1
|
Bazarbashi S, El Zawahry HM, Owaidah T, AlBader MA, Warsi A, Marashi M, Dawoud E, Jaafar H, Sholkamy SM, Haddad F, Cohen AT. The Role of Direct Oral Anticoagulants in the Treatment of Cancer-Associated Venous Thromboembolism: Review by Middle East and North African Experts. J Blood Med 2024; 15:171-189. [PMID: 38686358 PMCID: PMC11057512 DOI: 10.2147/jbm.s411520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/01/2024] [Indexed: 05/02/2024] Open
Abstract
Venous thromboembolism is a leading cause of morbidity and mortality in patients with active cancer who require anticoagulation treatment. Choice of anticoagulant is based on careful balancing of the risks and benefits of available classes of treatment: vitamin K antagonists, low-molecular-weight heparin (LMWH), and direct oral anticoagulants (DOACs). Results from randomized controlled trials have shown the consistent efficacy of DOACs versus LMWH in the treatment of cancer-associated venous thromboembolism (VTE). However, increased major gastrointestinal bleeding was observed for edoxaban and rivaroxaban, but not apixaban, compared with LMWH dalteparin. Most guidelines recommend DOACs for the treatment of cancer-associated VTE in patients without gastrointestinal or genitourinary cancer, and with considerations for renal impairment and drug-drug interactions. These updates represent a major paradigm shift for clinicians in the Middle East and North Africa. The decision to prescribe a DOAC for a patient with cancer is not always straightforward, particularly in challenging subgroups of patients with an increased risk of bleeding. In patients with gastrointestinal malignancies who are at high risk of major gastrointestinal bleeds, apixaban may be the preferred DOAC; however, caution should be exercised if patients have upper or unresected lower gastrointestinal tumors. In patients with gastrointestinal malignancies and upper or unresected lower gastrointestinal tumors, LMWH may be preferred. Vitamin K antagonists should be used only when DOACs and LMWH are unavailable or unsuitable. In this review, we discuss the overall evidence for DOACs in the treatment of cancer-associated VTE and provide treatment suggestions for challenging subgroups of patients with cancer associated VTE.
Collapse
Affiliation(s)
- Shouki Bazarbashi
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Alfaisal University, Riyadh, Saudi Arabia
| | - Heba Mohamed El Zawahry
- Department of Medical Oncology, The National Cancer Institute, Cairo University, Cairo, Egypt
| | - Tarek Owaidah
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Ashraf Warsi
- Department of Adult Hematology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs–Western Region, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs–Western Region, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs-Western Region, Jeddah, Saudi Arabia
| | - Mahmoud Marashi
- Hematology Department, Dubai Hospital, Dubai, United Arab Emirates
- Department of Hematology, Mediclinic City Hospital, Dubai, United Arab Emirates
| | - Emad Dawoud
- Department of Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Hassan Jaafar
- Department of Oncology, Sheikh Khalifa Specialty Hospital, Ras Al-Khaimah, United Arab Emirates
| | | | - Fady Haddad
- Vascular and Endovascular Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alexander T Cohen
- Department of Haematological Medicine, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, King’s College London, London, UK
| |
Collapse
|
2
|
La CC, Smith SA, Vappala S, Adili R, Luke CE, Abbina S, Luo HD, Chafeeva I, Drayton M, Creagh LA, de Guadalupe Jaraquemada-Peláez M, Rhoads N, Kalathottukaren MT, Henke PK, Straus SK, Du C, Conway EM, Holinstat M, Haynes CA, Morrissey JH, Kizhakkedathu JN. Smart thrombosis inhibitors without bleeding side effects via charge tunable ligand design. Nat Commun 2023; 14:2177. [PMID: 37100783 PMCID: PMC10133246 DOI: 10.1038/s41467-023-37709-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
Current treatments to prevent thrombosis, namely anticoagulants and platelets antagonists, remain complicated by the persistent risk of bleeding. Improved therapeutic strategies that diminish this risk would have a huge clinical impact. Antithrombotic agents that neutralize and inhibit polyphosphate (polyP) can be a powerful approach towards such a goal. Here, we report a design concept towards polyP inhibition, termed macromolecular polyanion inhibitors (MPI), with high binding affinity and specificity. Lead antithrombotic candidates are identified through a library screening of molecules which possess low charge density at physiological pH but which increase their charge upon binding to polyP, providing a smart way to enhance their activity and selectivity. The lead MPI candidates demonstrates antithrombotic activity in mouse models of thrombosis, does not give rise to bleeding, and is well tolerated in mice even at very high doses. The developed inhibitor is anticipated to open avenues in thrombosis prevention without bleeding risk, a challenge not addressed by current therapies.
