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Hagiwara K, Watanabe Y, Suzuki T, Okamura Y, Yamashita H. Prevalence of preoperative asymptomatic deep vein thrombosis in patients undergoing elective general surgery for benign disease. Ann Gastroenterol Surg 2023; 7:1042-1048. [PMID: 37927917 PMCID: PMC10623937 DOI: 10.1002/ags3.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 11/07/2023] Open
Abstract
Background The systemic inflammatory response following surgery as well as that of malignant disease itself is associated with a hypercoagulable state, and thromboprophylaxis is thus recommended during postoperative management of cancer patients. However, limited information is available on the prevalence of preoperative deep vein thrombosis (DVT) and its risk factors in surgical candidates, especially those receiving operations for benign diseases. Methods This is a retrospective observational study with data of all patients scheduled for elective general surgery between January 2011 and September 2020, undergoing lower extremity venous ultrasonography as preoperative screening for DVT. The prevalence of preoperative asymptomatic DVT was estimated and its associations with clinical variables were evaluated. Results Among 1512 patients included in the study, 161 (10.6%) had asymptomatic DVT before surgery. DVT prevalence was 13.7% in patients with malignant disease, while it was 8.6% in those with benign disease. The site of the thrombus was distal type in 141 (87.6%) patients, most commonly in the soleal vein. Advanced age (>70 years), female sex, and decreased hemoglobin level were significantly associated with preoperative asymptomatic DVT by multivariate analysis. The odds ratio for advanced age was the highest and rose as age increased. Malignant disease was not an independent risk factor for preoperative DVT. Conclusion This study showed the prevalence of asymptomatic DVT to be equal in patients with and without malignant disease undergoing elective general surgery. Preoperative DVT assessment is necessary regardless of the disease indicated for surgery, especially in patients with the risk factors identified in this study.
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Affiliation(s)
- Ken Hagiwara
- Division of Digestive Surgery, Department of SurgeryNihon University School of MedicineTokyoJapan
| | - Yutaka Watanabe
- Department of Cardiovascular SurgeryToride Medical Association HospitalIbarakiJapan
| | - Takeki Suzuki
- Department of SurgeryToride Medical Association HospitalIbarakiJapan
| | - Yukiyasu Okamura
- Division of Digestive Surgery, Department of SurgeryNihon University School of MedicineTokyoJapan
| | - Hiroharu Yamashita
- Division of Digestive Surgery, Department of SurgeryNihon University School of MedicineTokyoJapan
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2
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Wilk M, Waśko-Grabowska A, Skoneczna I, Szczylik C, Szmit S. Cardiac Biomarkers and Geriatric Assessment in Metastatic Castrate-Resistant Prostate Cancer During Abiraterone Acetate Therapy - A Cardio-Oncology Study. Cancer Control 2022; 29:10732748221140696. [PMID: 36447439 PMCID: PMC9716601 DOI: 10.1177/10732748221140696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/16/2022] [Accepted: 10/26/2022] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Abiraterone acetate (AA) is a drug used in advanced prostate cancer. However, known clinical factors with predictive and prognostic value are scarce. This study evaluated cardiovascular (CV) factors and geriatric scales as potential markers of superior response during AA therapy. METHODS This is a prospective observational study. Serum levels of high sensitivity troponin T (hsTnT), D-dimer, NT-proBNP and left ventricle ejection fraction (LVEF) were used for CV evaluation. Questionnaires of G8, VES-13, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (iADL), and Geriatric Depression Scale (GDS) were included in the geriatric screening assessment. All measures were taken before AA initiation. Survival curves and Cox proportional hazard models (univariate and multivariate) were used to determine the predictors for a longer time to treatment failure (TTF). RESULTS Forty nine patients were included in the study. Overall median TTF was 7.9 months (95% CI: 5.9-12.4). In univariate analysis, factors associated with inferior TTF were (P-value < .05): visceral metastases - HR 2.34; 95% CI: 1.24-4.45, history of coronary artery disease - HR 3.02; 95% CI: 1.19-7.66; LVEF < 50% - HR 2.53; 95% CI: 1.03-6.17; P = .041; age-adjusted D-dimer > upper reference limit (URL) - HR 3.53; 95% CI: 1.81-6.85; P < .001; hsTnT > URL - HR 2.17; 95% CI: 1.13-4.16; P = .016; NT-proBNP ≥ 300 pg/mL - HR 2.3; 95% CI: 1.22-4.34; P = .01; G8 score ≤14 points - HR 2.47; 95% CI: 1.29-4.74; P = .007. In multivariate analysis, age-adjusted D-dimer > URL, G8 score ≤ 14 points and visceral metastases remained statistically significant in prediction of inferior TTF. The number of these factors was associated with shorter median TTF: 0-1 factor - 14.1 months; 2 factors - 5.9 months; 3 factors - 2.7 months; P < .001, log-rank). CONCLUSIONS Age-adjusted D-dimer, and geriatric G8 scores may predict TTF in men with metastatic castration-resistant prostate cancer during AA therapy. These observations require further study in a larger population.
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Affiliation(s)
- Michał Wilk
- Department of Oncology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Anna Waśko-Grabowska
- Department of Oncology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Iwona Skoneczna
- Department of Chemotherapy, Grochowski Hospital, Warsaw, Poland
| | - Cezary Szczylik
- Department of Oncology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
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Şabanoğlu C. The secret enemy during a flight: Economy class syndrome. Anatol J Cardiol 2021; 25:13-17. [PMID: 34464293 DOI: 10.5152/anatoljcardiol.2021.s106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) are the major causes of morbidity and mortality in immobile patients. There is observational evidence that intercontinental air travel is associated with a high incidence of DVT and PTE during or within 48 hours of long-distance flights. This situation is known as the economy class syndrome and can affect both the cabin crew and passengers. The term "economy class syndrome" refers to the occurrence of thrombotic events that mainly occur in passengers in the economy class of the aircraft during long-haul flights. This syndrome results from several factors related to the aircraft cabin and the passenger, acting together to predispose to excessive blood coagulation, which can result in venous thromboembolism. In this review, we have shared the relationship between air travel and the formation of DVT and PTE.
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Affiliation(s)
- Cengiz Şabanoğlu
- Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital; Kırıkkale-Turkey
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4
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Ma M, Cao R, Wang W, Wang B, Yang Y, Huang Y, Zhao G, Ye L. The D-dimer level predicts the prognosis in patients with lung cancer: a systematic review and meta-analysis. J Cardiothorac Surg 2021; 16:243. [PMID: 34454552 PMCID: PMC8399789 DOI: 10.1186/s13019-021-01618-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/11/2021] [Indexed: 03/21/2023] Open
Abstract
OBJECTIVE Although the significance of increased plasma D-dimer levels in activating coagulation and fibrinolysis has been reported, it is still controversial whether it can be used to predict the prognosis of lung cancer patients. This meta-analysis was performed to explore the beneficial role of plasma D-dimer as a prognostic factor in lung cancer patients according to a larger sample capacity. MATERIALS AND METHODS MEDLINE, EMBASE, and Cochrane Central databases were searched from inception to January 2021. The data are mainly hazard ratio(HR) with 95% confidence interval (CI) and Kaplan-Meier survival curves. The publication bias was examined by Egger's test. RESULTS Finally, a total of 28 studies, enrolling 8452 patients were included in the current meta-analysis. Our results showed that the OS (HR = 1.742, 95%CI:1.542-1.969, P < 0.001) and PFS (HR = 1.385, 95%CI:1.169-1.641, P = 0.003) in the high D-dimer group were significantly lower than those in the low D-dimer group. Subgroup analysis suggested that localization, detection methods and disease stage had an important effect on the prognosis. CONCLUSION This meta-analysis revealed that the high plasma D-dimer level leads to lower survival than in the low D-dimer level, which might provide an important clue for high plasma D-dimer level as an independent factor of poor prognosis in patients with lung cancer.
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Affiliation(s)
- Mingsheng Ma
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
- Department of Cardiothoracic Surgery, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Run Cao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
| | - Wei Wang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
| | - Biying Wang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
| | - Yichen Yang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
| | - Yunchao Huang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
| | - Guangqiang Zhao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
| | - Lianhua Ye
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China.
