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Drabkin MJ, Bajwa R, Perez-Johnston R, Bryce Y, Boas FE, Siegelbaum R, Durack JC, Kishore S. Anticoagulation reduces iliocaval and iliofemoral stent thrombosis in patients with cancer stented for nonthrombotic venous obstruction. J Vasc Surg Venous Lymphat Disord 2020; 9:88-94. [PMID: 32791307 DOI: 10.1016/j.jvsv.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/02/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify factors associated with venous stent thrombosis in patients with cancer treated for nonthrombotic iliocaval or iliofemoral venous obstruction. METHODS We performed a retrospective review of relevant imaging and medical records from 30 consecutive patients with cancer treated at a single center who underwent venous stent placement for nonthrombotic iliocaval or iliofemoral venous obstruction between 2008 and 2018. Follow-up imaging was used to assess stent patency. Variables examined included patient demographics, cancer type, stent characteristics, anticoagulant, and antiplatelet medications and complications of treatment. RESULTS Overall primary stent patency was 83% (25/30). The median follow-up period was 44 days (range, 3-365 days). Ten percent of patients occluded owing to in-stent thrombosis and 7% owing to tumor compression of the stent without thrombosis. Therapeutic poststent anticoagulation with enoxaparin, warfarin, or a factor Xa inhibitor was initiated in 87% of the patients. Stent thrombosis occurred in one patient in the anticoagulation group (4%) at 50 days. Stent thrombosis occurred in two patients in the nonanticoagulation group (50%), one at 9 days and the other at 91 days. Anticoagulation was found to be protective against stent thrombosis in this population (hazard ratio, 0.015; P = .011). No statistically significant associations were found among the remaining variables. One patient in the anticoagulation group experienced major bleeding (1/26 [4%]). CONCLUSIONS Iliocaval and iliofemoral stent placement for nonthrombotic malignant venous obstruction is safe with favorable primary patency rates. Therapeutic anticoagulation is associated with less stent thrombosis in patients with cancer stented for nonthrombotic iliocaval and iliofemoral venous obstruction.
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Affiliation(s)
| | - Raazi Bajwa
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Yolanda Bryce
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - F Edward Boas
- Memorial Sloan Kettering Cancer Center, New York, NY
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Raposeiras-Roubín S, Abu-Assi E, D’Ascenzo F, Fernández-Barbeira S, Kinnaird T, Ariza-Solé A, Manzano-Fernández S, Templin C, Velicki L, Xanthopoulou I, Cerrato E, Quadri G, Rognoni A, Boccuzzi G, Montabone A, Taha S, Durante A, Gili S, Magnani G, Autelli M, Grosso A, Flores Blanco P, Garay A, Varbella F, Tommassini F, Caneiro Queija B, Cobas Paz R, Cespón Fernández M, Muñoz Pousa I, Gallo D, Morbiducci U, Domínguez-Rodríguez A, Baz-Alonso JA, Valdés M, Cequier Á, Gaita F, Alexopoulos D, Íñiguez-Romo A. Incidencia anual de trombosis del stent confirmadas y factores clínicos predictores en pacientes con SCA tratados con ticagrelor o prasugrel. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Raposeiras-Roubín S, Abu-Assi E, D'Ascenzo F, Fernández-Barbeira S, Kinnaird T, Ariza-Solé A, Manzano-Fernández S, Templin C, Velicki L, Xanthopoulou I, Cerrato E, Quadri G, Rognoni A, Boccuzzi G, Montabone A, Taha S, Durante A, Gili S, Magnani G, Autelli M, Grosso A, Flores Blanco P, Garay A, Varbella F, Tommassini F, Caneiro Queija B, Cobas Paz R, Cespón Fernández M, Muñoz Pousa I, Gallo D, Morbiducci U, Domínguez-Rodríguez A, Baz-Alonso JA, Valdés M, Cequier Á, Gaita F, Alexopoulos D, Íñiguez-Romo A. Annual Incidence of Confirmed Stent Thrombosis and Clinical Predictors in Patients With ACS Treated With Ticagrelor or Prasugrel. ACTA ACUST UNITED AC 2018; 72:298-304. [PMID: 29954720 DOI: 10.1016/j.rec.2018.05.021] [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: 08/27/2017] [Accepted: 02/28/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is little evidence on rates of stent thrombosis (ST) in patients receiving dual antiplatelet therapy (DAPT) with ticagrelor or prasugrel. The aim of this study was to analyze the incidence and predictors of ST after an acute coronary syndrome among patients receiving DAPT with ticagrelor vs prasugrel. METHODS We used data from the RENAMI registry (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction), analyzing a total of 4123 acute coronary syndrome patients discharged with DAPT with ticagrelor or prasugrel in 11 centers in 6 European countries. The endpoint was definite ST within the first year. A competitive risk analysis was carried out using a Fine and Gray regression model, with death being the competitive event. RESULTS A total of 2604 patients received DAPT with ticagrelor and 1519 with prasugrel; ST occurred in 41 patients (1.10%), with a similar cumulative incidence between ticagrelor (1.21%) and prasugrel (0.90%). The independent predictors of ST were age (sHR, 1.03; 95%CI, 1.01-1.06), ST segment elevation (sHR, 2.24; 95%CI, 1.22-4.14), previous myocardial infarction (sHR, 2.56; 95%CI, 1.19-5.49), and serum creatinine (sHR, 1.29; 95%CI, 1.08-1.54). CONCLUSIONS Stent thrombosis is infrequent in patients receiving DAPT with ticagrelor or prasugrel. The variables associated with an increased risk of ST were advanced age, ST segment elevation, previous myocardial infarction, and serum creatinine.
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Affiliation(s)
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - Fabrizio D'Ascenzo
- Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | - Tim Kinnaird
- Cardiology Department, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Manzano-Fernández
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Lazar Velicki
- Medical Faculty, University of Novi Sad, Novi Sad, Serbia; Institute of Cardiovascular Diseases Voivodina, Sremska Kamenica, Serbia
| | | | - Enrico Cerrato
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | | | | | - Salma Taha
- Department of Cardiology, Faculty of Medicine, Assiut University, Asiut, Egypt
| | | | - Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Giulia Magnani
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michele Autelli
- Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alberto Grosso
- Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Pedro Flores Blanco
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Alberto Garay
- Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Rafael Cobas Paz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - María Cespón Fernández
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Isabel Muñoz Pousa
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | | | - Mariano Valdés
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fiorenzo Gaita
- Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | - Andrés Íñiguez-Romo
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
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