Collapse
Affiliation(s)
- Chanel C La
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Chemistry, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie A Smith
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sreeparna Vappala
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Reheman Adili
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, USA
- Bloodworks Research Institute, 1551 Eastlake Avenue E.; Ste. 100, Seattle, WA, 98102, USA
| | - Catherine E Luke
- Department of Surgery, Section of Vascular Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Srinivas Abbina
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Haiming D Luo
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Chemistry, University of British Columbia, Vancouver, BC, Canada
| | - Irina Chafeeva
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Drayton
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Louise A Creagh
- Department of Chemical and Biological Engineering, University of British Columbia, Vancouver, BC, Canada
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | | | - Nicole Rhoads
- Bloodworks Research Institute, 1551 Eastlake Avenue E.; Ste.100, Seattle, WA, 98102, USA
| | - Manu Thomas Kalathottukaren
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter K Henke
- Department of Surgery, Section of Vascular Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Suzana K Straus
- Department of Chemistry, University of British Columbia, Vancouver, BC, Canada
| | - Caigan Du
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Edward M Conway
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- The School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Michael Holinstat
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Charles A Haynes
- Department of Chemical and Biological Engineering, University of British Columbia, Vancouver, BC, Canada
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - James H Morrissey
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Jayachandran N Kizhakkedathu
- Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada.
- Department of Chemistry, University of British Columbia, Vancouver, BC, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
- The School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
3
|
Lee LH, Danchaivijitr P, Uaprasert N, Gill H, Sacdalan DL, Ho GF, Parakh R, Pai P, Lee JK, Rey N, Cohen AT. Safe and effective treatment of venous Thromboembolism associated with Cancer: focus on direct Oral Anticoagulants in Asian patients. Exp Hematol Oncol 2022; 11:79. [PMID: 36303259 PMCID: PMC9615183 DOI: 10.1186/s40164-022-00331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Cancer-associated thrombosis (CAT) poses a significant disease burden and the incidence in Asian populations is increasing. Anticoagulation is the cornerstone of treatment, but can be challenging due to the high bleeding risk in some cancers and the high risk of recurrent venous thromboembolism (VTE) in patients with malignancies. Direct oral anticoagulants (DOACs) are well established as first-choice treatments for VTE in non-cancer patients, offering a more convenient and less invasive treatment option than low-molecular-weight heparin (LMWH). Asian patients have exhibited comparable efficacy and safety outcomes with other races in trials of DOACs for VTE in the general population. Although no specific data are available in Asian patients with CAT, results from randomized controlled trials of apixaban, edoxaban, or rivaroxaban versus the LMWH, dalteparin, indicate that DOACs are a reasonable alternative to LMWH for anticoagulation in Asian patients with CAT. This is further supported by analyses of real-world data in Asian populations demonstrating the efficacy and safety of DOACs in Asian patients with CAT. Apixaban, edoxaban, or rivaroxaban are recommended in the most recently updated international guidelines as first-line therapy for CAT in patients without gastrointestinal or genitourinary cancers and at low risk of bleeding. An increased risk of major gastrointestinal bleeding was evident with edoxaban or rivaroxaban, but not apixaban, versus dalteparin in the clinical trials, suggesting that apixaban could be a safe alternative to LMWH in patients with gastrointestinal malignancies. Determining the optimal anticoagulant therapy for patients with CAT requires careful consideration of bleeding risk, tumor type, renal function, drug-drug interactions, financial costs, and patients' needs and preferences.