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5
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Siddiqui NA, Malik M, Wijeratne Fernando R, Sreekantan Nair A, Illango J, Gor R, Hamid P. D-Dimer: A Potential Solution to Problems of Cancer Screening, Surveillance, and Prognosis Assessment. Cureus 2021; 13:e15064. [PMID: 34141508 PMCID: PMC8205645 DOI: 10.7759/cureus.15064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Research has established a direct link between the plasma level of D-dimer and underlying malignancy. D-dimer has a strong association with the detection and prognosis of several cancers. For these reasons, this literature review aimed to evaluate the usefulness of elevated D-dimer levels in the initial screening of cancer, cancer recurrence surveillance, and for use as a cancer prognostic tool. A search of PubMed up to February 1, 2021, was carried out by reviewers. This literature review includes studies investigating the relationship between pretreatment plasma D-dimer levels and cancer. From the findings, pretreatment D-dimer levels can assist with cancer screening and prognosis assessment. Pretreatment plasma D-dimer levels can function as an effective cancer recurrence control. Elevated pre-treatment plasma D-dimer concentration is valuable in facilitating cancer screening, predicting an augmented risk of cancer recurrence, and anticipating a worse cancer prognosis.
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Affiliation(s)
- Nabeel A Siddiqui
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mushrin Malik
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | | | - Janan Illango
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rajvi Gor
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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6
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Li J, Wang Y, Li J, Che G. Prognostic Value of Pretreatment D-Dimer Level in Small-Cell Lung Cancer: A Meta-Analysis. Technol Cancer Res Treat 2021; 20:1533033821989822. [PMID: 33563114 PMCID: PMC7879000 DOI: 10.1177/1533033821989822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose: Pretreatment plasma d-dimer has been reported to be a potential prognostic indicator of lung cancer. To determine the prognostic significance of pretreatment d-dimer level in predicting clinical outcomes, such as the overall survival (OS) and progression-free survival (PFS), of patients with small cell lung cancer (SCLC). Methods: A systematic search in PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, SinoMed, Wanfang and VIP databases was performed to identify available studies. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were applied to assess the association of pretreatment d-dimer level with prognosis of SCLC patients. All statistical analyses were conducted via the STATA 12.0 version software. Results: A total of 7 studies involving 964 patients were included in this meta-analysis and all patients were from China. The results showed that elevated pretreatment d-dimer level was significantly correlated with worse OS (HR = 1.90, 95% CI: 1.55-2.34, P < 0.001) and PFS (HR = 1.52, 95% CI: 1.24-1.85, P<0.001). Subgroup analyses based on the treatment, d-dimer cut-off, detection method and source of HR were also performed to further verify the prognostic value of pretreatment d-dimer level in SCLC. Conclusions: Pretreatment blood concentration of d-dimer may deserve as a reliable factor to predict prognosis of Chinese patients with SCLC. More well-designed prospective studies with large samples are still needed to verify our findings.
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Affiliation(s)
- Jialong Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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7
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Cong Y, Li Q, Zhang X, Chen Y, Yu K. mTOR Promotes Tissue Factor Expression and Activity in EGFR-Mutant Cancer. Front Oncol 2020; 10:1615. [PMID: 32923403 PMCID: PMC7456926 DOI: 10.3389/fonc.2020.01615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/24/2020] [Indexed: 12/18/2022] Open
Abstract
Mechanistic target of rapamycin (mTOR) signaling pathway mediates the function of oncogenic receptor tyrosine kinases (RTKs). We aimed to elucidate new role of mTOR in EGFR-mutant (EGFR-mut) non-small cell lung cancer (NSCLC) and glioblastoma (GBM) with a focus on tumor microenvironments. Here, we report a novel regulatory link between mTOR complexes (mTORCs) and tissue factor (TF), an initiator of tumor-derived thrombosis. TF is elevated in EGFR-mut NSCLC/GBM cell lines and tumors from patients with poor prognosis. Application of mTORC1/2 inhibitors (AZD8055, WYE-125132, MTI-31, and rapamycin) or genetic mTORC-depletion all reduced TF expression, which appeared to be differentially mediated depending on cellular context. In U87MG and HCC827 cells, mTORC1 exerted a dominant role via promoting TF mRNA transcription. In EGFR-TKI-resistant H1975 and PC9 cells, it was mTORC2 that played a major role in specific repression of lysosomal-targeted TF protein degradation. Successful inhibition of TF expression was demonstrated in AZD8055- or MTI-31-treated H1975 and U87MG tumors in mice, while a TF-targeted antibody antagonized TF activity without reducing TF protein. Both the mTOR- and TF-targeted therapy induced a multifaceted remodeling of tumor microenvironment reflecting not only a diminished hypercoagulopathy state (fibrin level) but also a reduced stromal fibrosis (collagen distribution), compromised vessel density and/or maturity (CD31 and/or α-SMA) as well as a substantially decreased infiltration of immune-suppressive M2-type tumor-associated macrophages (CD206/F4/80 ratio). Thus, our results have identified TF as a functional biomarker of mTOR. Downregulation of mTOR-TF axis activity likely contributes to the therapeutic mechanism of mTORC1/2- and TF-targeted agents in EGFR-mut advanced NSCLC and GBM.
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Affiliation(s)
- Ying Cong
- Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China
| | - Qingrou Li
- Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China
| | - Xuesai Zhang
- Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China
| | - Yaqing Chen
- Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China
| | - Ker Yu
- Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China
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8
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Chen X, Ji H, Wang J, Zhao G, Zheng B, Niu Z, He W. Prognostic Value of the Preoperative Plasma D-Dimer Levels in Patients with Upper Tract Urothelial Carcinoma in a Retrospective Cohort Study. Onco Targets Ther 2020; 13:5047-5055. [PMID: 32606727 PMCID: PMC7292253 DOI: 10.2147/ott.s254514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/13/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Elevated plasma D-dimer levels were thought to be associated with decreasing survival in various cancers. The relationship between plasma D-dimer levels and clinicopathology and the optimal D-dimer cutoff as a prognostic predictor has not been determined in patients with upper tract urothelial carcinoma (UTUC). We aimed to investigate the prognostic value of preoperative plasma D-dimer levels as a predictor of patient outcomes in UTUC following radical nephroureterectomy. Patients and Methods We retrospectively reviewed data for 232 patients. The D-dimer cutoff value was set at 0.36 mg/L, and we used the Kaplan-Meier method and Cox's proportional hazards regression models to analyze the association between D-dimer levels and oncological outcomes. Multivariate Cox regression was used to develop a nomogram, which we evaluated for accuracy using a receiver operating characteristic curve, calibration plot, and decision curve analysis. Results Plasma D-dimer levels ≥0.36 mg/L were significantly associated with advanced tumor status regarding size, location, hydronephrosis, tumor grade, lymph node involvement, grade, and stage (all p < 0.05). The Kaplan-Meier analysis showed that plasma D-dimer levels ≥0.36 mg/L predicted worse oncological outcomes vs levels <0.36 mg/L (all p < 0.001). Univariate and multivariate analyses showed that elevated preoperative plasma D-dimer level was an independent predictor of recurrence-free survival (hazard ratio (HR): 1.67, 95% confidence interval (CI): 1.07-2.63; p = 0.025), cancer-specific survival (HR: 2.34, 95% CI: 1.30-4.19; p = 0.004), and overall survival (HR: 1.98, 95% CI: 1.18-3.34; p = 0.010). We also developed a nomogram predicting 3- and 5-year overall survival probability. Conclusion D-dimer levels may be a useful prognostic predictor of survival and improve risk stratification and precisely individualize treatment for patients with UTUC.
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Affiliation(s)
- Xiaoxu Chen
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Haiyong Ji
- The Third Department of Surgery, Ningjin People's Hospital, Dezhou, Shandong, People's Republic of China
| | - Jianwei Wang
- Department of Urology, Shandong Provincial ENT Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Guiting Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Bin Zheng
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Zhihong Niu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Wei He
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
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9
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Ramanathan RK, Thomas GW, Khorana AA, Shah S, Zhou C, Wong S, Cole G, James D, Gabrail NY. A Phase 2 Study of PCI-27483, a Factor VIIa Inhibitor in Combination with Gemcitabine for Advanced Pancreatic Cancer. Oncology 2019; 96:217-222. [PMID: 30844808 PMCID: PMC6492608 DOI: 10.1159/000495988] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/22/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Tissue factor overexpression is associated with tumor progression, venous thromboembolism, and worsened survival in patients with cancer. Tissue factor and activated factor VII (FVIIa) complex may contribute to tumor invasiveness by promoting cell migration and angiogenesis. The study objective was to evaluate safety, pharmacokinetics, and efficacy of PCI-27483, a selective FVIIa inhibitor. METHODS This was an open-label, multicenter phase 2 trial of patients with advanced pancreatic cancer. Part A of the study was an intrapatient dose escalation lead-in portion in patients concurrently receiving gemcitabine, and in part B, patients were randomized 1: 1 to the recommended phase 2 dose combination PCI-27483-gemcitabine versus gemcitabine alone. RESULTS Target international normalized ratio (between 2.0-3.0) was achieved following PCI-27483 treatment. Overall safety of PCI-27483-gemcitabine (n = 26) was similar to gemcitabine alone (n = 16), with a higher incidence of mostly low-grade bleeding events (65% vs. 19%). Progression-free survival (PFS) and overall survival (OS) were not significantly different between patients treated with PCI-27483-gemcitabine (PFS: 3.7 months, OS: 5.7 months) and those treated with gemcitabine alone (PFS: 1.9 months, OS: 5.6 months). CONCLUSIONS Targeted inhibition of the coagulation cascade was achieved by administering PCI-27483. PCI-27483-gemcitabine was well tolerated, but superiority to single agent gemcitabine was not demonstrated.
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Affiliation(s)
- Ramesh K Ramanathan
- Honor Health Research Institute/Translational Genomics Research Institute, Scottsdale, Arizona, USA
| | - Gary W Thomas
- South Carolina Cancer Specialists, Hilton Head Island, South Carolina, USA
| | | | - Satish Shah
- Gettysburg Cancer Center, Gettysburg, Pennsylvania, USA
| | - Cathy Zhou
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California, USA
| | - Sofia Wong
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California, USA
| | - George Cole
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California, USA,
| | - Danelle James
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California, USA
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10
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Zhang C, Jia Y, Jia Y, Zhang X, Li K. Prognostic and predictive value of plasma D-dimer levels in patients with small-cell lung cancer. Int J Clin Oncol 2018; 23:1070-1075. [PMID: 30168089 DOI: 10.1007/s10147-018-1320-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/18/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND To investigate the predictive value of plasma D-dimer levels for short-term therapeutic effect and progression-free survival (PFS) in patients with small-cell lung cancer (SCLC); and to analyze the correlation between baseline plasma D-dimer levels and other clinicopathological features. The aim of the study was to investigate whether the levels of plasma D-dimer could serve as a predictive and prognostic factor in patients with SCLC. METHODS A retrospective review of the clinicopathological data of 160 patients with pathologically confirmed SCLC, who were treated at the Department of Thoracic Oncology of Tianjin Medical University Tumor Institute and Hospital between June 2011 and June 2016, was performed. At the same time, we collected 100 patients with benign pulmonary diseases as a control group. The correlations between baseline plasma D-dimer levels and other clinical features, therapeutic effect and PFS were analyzed statistically. RESULTS The level of plasma D-dimer in patients with SCLC was significantly higher than that of patients with benign pulmonary diseases (P = 0.001). The PFS of patients with elevated D-dimer levels before therapy were significantly shorter than that of patients with normal D-dimer levels (6.0 versus 7.5 months, P = 0.013). The patients whose plasma D-dimer level always (before and after treatment) in the normal range have the best prognosis, and continuously elevated D-dimer carried out a poor prognosis (8.0 versus 5.0 months). According to multivariate analysis, elevated D-dimer level was confirmed to be an independent prognostic factor for worse survival (P = 0.029). The level of D-dimer was associated with tumor stage, the level of neuron-specific enolase, the presence of distant metastasis, hyponatremia, and the Karnofsky performance status score; and levels decreased when therapy was effective, but increased when the disease progressed. CONCLUSIONS High levels of baseline plasma D-dimer may indicate advanced disease stage and poor prognosis. Therefore, plasma D-dimer levels could serve as a predictive and prognostic factor in patients with SCLC.
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Affiliation(s)
- Cuicui Zhang
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
- National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China
- Tianin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
- Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Rd, Tiyuanbei, Hexi District, Tianjin, People's Republic of China
| | - Yongsheng Jia
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
- National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China
- Tianin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
- Thyroid and Neck Department, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
| | - Yanan Jia
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
- National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China
- Tianin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
- Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Rd, Tiyuanbei, Hexi District, Tianjin, People's Republic of China
| | - Xiaoling Zhang
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
- National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China
- Tianin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
- Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Rd, Tiyuanbei, Hexi District, Tianjin, People's Republic of China
| | - Kai Li
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China.
- National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China.
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People's Republic of China.
- Tianin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China.
- Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Rd, Tiyuanbei, Hexi District, Tianjin, People's Republic of China.
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11
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Easaw JC, McCall S, Azim A. ClotAssist: A program to treat cancer-associated thrombosis in an outpatient pharmacy setting. J Oncol Pharm Pract 2018. [PMID: 29540105 DOI: 10.1177/1078155218760704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Stable cancer patients diagnosed with a pulmonary embolus or deep vein thrombosis are commonly referred to the emergency department for management. This practice strains an already overburdened emergency department and is associated with long wait times and poor disease/injection education for patients. This pilot study sought to determine if stable cancer patients with newly diagnosed cancer-associated thrombosis could be effectively managed by community-based pharmacists who followed an evidence-based protocol to prescribe and initiate low-molecular weight heparin therapy. We hypothesized that this novel care pathway could provide faster patient care with more comprehensive disease education, self-injection training, and follow-up. Fifty-five patients with various cancers, including gastroesophageal, urogenital, breast, brain, and lung were enrolled into this pilot study. We observed that this alternative first-dose treatment pathway provided safe and effective treatment of venous thromboembolism combined with excellent patient satisfaction. Following their interaction with the pharmacist, patients felt confident about their ability to self-inject and about their venous thromboembolism management overall. No occurrences of bleeding or other side-effects were observed. This pilot study demonstrates that community-based pharmacists are capable of delivering complex care services in the outpatient environment, particularly in the management of venous thromboembolism.
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Affiliation(s)
- Jacob C Easaw
- 1 Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Susan McCall
- 2 Patient Solutions Thrombosis, LEO Pharma Inc., Thornhill, Canada
| | - Adrian Azim
- 3 Shoppers Drug Mart North Hill Centre, Calgary, Alberta, Canada
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12
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Ordookhani A, Motazedi A, Burman KD. Thrombosis in Thyroid Cancer. Int J Endocrinol Metab 2018; 16:e57897. [PMID: 29696039 PMCID: PMC5903374 DOI: 10.5812/ijem.57897] [Citation(s) in RCA: 5] [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] [Received: 04/05/2017] [Revised: 07/26/2017] [Accepted: 08/23/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The number of studies on venous thromboembolism (VTE) and thyroid cancer is very scarce and existing data are contradictory. This paper reviews VTE in thyroid cancer. METHODS The following words were used for a comprehensive literature review using MEDLINE database: Blood coagulation factors; thyroid hormones; blood coagulation tests; venous thromboembolism; receptors thyroid hormone; hemostasis; fibrinolysis; bleeding; blood coagulation disorders; thyroid neoplasms; Thyroid cancer, papillary; Thyroid cancer, follicular; Thyroid carcinoma, anaplastic; Thyroid cancer, Hurthle cell; Familial medullary thyroid carcinoma; venous thrombosis; Pulmonary embolism; Blood coagulation factors. The studies, which include any changes in hemostasis and thyroid cancer were included and reviewed. RESULTS Although few studies have shown a possible increase in VTE occurrence in thyroid cancer in patients ≥ 60 years old and in proximity to cancer diagnosis, other studies could not find any difference compared to general population. New thyroid cancer classification excluding common subtype(s) with benign nature, may affect the results of the future studies on association of VTE and thyroid cancer. CONCLUSIONS Prospective studies on the occurrence of VTE in various types and severities of thyroid cancer and in different age groups are warranted, as the results would affect clinical practice on the necessity of usage of anticoagulants in some thyroid cancer groups.
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Affiliation(s)
- Arash Ordookhani
- MD, Endocrine Section, Department of Internal Medicine, Providence Hospital, Washington, DC, 20017
| | - Abbas Motazedi
- MD, Endocrine Section, Department of Internal Medicine, Providence Hospital, Washington, DC, 20017
| | - Kenneth D. Burman
- MD, Endocrine Section, MedStar Washington Hospital Center, Washington, DC, 20010
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13
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Li W, Yue H. Thymidine phosphorylase: A potential new target for treating cardiovascular disease. Trends Cardiovasc Med 2017; 28:157-171. [PMID: 29108898 DOI: 10.1016/j.tcm.2017.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022]
Abstract
We recently found that thymidine phosphorylase (TYMP), also known as platelet-derived endothelial cell growth factor, plays an important role in platelet activation in vitro and thrombosis in vivo by participating in multiple signaling pathways. Platelets are a major source of TYMP. Since platelet-mediated clot formation is a key event in several fatal diseases, such as myocardial infarction, stroke and pulmonary embolism, understanding TYMP in depth may lead to uncovering novel mechanisms in the development of cardiovascular diseases. Targeting TYMP may become a novel therapeutic for cardiovascular disorders. In this review article, we summarize the discovery of TYMP and the potential molecular mechanisms of TYMP involved in the development of various diseases, especially cardiovascular diseases. We also offer insights regarding future studies exploring the role of TYMP in the development of cardiovascular disease as well as in therapy.
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Affiliation(s)
- Wei Li
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall, University, Huntington, WV; Marshall Institute for Interdisciplinary Research, Marshall University, Huntington, WV.
| | - Hong Yue
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall, University, Huntington, WV
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14
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Zhang X, Li Q, Zhao H, Ma L, Meng T, Qian J, Jin R, Shen J, Yu K. Pathological expression of tissue factor confers promising antitumor response to a novel therapeutic antibody SC1 in triple negative breast cancer and pancreatic adenocarcinoma. Oncotarget 2017; 8:59086-59102. [PMID: 28938620 PMCID: PMC5601716 DOI: 10.18632/oncotarget.19175] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/05/2017] [Indexed: 12/19/2022] Open
Abstract
The pathological presence of tissue factor (TF) in cancer cells promotes tumor-initiated thrombosis and cancer metastasis. We found that TF is aberrantly present in large percentage of aggressive triple negative breast cancer (TNBC) and pancreatic adenocarcinoma (PaC), two most lethal forms of malignancy that urgently need effective treatment. TF expression in TNBC clustered with higher levels of vimentin, basal-type keratins KRT5/14 and caveolin-1 but lower levels of luminal-type biomarkers. We developed a novel and specific anti-TF therapeutic antibody SC1, which displayed an exceedingly high potency against TF extracellular domain (EC50: 0.019 nM), TF-positive TNBC- or PaC cells (EC50: 2.5 nM), intracellular protease activated receptor 2 (PAR2) signaling (IC50: 2-3 nM) and tumor-initiated coagulation (IC50: <10 nM). Depletion of TF or SC1-treatment in TNBC or PaC cells inhibited TF-induced cell migration, lung metastasis and tumor growth in vivo, accompanied by diminished levels of tumor angiogenesis and stromal fibrosis. We further propose TF as a promising target for antibody-drug conjugate (ADC) development based on its rapid and efficient internalization of SC1-drug conjugate. Both SC1-DM1 and SC1-MMAE elicited exquisite cytotoxicity in TF-positive TNBC and PaC cells (IC50: 0.02-0.1 nM) but not in TF-negative cells (>100 nM) achieving >5000 fold target selectivity. Following a weekly intravenous administration, SC1-MMAE and its humanized hSC1-MMAE inhibited TNBC- and PaC tumor growth achieving MED of 0.3-1 mg/kg and were both well tolerated. Thus, the prevalent TF expression in TNBC and PaC renders these challenging tumors highly susceptible to TF-targeted treatment and may offer new opportunity in cancer patients.
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Affiliation(s)
- Xuesai Zhang
- Department of Pharmacology, Fudan University School of Pharmacy, Shanghai, China
| | - Qingrou Li
- Department of Pharmacology, Fudan University School of Pharmacy, Shanghai, China
| | - Hui Zhao
- Department of Pharmacology, Fudan University School of Pharmacy, Shanghai, China
| | - Lanping Ma
- Department of Medicinal Chemistry, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Tao Meng
- Department of Medicinal Chemistry, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Jianchang Qian
- Department of Pharmacology, Fudan University School of Pharmacy, Shanghai, China
| | - Rui Jin
- Department of Pharmacology, Fudan University School of Pharmacy, Shanghai, China
| | - Jingkang Shen
- Department of Medicinal Chemistry, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Ker Yu
- Department of Pharmacology, Fudan University School of Pharmacy, Shanghai, China
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15
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Woodruff S, Feugère G, Abreu P, Heissler J, Ruiz MT, Jen F. A post hoc analysis of dalteparin versus oral anticoagulant (VKA) therapy for the prevention of recurrent venous thromboembolism (rVTE) in patients with cancer and renal impairment. J Thromb Thrombolysis 2017; 42:494-504. [PMID: 27344439 PMCID: PMC5040733 DOI: 10.1007/s11239-016-1386-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Venous thromboembolism (VTE) is a common and serious complication in patients with cancer; treatment guidelines recommend extended therapy of ≥6 months with low-molecular-weight heparin (LMWH) for treatment and prevention of recurrent VTE (rVTE) in this population. This post hoc analysis used data from the CLOT study—a phase III, randomized, open-label, controlled study (N = 676)—to compare the efficacy and safety of dalteparin, a LMWH, versus vitamin K antagonist (VKA) for prevention of rVTE in patients with cancer and renal impairment (creatinine clearance <60 ml/min). Overall, 162/676 (24 %) patients had renal impairment at baseline. Patients received subcutaneous dalteparin 200 IU/kg once daily during month 1, followed by 150 IU/kg once daily for months 2–6; or VKA once daily for 6 months, with initial overlapping subcutaneous dalteparin 200 IU/kg once daily for ≥5 days until international normalized ratio was 2.0–3.0 for 2 consecutive days. Endpoints included the rates of rVTE (primary) and bleeding events. Overall, fewer dalteparin-treated patients (2/74 [2.7 %]) experienced ≥1 adjudicated symptomatic rVTE compared with VKA-treated patients (15/88 [17.0 %]; hazard ratio = 0.15 [95 % confidence interval 0.03–0.65]; p = 0.01). Bleeding event rates for both treatments were similar (p = 0.47). In summary, compared with VKA, dalteparin significantly reduced risk of rVTE in patients with cancer and renal impairment (p = 0.01) while exhibiting a comparable safety profile. This analysis supports dosing patients with renal impairment in accordance with patients with normal renal function; however, anti-Xa monitoring could be considered to further support safety in selected patients, particularly those with very severe renal impairment.
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16
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Karakatsanis SJ, Roumpi A, Syrigos KN. The use of novel oral anticoagulants in cancer patients with venous thromboembolism. Semin Oncol 2016; 43:655-665. [DOI: 10.1053/j.seminoncol.2016.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 11/10/2016] [Indexed: 11/11/2022]
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17
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Tannous P, Mukadam Z, Kammari C, Banavasi H, Soubani AO. Yield of computed tomography pulmonary angiogram in the emergency department in cancer patients suspected to have pulmonary embolism. Hematol Oncol Stem Cell Ther 2016; 9:131-136. [PMID: 27614231 DOI: 10.1016/j.hemonc.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/14/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE/BACKGROUND The use of computed tomography pulmonary angiography (CTPA) in the emergency department (ED) for patients suspected to have pulmonary embolism (PE) has been steadily rising in the last 2decades. However, there are limited studies that specifically address the use of CTPA in the ED for cancer patients suspected to have PE. The objective of this study is to assess the rate of positive PE by CTPA in the ED in cancer patients and the variables that are associated with positive results. METHODS A retrospective review of electronic medical records for 208 consecutive patients with cancer who presented to the ED and received a CTPA for suspected PE over a 12-month period. The review included demographics, type and status of cancer, presenting symptoms, CTPA results, calculation of Wells Score, management based on CT findings, and outcome of patients. RESULTS Among the 208 patients who met the inclusion criteria during our study period (mean age 57±13.37years, 73% women, 59% African American, and 32% Caucasians), 5.7% were diagnosed with PE. One hundred and eighty-two (83.7%) had a Wells Score ⩽4, of which 2.2% were found to have to have PE, 22 (16.3%) patients had a Wells Score >4, of which 36.4% were found to have PE (p<.0001). Sensitivity and specificity of Wells >4 was 66.7% and 92.9%, respectively, with an odds ratio of 27 (95% CI 6.6-113.6). Receiver operator characteristics area under the curve for Wells Score was 0.868. Age, race, sex, malignancy type, stage, status, clinical presentation, D-dimer, and a previous history of venous thromboembolism were not found to have statistically significant predictive values. CONCLUSION The yield of CTPA to rule out PE in patients with cancer presenting in the ED is low. Following a validated decision-making protocol such as Wells Criteria may significantly decrease the number of CTPA used in the ED.
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Affiliation(s)
- Pierre Tannous
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Zubin Mukadam
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Chetan Kammari
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Harsha Banavasi
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
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18
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Bauersachs RM. LMWH in cancer patients with renal impairment – better than warfarin? Thromb Res 2016; 140 Suppl 1:S160-4. [DOI: 10.1016/s0049-3848(16)30116-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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19
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Incidental venous thromboembolic events in cancer patients: what we know in 2016. Thromb Res 2016; 140 Suppl 1:S18-20. [DOI: 10.1016/s0049-3848(16)30093-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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20
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Mahé I, Puget H, Buzzi JC, Lamuraglia M, Chidiac J, Strukov A, Helfer H, Perozziello A. Adherence to treatment guidelines for cancer-associated thrombosis: a French hospital-based cohort study. Support Care Cancer 2016; 24:3369-77. [DOI: 10.1007/s00520-016-3164-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/07/2016] [Indexed: 11/28/2022]
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21
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Bauersachs RM. Guidelines for the management of cancer and thrombosis – Special aspects in women. Thromb Res 2015; 135 Suppl 1:S16-22. [DOI: 10.1016/s0049-3848(15)50434-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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22
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Zalpour A, Oo TH. Clinical utility of apixaban in the prevention and treatment of venous thromboembolism: current evidence. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:2181-91. [PMID: 25395835 PMCID: PMC4226443 DOI: 10.2147/dddt.s51006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Anticoagulation with heparin and vitamin K antagonist has been the mainstay of prevention and treatment of venous thromboembolism (VTE) for many years. In recent years, novel oral anticoagulants such as dabigatran etexilate (a direct thrombin inhibitor) and rivaroxaban, apixaban, and edoxaban (a direct factor Xa inhibitor) have emerged for the prevention and treatment of VTE. Novel oral anticoagulants have been shown to be noninferior to vitamin K antagonist or heparin in the prevention and treatment of VTE. This review specifically examines the role of apixaban in the prevention and treatment of VTE based on the available literature. The management of apixaban in the perioperative setting is also explored because some patients on apixaban may require surgical intervention. Finally, we discuss the management of apixaban-induced major bleeding complications, the relevance of drug–drug interactions, and patient education.
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Affiliation(s)
- Ali Zalpour
- Division of Pharmacy - Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thein Hlaing Oo
- Section of Thrombosis and Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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23
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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.
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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
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24
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Cordeiro E, Jackson TD, Elnahas A, Cil T. Higher rate of breast surgery complications in patients with metastatic breast cancer: an analysis of the NSQIP database. Ann Surg Oncol 2014; 21:3167-72. [PMID: 25081343 DOI: 10.1245/s10434-014-3959-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Four percent of breast cancer patients present with metastatic disease. To date, no one has examined whether these patients are at higher risk of postoperative complications. The objective of this study was to determine morbidity and mortality associated with breast surgery in the metastatic setting. METHODS We analyzed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, including breast cancer patients undergoing primary breast surgery from 2005 to 2012. Patients with bilateral surgery or severe comorbidities were excluded. Multivariable logistic regression was performed to determine the independent effect of metastatic breast cancer on postoperative morbidity and mortality. RESULTS We identified 68,316 patients who underwent breast surgery for invasive breast cancer; 1,031 (1.5 %) had metastatic disease. The 30-day unadjusted morbidity was significantly higher in the metastatic cohort (7.5 vs. 3.7 %; p < 0.001), as was the all-cause 30-day mortality (1.8 vs. 0.06 %; p < 0.001). The metastatic cohort was more likely to experience an: infectious, respiratory, thromboembolic, cardiac, or bleeding complication than non-metastatic patients. However, preoperative chemo- and radiation therapy did not contribute to an overall increased complication rate. The adjusted odds ratio for postoperative complications in the setting of metastatic disease was 1.6 (95 % confidence limit 1.2-2.1). CONCLUSIONS This is the first study documenting the morbidity and mortality associated with breast surgery in metastatic breast cancer. The 30-day morbidity and mortality in this population is higher than in patients with stage I-III disease. Although the complication rate is increased, operating on the primary in metastatic breast cancer is relatively safe.
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Affiliation(s)
- Erin Cordeiro
- Department of Surgery, University of Toronto, Toronto, ON, Canada,
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25
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Kim DS, Park KM, Won YS, Kim JY, Lee JK, Kim JG, Oh ST, Jung SS, Kang WK. Occurrence and Prognosis of Symptomatic Venous Thromboembolism in Colorectal Cancer Surgery Patients. Vasc Specialist Int 2014. [PMID: 26217616 PMCID: PMC4480307 DOI: 10.5758/vsi.2014.30.2.49] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Colorectal cancer (CRC) has a high risk for postoperative thromboembolic complications such as venous thromboembolism (VTE) compared to other surgical diseases, but the relationship between VTE and CRC in Asian patients remains poorly understood. The present study examined the incidence of symptomatic VTE in Korean patients who underwent surgery for CRC. We also identified risk factors, incidence and survival rate for VTE in these patients. MATERIALS AND METHODS The patients were identified from the CRC database treated from January 2011 to December 2012 in a single institution. These patients were classified into VTE and non-VTE groups, their demographic features were compared, and the factors which had significant effects on VTE and mortality between the two groups were analyzed. RESULTS We analyzed retrospectively a total of 840 patients and the incidence of VTE was 3.7% (31 patients) during the follow-up period (mean, 17.2 months). Histologic subtype (mucinous adenocarcinoma) and previous history of VTE affected the incidence of VTE on multivariate analysis. There was a statistically significant difference in survival rate between the VTE and non-VTE group, but VTE wasn't the factor affecting survival rate on multivariate analysis. Comparing differences in survival rate for each pathologic stage, there was only a significant difference in stage II patients. CONCLUSION Among CRC patients after surgery, the incidence of VTE was approximately 3% within 1 year and development of VTE wasn't a significant risk factor for death in our study but these findings are not conclusive due to our small sample size.
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Affiliation(s)
- Dae Sik Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Keun-Myoung Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Sung Won
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jang Yong Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Kwon Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Gi Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Taek Oh
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Seol Jung
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Kyung Kang
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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26
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Chen KD, Wang CC, Tsai MC, Wu CH, Yang HJ, Chen LY, Nakano T, Goto S, Huang KT, Hu TH, Chen CL, Lin CC. Interconnections between autophagy and the coagulation cascade in hepatocellular carcinoma. Cell Death Dis 2014; 5:e1244. [PMID: 24853422 PMCID: PMC4047908 DOI: 10.1038/cddis.2014.212] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/04/2014] [Accepted: 03/19/2014] [Indexed: 01/04/2023]
Abstract
Autophagy has an important role in tumor biology of hepatocellular carcinoma (HCC). Recent studies demonstrated that tissue factor (TF) combined with coagulation factor VII (FVII) has a pathological role by activating a G-protein-coupled receptor called protease-activated receptor 2 (PAR2) for tumor growth. The present study aimed to investigate the interactions of autophagy and the coagulation cascade in HCC. Seventy HCC patients who underwent curative liver resection were recruited. Immunohistochemical staining and western blotting were performed to determine TF, FVII, PAR2 and light chain 3 (LC3A/B) expressions in tumors and their contiguous normal regions. We found that the levels of autophagic marker LC3A/B-II and coagulation proteins (TF, FVII and PAR2) were inversely correlated in human HCC tissues. Treatments with TF, FVII or PAR2 agonist downregulated LC3A/B-II with an increased level of mTOR in Hep3B cells; in contrast, knockdown of TF, FVII or PAR2 increased LC3A/B. Furthermore, mTOR silencing restored the impaired expression of LC3A/B-II in TF-, FVII- or PAR2-treated Hep3B cells and activated autophagy. Last, as an in vivo correlate, we administered TF, FVII or PAR2 agonist in a NOD/severe combined immunodeficiency xenograft model and showed decreased LC3A/B protein levels in HepG2 tumors with treatments. Overall, our present study demonstrated that TF, FVII and PAR2 regulated autophagy mainly via mTOR signaling. The interaction of coagulation and autophagic pathways may provide potential targets for further therapeutic application in HCC.
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Affiliation(s)
- K-D Chen
- Center for Translational Research in Biomedical Sciences, Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - C-C Wang
- Center for Translational Research in Biomedical Sciences, Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - M-C Tsai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung, Taiwan
| | - C-H Wu
- Center for Translational Research in Biomedical Sciences, Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - H-J Yang
- Center for Translational Research in Biomedical Sciences, Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - L-Y Chen
- Center for Translational Research in Biomedical Sciences, Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - T Nakano
- 1] Center for Translational Research in Biomedical Sciences, Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan [2] Graduate Institute of Clinical Medical Sciences, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - S Goto
- 1] Center for Translational Research in Biomedical Sciences, Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan [2] Iwao Hospital, Yufuin, Japan
| | - K-T Huang
- Center for Translational Research in Biomedical Sciences, Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - T-H Hu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung, Taiwan
| | - C-L Chen
- Center for Translational Research in Biomedical Sciences, Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - C-C Lin
- Center for Translational Research in Biomedical Sciences, Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Qi WX, Lin F, Sun YJ, Tang LN, Shen Z, Yao Y. Risk of venous and arterial thromboembolic events in cancer patients treated with gemcitabine: a systematic review and meta-analysis. Br J Clin Pharmacol 2014; 76:338-47. [PMID: 23834355 DOI: 10.1111/bcp.12203] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/04/2013] [Indexed: 12/14/2022] Open
Abstract
AIMS Gemcitabine has been associated with an increased risk of arterial and venous thromboembolic events (ATEs and VTEs), although the overall risk remains unclear. As indications for its use in oncology are expanding, a comprehensive characterization of these complications becomes imperative. METHODS Pubmed was searched for articles published from 1 January 1990 to 31 December 2012. Eligible studies included prospective randomized controlled phase II and III trials evaluating gemcitabine based vs. non-gemcitabine based chemotherapy in patients with solid tumours. Data on VTEs and ATEs were extracted. Overall incidence rates, odds ratio (OR), and 95% confidence intervals (CIs) were calculated employing fixed or random effects models depending on the heterogeneity of included trials. RESULTS A total of 4845 patients from 19 trials were included. Among patients treated with gemcitabine based chemotherapy, the overall incidence of VTEs (13 studies comprising 3823 patients) and ATEs (eight studies consisting of 2431 patients) was 2.1% (95% CI 1.2%, 3.8%) and 2.2% (95% CI 1.4%, 3.2%). The associated ORs of VTEs and ATEs were 1.56 (95% CI 0.86, 2.83, P = 0.15) and 1.82 (95% CI 0.89, 3.75, P = 0.10) compared with non-gemcitabine based therapy. A tendency to increase the risk of ATE and VTEs was also detected in any prespecified subgroup. CONCLUSION The use of gemcitabine does not significantly increase the risk of VTEs and ATEs in patients with solid tumours when compared with non-gemcitabine based chemotherapy.
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Affiliation(s)
- Wei-Xiang Qi
- Department of Oncology, the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Athale U. Thrombosis in pediatric cancer: identifying the risk factors to improve care. Expert Rev Hematol 2014; 6:599-609. [DOI: 10.1586/17474086.2013.842124] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Wang W, Wang H, Wang CM, Gou S, Chen ZH, Guo J. Treatment with Huisheng oral solution inhibits the development of pulmonary thromboembolism and metastasis in mice with Lewis lung carcinoma. Oncol Lett 2013; 7:87-94. [PMID: 24348827 PMCID: PMC3861555 DOI: 10.3892/ol.2013.1661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/18/2013] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate whether Huisheng oral solution (HSOS) has an inhibitory effect on the development of pulmonary thrombosis and metastasis in mice with Lewis lung carcinoma (LLC), and to explore the possible mechanisms involved. A mouse model of LLC was developed, and model mice were divided into either a treatment group or a control group to undergo treatment with HSOS or normal saline. Normal mice treated with saline were used as normal controls. On day 25 after treatment, blood samples were drawn from the eyes of half the mice in each group to determine blood cell counts and plasma levels of D-Dimer and vascular endothelial growth factor (VEGF), while heart blood samples were collected from the remaining mice to measure the rate of thrombin-induced platelet aggregation. For all mice, pathological analyses of the cerebrum, lung, mesentery, femoral vein, external iliac vein and spleen were performed. Tumors were weighed to assess the impact of HSOS treatment on tumor growth, and the number of thrombi, metastatic nodules and neovessels in the tumor tissue were counted. In addition, 24 normal New Zealand rabbits were divided into two groups and treated with either HSOS or normal saline to determine the rates of ADP-, collagen- or thrombin-induced platelet aggregation. Compared with the model group, HSOS treatment decreased the incidence of pulmonary thromboembolism and metastasis, the number of metastatic nodules, the plasma levels of D-dimer and VEGF, the rate of collagen-induced platelet aggregation in rabbits and the numbers of leukocytes and tumor neovessels (P<0.05 for all). It increased the thymus and spleen coefficients and the number of platelets (P<0.05 for all), but had no significant effect on thrombin-induced platelet aggregation in mice and rabbits, ADP-induced platelet aggregation in rabbits, or the number of red blood cells. The reduced rate of tumor growth was 9.7% in mice treated with HSOS. HSOS treatment effectively reduced the development of pulmonary thromboembolism and metastasis in mice bearing LLC via mechanisms possibly associated with ameliorating a blood hypercoagulable state, decreasing tumor angiogenesis and enhancing immunity.
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Affiliation(s)
- Wei Wang
- Department of Pharmacology, West China School of Pharmacy, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hong Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, Sichuan 610081, P.R. China
| | - Chun-Mei Wang
- Department of Pharmacology, West China School of Pharmacy, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Si Gou
- Department of Pharmacology, West China School of Pharmacy, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhong-Hua Chen
- Department of Pharmacology, West China School of Pharmacy, Sichuan University, Chengdu, Sichuan 610041, P.R. China ; Key laboratory of Drug Targeting, Ministry of Education, West China School of Pharmacy, Sichuan University, Sichuan 610041, P.R. China
| | - Jie Guo
- Chengdu Diao Tianfu Pharmaceutical Group Co., Ltd., Chengdu, Sichuan 610041, P.R. China
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Gil-Bernabé AM, Lucotti S, Muschel RJ. Coagulation and metastasis: what does the experimental literature tell us? Br J Haematol 2013; 162:433-41. [PMID: 23691951 DOI: 10.1111/bjh.12381] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Inhibition of coagulation greatly limits cancer metastasis in many experimental models. Cancer cells trigger coagulation, through expression of tissue factor or P-selectin ligands that have correlated with worse prognosis in human clinical studies. Cancer cells also affect coagulation through expression of thrombin and release of microparticles that augment coagulation. In the cancer-bearing host, coagulation facilitates tumour progression through release of platelet granule contents, inhibition of Natural Killer cells and recruitment of macrophages. We are revisiting this literature in the light of recent studies in which treatment of clinical cohorts with anticoagulant drugs led to diminished metastasis.
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Affiliation(s)
- Ana M Gil-Bernabé
- Department of Oncology, Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
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31
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Mezi S, Musio D, Orsi E, de Felice F, Verdinelli I, Morano F, Raffetto N, Tombolini V. Incidence of thromboembolic events in patients with locally advanced rectal cancer receiving neoadjuvant chemoradiotherapy. Acta Oncol 2013; 52:187-90. [PMID: 22671575 DOI: 10.3109/0284186x.2012.689114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Incidence of venous thromboembolism in patients undergoing surgical treatment for malignancy by type of neoplasm: An analysis of ACS-NSQIP data from 2005 to 2010. Surgery 2012; 152:186-92. [DOI: 10.1016/j.surg.2012.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 05/10/2012] [Indexed: 12/21/2022]
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Unsuspected visceral venous thrombosis, in patients with cancer of the gastrointestinal system. Thromb Res 2012; 130:682-4. [PMID: 22841662 DOI: 10.1016/j.thromres.2012.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 07/05/2012] [Accepted: 07/09/2012] [Indexed: 11/20/2022]
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Hanna N, Bikov KA, McNally D, Onwudiwe NC, Dalal M, Mullins CD. Impact of venous thromboembolism on mortality of elderly Medicare patients with stage III colon cancer. Oncologist 2012; 17:1191-7. [PMID: 22767876 DOI: 10.1634/theoncologist.2012-0093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The improvement in survival rates for patients with colon cancer has shifted the focus from examining cancer-specific mortality to exploring all-cause mortality. Adverse events such as venous thromboembolism (VTE) affect overall survival times and the net clinical benefit of cancer management strategies. METHODS This retrospective study used Surveillance, Epidemiology and End Results (SEER) Medicare data to examine VTE incidence and mortality rates for elderly patients with stage III colon cancer who were diagnosed in 2004 or 2005 and followed through 2007. The impact of VTE on mortality was estimated using multivariable Cox proportional hazards regression. RESULTS In all, 20.7% of 4,985 elderly patients with stage III colon cancer had clinically diagnosed VTE following diagnosis. All-cause mortality risk was higher for patients with a VTE diagnosis (hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 1.04-1.27), greater comorbidity burden, more advanced tumor depth and nodal involvement within stage III, advanced age, and male sex; the risk was lower for patients treated with chemotherapy. VTE was associated with higher mortality hazards (HR: 1.41, 95% CI: 1.21-1.64) for patients treated with adjuvant chemotherapy but not for untreated patients. CONCLUSIONS A new diagnosis of VTE significantly reduced survival rates for elderly patients with stage III colon cancer and further reduced survival rates for patients treated with chemotherapy. Improved prevention and management of VTE for elderly patients with stage III colon cancer who are at risk for VTE is warranted, particularly for patients treated with chemotherapy.
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Affiliation(s)
- Nader Hanna
- Director of Clinical Operations, Division of General and Oncologic Surgery, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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Petrelli F, Cabiddu M, Borgonovo K, Barni S. Risk of venous and arterial thromboembolic events associated with anti-EGFR agents: a meta-analysis of randomized clinical trials. Ann Oncol 2012; 23:1672-1679. [DOI: 10.1093/annonc/mdr592] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Reinke CE, Hadler RA, Karakousis GC, Fraker DL, Kelz RR. Does the presence of thyroid cancer increase the risk of venous thromboembolism in patients undergoing thyroidectomy? Surgery 2011; 150:1275-85. [DOI: 10.1016/j.surg.2011.09.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 09/23/2011] [Indexed: 10/14/2022]
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Venous thromboembolism in patients with pancreatic cancer: implications of circulating tissue factor. Blood Coagul Fibrinolysis 2011; 22:295-300. [PMID: 21372691 DOI: 10.1097/mbc.0b013e32834512f4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Among cancers, pancreatic cancer is known to be associated with a higher incidence of venous thromboembolism (VTE). The aim of the study was to determine the implication of circulating tissue factor (TF) in VTE related to active pancreatic cancer. One hundred and sixty-four consecutive patients who participated to the Etude des Determinants et Interactions de la Thrombose veineuse (EDITH) study between January 2005 and August 2007 for symptomatic VTE related to active pancreatic cancer (n = 8), active cancer of other location (n = 42) or classified as unprovoked (n = 114) were included. TF activity (TFa) was measured in a one-stage kinetic chromogenic method. There were no differences of median TFa levels between patients with VTE related to cancer of other type than pancreas [2.01 pmol/l range (0.05-43.92)] and patients with unprovoked VTE [1.78 pmol/l (range 0.05-63.72), P = 0.21]. Median TFa levels were higher in patients with VTE related to pancreatic cancer [12.67 pmol/l (range 0.05-112.04)] than in patients with VTE related to cancer of other type [2.01 pmol/l (range 0.05-43.92), P = 0.02]. Higher levels of circulating TFa during the course of pancreatic cancer may explain the higher incidence of VTE associated with this type of cancer.
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Narducci F, Jean-Laurent M, Boulanger L, El Bédoui S, Mallet Y, Houpeau JL, Hamdani A, Penel N, Fournier C. Totally implantable venous access port systems and risk factors for complications: a one-year prospective study in a cancer centre. Eur J Surg Oncol 2011; 37:913-8. [PMID: 21831566 DOI: 10.1016/j.ejso.2011.06.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 06/25/2011] [Accepted: 06/28/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Totally Implantable Venous Access Port Systems (TIVAPS) are widely used in oncology, but complications are frequent, sometimes necessitating device removal and consequently delays in chemotherapy. The aim of this study was to investigate possible risk factors for morbidity. METHODS A total of 815 consecutive cancer patients (median age: 56.2 years [0.8-85.2]; 522 female) were enrolled in this observational, single-centre study between May 2nd 2006 and April 30th 2007. TIVAPS implantation involved principally cephalic or external jugular vein access. Patients were followed up for one year unless the device was removed earlier. RESULTS The overall morbidity rate was 16.1% (131/815). Complications necessitated device removal in 55 patients a mean of 3.7 months [0.2-12.0] after implantation. These comprised TIVAPS-related infection (19), port expulsion (14), catheter migration (6), venous thrombosis (5), mechanical problems (3), skin disorders (2), pain (2), drug extravasation (2) infection unrelated to TIVAPS (1) and inflammation (1). No patient died during the study. The factor most strongly predictive of complications was the interval between insertion and first use of the TIVAPS, ranging from 0 to 135 days (median: 8.0 days). The morbidity rate was 24.4% when this interval was 0-3 days, 17.1% when it was 4-7 days and 12.1% when it exceeded 7 days (p < 0.01; Chi(2) test). The median interval was 6 days (0-53) and 8 days (0-135), respectively, in patients with and without complications (p < 0.001). CONCLUSION To reduce complications, an interval of at least 8 days between placement of the TIVAPS and its first use may be advisable.
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Affiliation(s)
- F Narducci
- Centre Régional de Lutte Contre le Cancer Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France.
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Abstract
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality worldwide. However, the mechanisms by which clots are formed in the deep veins have not been determined. Tissue factor (TF) is the primary initiator of the coagulation cascade and is essential for hemostasis. Under pathological conditions, TF is released into the circulation on small-membrane vesicles termed microparticles (MPs). Recent studies suggest that elevated levels of MP TF may trigger thrombosis. This review provides an overview of the role of TF in VTE.
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Affiliation(s)
- David A Manly
- Brody School of Medicine, East Caroline University, Greenville, North Carolina 27834, USA
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DiPasco PJ, Misra S, Koniaris LG, Moffat FL. Thrombophilic state in cancer, Part I: Biology, incidence, and risk factors. J Surg Oncol 2011; 104:316-22. [DOI: 10.1002/jso.21925] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 03/14/2011] [Indexed: 12/21/2022]
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Previtali E, Bucciarelli P, Passamonti SM, Martinelli I. Risk factors for venous and arterial thrombosis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:120-38. [PMID: 21084000 PMCID: PMC3096855 DOI: 10.2450/2010.0066-10] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 08/31/2010] [Indexed: 01/04/2023]
Affiliation(s)
- Emanuele Previtali
- A. Bianchi Bonomi Haemophilia and Thrombosis Centre, Department of Internal Medicine and Medical Specialties, IRCSS General Hospital, Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy
| | - Paolo Bucciarelli
- A. Bianchi Bonomi Haemophilia and Thrombosis Centre, Department of Internal Medicine and Medical Specialties, IRCSS General Hospital, Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy
| | - Serena M. Passamonti
- A. Bianchi Bonomi Haemophilia and Thrombosis Centre, Department of Internal Medicine and Medical Specialties, IRCSS General Hospital, Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy
| | - Ida Martinelli
- A. Bianchi Bonomi Haemophilia and Thrombosis Centre, Department of Internal Medicine and Medical Specialties, IRCSS General Hospital, Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy
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Block KI. Cost savings with clinical solutions: the impact of reforming health and health care economics with integrative therapies. Integr Cancer Ther 2010; 9:129-35. [PMID: 20603903 DOI: 10.1177/1534735410373761] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Keith I Block
- Block Center for Integrative Cancer Treatment, 1800 Sherman, Evanston, IL 60201, USA.
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Kasthuri RS, Glover SL, Boles J, Mackman N. Tissue factor and tissue factor pathway inhibitor as key regulators of global hemostasis: measurement of their levels in coagulation assays. Semin Thromb Hemost 2010; 36:764-71. [PMID: 20978997 DOI: 10.1055/s-0030-1265293] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The tissue factor (TF)/factor (F)VIIa complex is the primary initiator of coagulation in vivo. Tissue factor pathway inhibitor (TFPI) is the physiological inhibitor of the TF/FVIIa complex. Deficiencies of either TF or TFPI have not been reported in humans, and a complete absence of either of these two proteins in mice is embryonically lethal. To maintain normal hemostasis, levels of TF and TFPI need to be balanced. Increased levels of TF can overwhelm the inhibitory capacity of TFPI, resulting in thrombosis. Decreased levels of TF are associated with bleeding. Global assays of coagulation are defined as tests capable of evaluating all components of the clotting cascade that are present in plasma. In these tests the thrombogenic surface is either provided by platelets or exogenous phospholipids. Clotting assays currently used in clinical practice are not designed to measure endogenous levels of TF and TFPI. Therefore, there is a need to develop sensitive and specific assays for measuring levels of functional TF and TFPI in whole blood and plasma. These assays could be useful in patient management in many scenarios.
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Affiliation(s)
- Raj S Kasthuri
- Division of Hematology and Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Venous Thromboembolic Events in the Rehabilitation Setting. PM R 2010; 2:647-63. [DOI: 10.1016/j.pmrj.2010.03.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 03/12/2010] [Accepted: 03/14/2010] [Indexed: 11/20/2022]
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Saraiya B, Goodin S. Management of venous thromboembolism and the potential to impact overall survival in patients with cancer. Pharmacotherapy 2010; 29:1344-56. [PMID: 19857150 DOI: 10.1592/phco.29.11.1344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The risk of venous thromboembolism (VTE) in patients with cancer is 6-12-fold higher than in the general population, and VTE is the second leading cause of death in this population, after cancer itself. The etiology underlying the increased risk of VTE is multifactorial and complex, involving patient-, tumor-, and treatment-related factors. In patients with cancer, cumulative results from studies in those with VTE versus without VTE suggest that anticoagulation therapy, particularly with low-molecular-weight heparins, prevents morbidity and may reduce mortality. Despite the availability of effective and safe therapeutic options, VTE is often underrecognized and suboptimally managed. Interventions such as assessing individual patient risk of VTE, providing VTE prophylaxis and/or prompt treatment, and adopting VTE guidelines are essential aspects of cancer-related care. Aggressive VTE management and strategies are critical to improving survival in patients with cancer and VTE.
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Affiliation(s)
- Biren Saraiya
- Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey, USA
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Barbera L, Thomas G. Erythropoiesis stimulating agents, thrombosis and cancer. Radiother Oncol 2010; 95:269-76. [PMID: 20219259 DOI: 10.1016/j.radonc.2010.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 02/09/2010] [Indexed: 12/27/2022]
Abstract
Venous thromboembolism (VTE) is common in cancer and is associated with both morbidity and mortality. Erythropoiesis stimulating agents (ESAs) were originally developed to correct anemia. Recent trials in cancer patients however, raise concerns over both increased VTE rates and the possibility of worse tumour outcomes and increased mortality with ESA use. The most common reason offered for explaining the possible negative impact of ESAs on cancer outcomes has been the stimulation of erythropoietin receptors on tumour cells. Despite an extensive literature, it is unlikely that most practicing appreciate the intricate relationship and interaction between the coagulation pathways, angiogenesis and tumour progression and ESA effects. This paper will review these connections and interactions and examine the hypothesis that other mechanisms may underlie the possible negative impact of ESAs on cancer outcomes.
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Affiliation(s)
- Lisa Barbera
- Department of Radiation Oncology, University of Toronto, Canada
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Sweetland S, Green J, Liu B, Berrington de González A, Canonico M, Reeves G, Beral V. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study. BMJ 2009; 339:b4583. [PMID: 19959589 PMCID: PMC2788913 DOI: 10.1136/bmj.b4583] [Citation(s) in RCA: 291] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine the duration and magnitude of increased risk of venous thromboembolism after different types of surgery. DESIGN Prospective cohort study (Million Women Study). SETTING Questionnaire data from the Million Women Study linked with hospital admission and death records. PARTICIPANTS 947 454 middle aged women in the United Kingdom recruited in 1996-2001 and followed by record linkage to routinely collected NHS data on hospital admissions and deaths. During follow-up 239 614 admissions were for surgery; 5419 women were admitted, and a further 270 died, from venous thromboembolism. MAIN OUTCOME MEASURES Adjusted relative risks and standardised incidence rates for hospital admission or death from venous thromboembolism (pulmonary embolism or deep vein thrombosis), by time since and type of surgery. RESULTS Compared with not having surgery, women were 70 times more likely to be admitted with venous thromboembolism in the first six weeks after an inpatient operation (relative risk 69.1, 95% confidence interval 63.1 to 75.6) and 10 times more likely after a day case operation (9.6, 8.0 to 11.5). The risks were lower but still substantially increased 7-12 weeks after surgery (19.6, 16.6 to 23.1 and 5.5, 4.3 to 7.0, respectively). This pattern of risk was similar for pulmonary embolism (n=2487) and deep venous thrombosis (n=3529). The postoperative risks of venous thromboembolism varied considerably by surgery type, with highest relative risks after inpatient surgery for hip or knee replacement and for cancer-1-6 weeks after surgery the relative risks were, respectively, 220.6 (187.8 to 259.2) and 91.6 (73.9 to 113.4). CONCLUSION The risk of deep vein thrombosis and pulmonary embolism after surgery is substantially increased in the first 12 postoperative weeks, and varies considerably by type of surgery. An estimated 1 in 140 middle aged women undergoing inpatient surgery in the UK will be admitted with venous thromboembolism during the 12 weeks after surgery (1 in 45 after hip or knee replacement and 1 in 85 after surgery for cancer), compared with 1 in 815 after day case surgery and only 1 in 6200 women during a 12 week period without surgery.
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Affiliation(s)
- Siân Sweetland
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford OX3 7LF
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Abstract
Tissue factor (TF) is a transmembrane glycoprotein that localizes the coagulation serine protease factor VII/VIIa (FVII/VIIa) to the cell surface. The primary function of TF is to activate the clotting cascade. The TF:FVIIa complex also activates cells by cleavage of a G-protein coupled receptor called protease-activated receptor 2 (PAR2). TF is expressed by tumor cells and contributes to a variety of pathologic processes, such as thrombosis, metastasis, tumor growth, and tumor angiogenesis. For instance, tumor cells release TF-positive procoagulant microparticles into the circulation and these may trigger venous thromboembolism in patients with cancer. TF on circulating tumor cells also leads to the coating of the cells with fibrin that traps them within the microvasculature and facilitates hematogenous metastasis. In addition, TF:FVIIa-dependent activation of PAR2 on tumor cells increases tumor growth via an undefined mechanism. One possibility is that PAR2-dependent signaling increases the expression of proangiogenic proteins. Other studies have reported that endothelial cells in the tumor vasculature express TF and this may enhance angiogenesis. These results suggest that inhibition of TF should reduce several pathologic pathways that increase tumor growth and metastasis. This would represent a novel approach to anticancer therapy. Initial studies using inhibitors of the TF:FVIIa complex in mouse tumor models have produced encouraging results. Nevertheless, additional studies are needed to determine if this strategy can be successfully translated to the treatment of cancer patients.
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Affiliation(s)
- Raj S Kasthuri
- Division of Hematology and Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Yang X, Brandenburg NA, Freeman J, