1995 and 2003. One reason is that the new anti-tumor agents have more pronounced prothrombotic activity than those of traditional chemotherapeutic drugs. Assessment of the thrombotic risk of cancer patients becomes more important. Several guidelines have been published concerning the prevention and treatment of thromboembolism in patients with malignancy. The risk of thrombosis is influenced not only by the type of malignancy but there are also large individual differences. Furthermore, the risk of thrombosis changes during the disease process in the same patient. Perioperative thromboprophylaxis is a very important issue considering oncologic surgery. Thromboprophylaxis of oncologic patients has a high significance in respect of morbidity and mortality. However, thromboprophylaxis may also cause serious complications thus the correct risk assessment of cancer patients is very important.
Collapse
Affiliation(s)
- Klára Gadó
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest Korányi S. u. 2/A 1083.
| | | |
Collapse
|
25
|
Caruselli M, Galante D, Ficcadenti A, Carboni L, Franco F, Fabrizzi B, Amici L, Giretti R, Rocchi G, Rinaldelli G. Optimal position of a long-term central venous catheter tip in a pediatric patient with congenital diseases. Pediatr Rep 2012; 4:e32. [PMID: 25396037 PMCID: PMC4227319 DOI: 10.4081/pr.2012.e32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 08/28/2012] [Accepted: 09/07/2012] [Indexed: 12/26/2022] Open
Abstract
Progress in medical and scientific research has increased the chances of survival for young patients with congenital diseases, children who, in the past, would not have had any chance of survival. Nowadays, congenital diseases can be treated with appropriate replacement therapies. These treatments can be difficult to administer in young patients because of the high frequency of administration (sometimes more than a dose per week), the use of intravenous infusion and the long-term or life-term requirement.
Collapse
Affiliation(s)
- Marco Caruselli
- Anestesia and Intensive Care Unit, Salesi Children's Hospital , Ancona, Italy
| | - Dario Galante
- Anesthesia and Intensive Care Unit, University Hospital , Foggia, Italy
| | - Anna Ficcadenti
- Pediatric Clinic Institute, Rares Diseases Center, Politecnic University of Marches , Ancona, Italy
| | - Laura Carboni
- Anesthesia and Intensive Care Unit, Burlo Garofolo Children's Hospital , Trieste, Italy
| | - Federica Franco
- Anesthetics Department, Universitiy College Hospital , London, UK
| | - Benedetta Fabrizzi
- Pediatric Clinic Institute, Oncohaematogical Unit, Politecnic University of Marches , Ancona, Italy
| | - Lucia Amici
- Pediatric Radiology Unit, Salesi Children's Hospital , Ancona, Italy
| | - Roberto Giretti
- Anestesia and Intensive Care Unit, Salesi Children's Hospital , Ancona, Italy
| | - Giovanni Rocchi
- Anestesia and Intensive Care Unit, Salesi Children's Hospital , Ancona, Italy
| | | |
Collapse
|
26
|
Bhagya Rao B, Kalayarasan R, Kate V, Ananthakrishnan N. Venous Thromboembolism in Cancer Patients Undergoing Major Abdominal Surgery: Prevention and Management. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/783214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cancer is an important risk factor for venous thrombosis. Venous thromboembolism is one of the most common complications of cancer and the second leading cause of death in these patients. Recent research has given insight into mechanism and various risk factors in cancer patients which predispose to thromboembolism. The purpose of this review is to summarize the current knowledge on the prophylaxis, diagnosis, and management of venous thromboembolism in these patients.
Collapse
Affiliation(s)
- Bhavana Bhagya Rao
- Department of Gastroenterology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - R. Kalayarasan
- Department of Surgical Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Vikram Kate
- Department of General and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - N. Ananthakrishnan
- Department of Surgery, Mahatma Gandhi Medical College & Research Institute, Pondicherry 607402, India
| |
Collapse
|
27
|
Bachmeyer C, Pellen JC. Thromboprophylaxis in patients receiving chemotherapy. N Engl J Med 2012; 366:1839; author reply 1839-40. [PMID: 22571208 DOI: 10.1056/nejmc1203094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
28
|
|
29
|
[Thrombosis and breast cancer: incidence, risk factors, physiopathology and treatment]. Bull Cancer 2012; 99:199-210. [PMID: 22285357 DOI: 10.1684/bdc.2011.1533] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Breast cancer is associated with a low rate of thromboembolic events (TEE) when compared to other cancers, without influence of the histological type on incidence. Risk factors include the stage of cancer, and the patients' profile and management: hospitalization, surgery and presence of a central catheter but also some cytotoxic chemotherapy, tamoxifen, and some anti-angiogenic targeted therapies. The pathophysiology of TEE includes a cross-stimulation phenomenon, involving tumor cells with procoagulant activity, and factors of hemostasis, coagulation and fibrinolysis. Circulating cellular microparticles bearing tissue factor play a major role, as well as thrombogenic platelet interactions with tumor cells via P-selectin. The occurrence of TEE in a cancer patient significantly increases the risk of death. Prevention is framed by recommendations in surgical patients. Curative treatment is based on the use of low molecular weight heparin for at least six months.
Collapse
|
30
|
Elice F, Rodeghiero F. Hematologic malignancies and thrombosis. Thromb Res 2011; 129:360-6. [PMID: 22197450 DOI: 10.1016/j.thromres.2011.11.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 11/17/2011] [Accepted: 11/20/2011] [Indexed: 12/22/2022]
Abstract
Patients with hematologic malignancies have an increased risk of venous thromboembolism (VTE), particularly at diagnosis and during the treatment with chemotherapy, asparaginase or immunomodulatory drugs (IMiDs). A disease-dependent hypercoagulable condition associated with other risk factors like drugs, central venous catheter (CVC), immobility and infections are responsible for this high VTE rate. Thrombotic complications have a significant impact on morbidity and in some cases also on mortality of patients with onco-hematologic diseases, therefore thromboprophylaxis to prevent VTE in this setting is needed. However, thrombocytopenia and hemorrhagic complications pone many difficulties in the management of an anticoagulant or antiaggregant treatment in these patients. Recommendations from current guidelines are limited to multiple myeloma patients treated with thalidomide or lenalidomide associated with dexamethasone or chemotherapy, but hematological clinical departments should implement a policy for prevention and treatment of thromboembolic complications in hematologic malignancies.
Collapse
Affiliation(s)
- F Elice
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | | |
Collapse
|
31
|
Van Horn A, Chamberlain MC. Neoplastic meningitis. ACTA ACUST UNITED AC 2011; 10:45-53. [PMID: 22005214 DOI: 10.1016/j.suponc.2011.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/02/2011] [Indexed: 02/06/2023]
Abstract
Neoplastic meningitis occurs in approximately 5%-10% of all patients with cancer, and aggressive supportive measures are a critical component of comprehensive care. A literature review of the current diagnostic methods, randomized controlled trials, and available treatments was undertaken; and a comprehensive discussion of best-practice supportive care measures is provided. Although the prognosis for those diagnosed with neoplastic meningitis is poor, treatment and supportive care may allow stabilization of neurologic symptoms and afford protection from further neurologic deterioration, allowing patients to maximize their function and independence and adjust their expectations of treatment from cure to palliation.
Collapse
Affiliation(s)
- Alixis Van Horn
- Department of Neurology and Neurological Surgery, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
32
|
Margey R, Schainfeld RM. Upper Extremity Deep Vein Thrombosis: The Oft-forgotten Cousin of Venous Thromboembolic Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:146-58. [PMID: 21271312 DOI: 10.1007/s11936-011-0113-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OPINION STATEMENT Upper extremity deep venous thrombosis (UEDVT) accounts for between 4% and 10% of all deep venous thromboses, and may be due to primary or secondary causes. The incidence of UEDVT is increasing, partly due to the exponential growth in the use of central venous catheters and the increasing placement of permanent cardiac pacemaker or defibrillator devices. UEDVT not only compromises future vascular access but results in significant morbidity and mortality, with symptomatic pulmonary embolus occurring in approximately 12%, post-thrombotic syndrome in 13%, and mortality ranging from 15-50%. Treatment of UEDVT depends on the underlying cause, primary or secondary. In this review, we will evaluate the management options and present a proposed treatment algorithm for primary UEDVT, involving catheter-directed thrombolysis, selective use of mechanical thrombectomy, anticoagulation and antithrombotic therapy, expeditious early first rib resection to decompress the thoracic outlet, and the role of adjunctive endovascular balloon angioplasty and stenting in improving axillo-subclavian vein patency. With regard to secondary UEDVT, we will present a treatment algorithm for managing central venous catheter (CVC) thrombosis; review the options for antithrombotic and anticoagulant therapy; and discuss the role of endovascular therapy. Finally, we will review the data supporting the growing role of percutaneous transluminal angioplasty (PTA) or venoplasty and endovascular stenting as the modality of choice in managing SVC obstruction, whether due to benign or malignant causes, and provide a brief description of the role, benefits and potential complications of SVC filter placement.
Collapse
Affiliation(s)
- Ronan Margey
- Section of Vascular Medicine, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Gray-Bigelow 800, 55 Fruit Street, Boston, MA, 02114, USA
| | | |
Collapse
|
33
|
Abstract
Patients with cancer are at increased risk of venous thromboembolism (VTE). In these patients VTE is associated with substantial morbidity and complicates the clinical management of cancer. Emerging research indicates a probable detrimental effect of VTE on cancer survival. Although VTE may develop at any stage of cancer disease, the risk of VTE is particularly high in association with three clinical settings including surgery for cancer, use of a central vein catheter (CVC) and chemotherapy. Guidelines recommend post-operative prophylaxis (for at least 7-10 days) for patients undergoing elective cancer surgery. A prolonged prophylaxis (for upto four post-operative weeks) is recommended in cancer patients at high risk for VTE. The role of antithrombotic prophylaxis in the prevention of CVC-related thrombosis remains controversial. The PROTECHT study has recently evaluated the benefit of antithrombotic prophylaxis in cancer patients receiving chemotherapy, showing a statistically significant 50% relative risk reduction in symptomatic thromboembolic events. The international guidelines currently agree in non-recommending routine prophylaxis in ambulatory patients who receive anticancer chemotherapy but suggest an individual risk-based evaluation. To better identify cancer patients at high risk for VTE, simple predictive models have been validated. Further intervention studies are currently on-going to explore the benefit of antithrombotic prophylaxis in individual high-risk groups of patients. The long-term treatment of cancer-related VTE is based on therapeutic doses of LMWH in preference to warfarin. The optimal duration of antithrombotic treatment in cancer patients remains to be fully defined.
Collapse
Affiliation(s)
- G Agnelli
- Internal and Cardiovascular Medicine, Stroke Unit, Department of Internal Medicine, University of Perugia, Perugia, Italy.
| | | |
Collapse
|
34
|
|
35
|
Vitale FV, Rotondo S, Sessa E, Parisi A, Giaimo V, D’Angelo A, Antonelli G, Romeo P, Ferraù F. Low molecular weight heparin administration in cancer patients with hypercoagulability-related complications and carrying brain metastases: A case series study. J Oncol Pharm Pract 2011; 18:10-6. [DOI: 10.1177/1078155210390254] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Venous thromboembolism (VTE) and brain metastases (MTS) are significant clinical problems in the cancer patient population. Brain MTS and deep vein thrombosis are life-threatening conditions because of the risk of fatal endocranic hypertension and pulmonary embolism. Low molecular weight heparin (LMWH) is a major treatment for cancer patients suffering from VTE with regard to the management of the acute phase and subsequent secondary prophylaxis. Treatment with anticoagulants is feared because of the risk of triggering a massive intracranial hemorrhage. Methods. The medical records of patients with hypercoagulability-related complications and carrying brain MTS treated with LMWH, in a 10-year period, were scrutinized. The authors aimed to focus on the occurrence of intracranial hemorrhage in anticoagulated patients; furthermore, data were collected with regard to the characteristics of the administered LMWHs along with the duration and dosing of the anticoagulative treatment. Results. A total of 38 patients (pts) carrying an intracranial metastatic tumor were administered LMWHs: calcium nadroparin (32 pts); enoxaparin (2 pts); reviparin (2 pts); parnaparin (2 pts). Reason for LMWH therapy: deep vein thrombosis and/or pulmonary embolism (15 pts); superficial thrombophlebitis (15 pts); intracardiac thrombus (1 pt); mild DIC (5 pts); acute DIC (1 pt); Raynaud phenomenon (1 pt); atrial fibrillation (1 pt). Median duration of LMWH therapy: 13 weeks (range 1–52). None of the patients developed clinical and/or radiographic findings imputable to intracranial hemorrhage. Conclusion. There is no standard medical approach for the management of patients who require anticoagulant treatment and are suffering from brain MTS. These patients as necessary, might be anticoagulated with LMWH and its dose reduction is to be considered.
Collapse
Affiliation(s)
| | | | - Edoardo Sessa
- Centro Neurolesi, IRCCS Bonino Pulejo, Messina, Italy
| | - Alessandra Parisi
- Division of Medical Oncology, San Vincenzo Hospital, Taormina, Italy
| | - Valentina Giaimo
- Division of Medical Oncology, San Vincenzo Hospital, Taormina, Italy
| | | | | | - Placido Romeo
- Unit of Diagnostic and Interventional Radiology, San Vincenzo Hospital Taormina, Italy
| | - Francesco Ferraù
- Division of Medical Oncology, San Vincenzo Hospital, Taormina, Italy
| |
Collapse
|