Collapse
Affiliation(s)
- Lai Heng Lee
- Haematology Department, Singapore General Hospital, Bukit Merah, Singapore
| | - Pongwut Danchaivijitr
- Division of Medical Oncology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Noppacharn Uaprasert
- Research Unit in Translational Hematology, Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Harinder Gill
- Department of Medicine, The University of Hong Kong, 102 Pokfulam Road, Pokfulam Hong Kong, Pokfulam, Hong Kong, China.
| | | | - Gwo Fuang Ho
- Clinical Oncology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Rajiv Parakh
- Division of Peripheral Vascular & Endovascular Service, Medanta-Medicity, Gurgaon, Haryana, India
| | - Paresh Pai
- Vascular and Endovascular Surgery, The Vascular Clinic, Mumbai, India
| | - Jen-Kuang Lee
- Cardiology Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Nannette Rey
- de La Salle Medical and Health Sciences Institute, Dasmarinas Cavite, Philippines
| | - Alexander T Cohen
- Department of Haematological Medicine, Guy's and St Thomas' Hospitals, NHS Trust, King's College, London, UK
| |
Collapse
|
4
|
Tsubata Y, Hotta T, Hamai K, Furuya N, Yokoyama T, Saito R, Nakamura A, Masuda T, Hamaguchi M, Kuyama S, Honda R, Senoo T, Nakanishi M, Yamasaki M, Ishikawa N, Fujitaka K, Kubota T, Ohtsu H, Kobayashi K, Isobe T. Incidence of venous thromboembolism in advanced lung cancer and efficacy and safety of direct oral anticoagulants: a multicenter, prospective, observational study (Rising-VTE/NEJ037 study). Ther Adv Med Oncol 2022; 14:17588359221110171. [PMID: 35898966 PMCID: PMC9310216 DOI: 10.1177/17588359221110171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/09/2022] [Indexed: 12/21/2022] Open
Abstract
Background: Venous thromboembolism (VTE) is a well-known type of cancer-associated thrombosis and a common complication of malignancy. However, the incidence of VTE associated with lung cancer and the effectiveness of direct oral anticoagulants remain unclear. This study aimed to identify the incidence of VTE associated with lung cancer at the time of diagnosis or during treatment, the efficacy and safety of edoxaban, and associated risk factors. Methods: The Rising-VTE/NEJ037 study was a multicenter prospective observational study. Altogether, 1021 patients with lung cancer who were unsuitable for radical resection or radiation were enrolled and followed up for 2 years. Patients with VTE at the time of lung cancer diagnosis started treatment with edoxaban. The primary endpoint of this trial was the rate of newly diagnosed VTE after enrollment or recurrence rate 6 months after treatment initiation. Results: Data were available for 1008 patients. The median age was 70 years (range: 30–94 years), and 70.8% were men. Sixty-two patients had VTE at the time of lung cancer diagnosis, and 38 (9.9%) developed VTE at follow-up. No cases of VTE recurrence were recorded 6 months after treatment initiation with edoxaban. Major and clinically relevant non-major bleeding events occurred in 4.9% of patients and increased to 22.7% in the edoxaban treatment group. Conclusions: VTE occurrence should be monitored during lung cancer treatment. Although treatment with edoxaban was highly effective in preventing VTE recurrence, its administration should be cautiously considered because of the high bleeding rate. Trial registration: jRCTs061180025.
Collapse
Affiliation(s)
- Yukari Tsubata
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Takamasa Hotta
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kosuke Hamai
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Minami-ku, Hiroshima, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Toshihide Yokoyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Ryota Saito
- Department of Respiratory Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Atsushi Nakamura
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Aoba-ku, Sendai, Miyagi, Japan
| | - Takeshi Masuda
- Department of Respiratory Medicine, Hiroshima University Hospital, Minami-ku, Hirosima, Japan
| | - Megumi Hamaguchi
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
| | - Ryoichi Honda
- Department of Respiratory Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Tadashi Senoo
- Department of Respiratory Medicine, National Hospital Organization, Kure Medical Center, Kure, Hiroshima, Japan
| | - Masamoto Nakanishi
- Department of Medical Oncology, Yamaguchi-Ube Medical Center, Ube, Yamaguchi, Japan
| | - Masahiro Yamasaki
- Department of Respiratory Disease, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, Japan
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Minami-ku, Hiroshima, Japan
| | - Kazunori Fujitaka
- Department of Respiratory Medicine, Hiroshima University Hospital, Minami-ku, Hirosima, Japan
| | - Tetsuya Kubota
- Department of Respiratory Medicine and Allergology, Kochi University Hospital, Nankoku, Kochi, Japan
| | - Hiroshi Ohtsu
- Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kunihiko Kobayashi
- Department of Pulmonary Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Takeshi Isobe
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| |
Collapse
|
5
|
Rungjirajittranon T, Owattanapanich W, Chinthammitr Y, Ruchutrakool T, Suwanawiboon B. Direct oral anticoagulants versus low-molecular-weight heparins for the treatment of acute venous thromboembolism in patients with gastrointestinal cancer: a systematic review and meta-analysis. Thromb J 2022; 20:41. [PMID: 35902879 PMCID: PMC9330678 DOI: 10.1186/s12959-022-00399-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 07/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background The association between gastrointestinal (GI) cancer and a high incidence of venous thromboembolism (VTE) is well known. Previous randomized controlled studies demonstrated that direct oral anticoagulants (DOACs) effectively treat cancer-associated thrombosis (CAT). However, some DOACs appeared to increase the risk of bleeding, particularly in patients with GI malignancies. Therefore, the current systematic review and meta-analysis were conducted to evaluate the safety and efficacy of DOACs in GI cancer-associated thrombosis. Methods Two investigators individually reviewed all studies that compared DOACs and low-molecular-weight heparins (LMWHs) in GI cancer-associated thrombosis and were published in MEDLINE and EMBASE before February 2022. The effect estimates and 95% confidence intervals (CIs) from each eligible study were combined using the Mantel–Haenszel method. Results A total of 2226 patients were included in the meta-analysis. The rates of major bleeding in the DOAC and LMWH groups were not significantly different (relative risk [RR]: 1.31; 95% CI: 0.84–2.04; P = 0.23; I2 = 41%). However, the rate of clinically relevant nonmajor bleeding (CRNMB) was significantly higher in the DOAC group (RR: 1.76; 95% CI: 1.24–2.52; P = 0.002; I2 = 8%). The risks of recurrent VTE in the groups did not significantly differ (RR: 0.72; 95% CI: 0.49–1.04; P = 0.08; I2 = 0%). Conclusions The current data suggest that treatment of GI cancer-associated thrombosis with DOACs significantly increases the risk of CRNMB. However, the risk of major bleeding was not significantly different. The efficacy of DOACs for preventing recurrent VTE in GI cancer was comparable to that of LMWHs. Trial registration INPLASY202180113. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-022-00399-7.
Collapse
Affiliation(s)
- Tarinee Rungjirajittranon
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerapat Owattanapanich
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yingyong Chinthammitr
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Theera Ruchutrakool
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bundarika Suwanawiboon
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
6
|
A review of latest clinical practice guidelines for the management of cancer-associated thrombosis. Best Pract Res Clin Haematol 2022; 35:101348. [DOI: 10.1016/j.beha.2022.101348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/24/2022] [Indexed: 11/19/2022]
|
7
|
Athanazio RA, Ceresetto JM, Marfil Rivera LJ, Cesarman-Maus G, Galvez K, Marques MA, Tabares AH, Ortiz Santacruz CA, Santini FC, Corrales L, Cohen AT. Direct Oral Anticoagulants for the Treatment of Cancer-Associated Venous Thromboembolism: A Latin American Perspective. Clin Appl Thromb Hemost 2022; 28:10760296221082988. [PMID: 35261295 PMCID: PMC8918974 DOI: 10.1177/10760296221082988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in patients with cancer. On the basis of results from randomized controlled trials, direct oral anticoagulants (DOACs) are now recommended for the treatment of cancer-associated VTE. The decision to use a DOAC requires consideration of bleeding risk, particularly in patients with gastrointestinal (GI) malignancies, the cost-benefit and convenience of oral therapy, and patient preference. While efficacy with apixaban, edoxaban, and rivaroxaban versus dalteparin has been consistent in the treatment of cancer-associated VTE, heterogeneity is evident with respect to major GI bleeding, with an increased risk with edoxaban and rivaroxaban but not apixaban. Although cost and accessibility vary in different countries of Latin America, DOACs should be considered for the long-term treatment of cancer-associated VTE in all patients who are likely to benefit. Apixaban may be the preferred DOAC in patients with GI malignancies and LMWH may be preferred for patients with upper or unresected lower GI tumors. Vitamin K antagonists should only be used for anticoagulation when DOACs and low molecular weight heparin are inaccessible or unsuitable.
Collapse
Affiliation(s)
- Rodrigo Abensur Athanazio
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
- Rodrigo Abensur Athanazio, Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo,
Av. Dr. Enéas de Carvalho Aguiar, 44 - 5 andar (pneumologia), 05403-900 - São Paulo/SP – Brazil.
| | | | - Luis Javier Marfil Rivera
- Servicio de Hematología, Hospital Universitario “Dr José E González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Kenny Galvez
- Cancer Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Marcos Arêas Marques
- Unit of Angiology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aldo Hugo Tabares
- Vascular Medicine and Thrombosis Service, Instituto Universitario de Ciencias Biomedicas de Córdoba (IUCBC), Córdoba, Argentina
| | | | | | - Luis Corrales
- Medical Oncology, Centro de Investigación y Manejo del Cáncer (CIMCA), San José, Costa Rica
| | - Alexander T. Cohen
- Department of Haematological Medicine, Guy's and St Thomas' Hospitals NHS Foundation Trust, King's College London, UK
| |
Collapse
|
8
|
Chapelle C, Ollier E, Girard P, Frere C, Mismetti P, Cucherat M, Laporte S. An epidemic of redundant meta-analyses. J Thromb Haemost 2021; 19:1299-1306. [PMID: 33660901 DOI: 10.1111/jth.15280] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/05/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Meta-analyses are widely used to strengthen available evidence and obtain more precise estimates of treatment effect than any individual trial. Paradoxically, multiplication of meta-analyses on the same topic can lead to confusion as practitioners no longer benefit from a rapid and synthetic response. This phenomenon may appear disproportionate when the number of published meta-analyses exceeds the number of original studies. OBJECTIVES To describe an example of redundant meta-analyses published in the same area with the same randomized clinical trials (RCTs). METHODS A systematic review was performed to identify all published meta-analyses of original RCTs that compared direct oral anticoagulants with low molecular weight heparins in cancer patients with venous thromboembolism (VTE). Forest plots were used to represent the meta-analyses results for efficacy (VTE recurrence) and safety (major bleeding) endpoints. An authors' network was constructed to explore the links between the authors of the published meta-analyses. RESULTS In the past 3 years, four original RCTs were the subject of 20 published meta-analyses by 142 authors: five, four, and 11 meta-analyses pooled the data of two, three, and four RCTs, respectively. The results of meta-analyses were similar regarding the risks of VTE recurrence and major bleeding. The 11 meta-analyses of four RCTs were published within 6 months of the publication of the last RCT. CONCLUSIONS The epidemic proportions of such redundant literature and authorship could be moderated by developing "living" meta-analyses and encouraging authors of new RCTs to update the corresponding meta-analysis in the same paper as their original research.
Collapse
Affiliation(s)
- Céline Chapelle
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
- SAINBIOSE U1059, Université Jean Monnet, Univ. Lyon, INSERM, Saint-Etienne, France
| | - Edouard Ollier
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
- SAINBIOSE U1059, Université Jean Monnet, Univ. Lyon, INSERM, Saint-Etienne, France
| | - Philippe Girard
- Institut Mutualiste Montsouris, Paris, France
- F-CRIN INNOVTE network, Saint Etienne, France
| | - Corinne Frere
- Sorbonne Université, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | - Patrick Mismetti
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
- SAINBIOSE U1059, Université Jean Monnet, Univ. Lyon, INSERM, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint Etienne, France
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
| | - Michel Cucherat
- Service de Pharmacologie, HCL, UMR CNRS 5558 Evaluation et Modélisation des Effets Thérapeutiques, Université Claude Bernard Lyon 1, Lyon, France
| | - Silvy Laporte
- Unité de Recherche Clinique, Innovation, Pharmacologie, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
- SAINBIOSE U1059, Université Jean Monnet, Univ. Lyon, INSERM, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint Etienne, France
| |
Collapse
|
9
|
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.
| |
Collapse
|
10
|
Meta-analysis fever in the wake of CARAVAGGIO. Thromb Res 2020; 196:141-142. [DOI: 10.1016/j.thromres.2020.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 08/23/2020] [Indexed: 11/22/2022]
|
11
|
Management of Cancer-Associated Thrombosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00851-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|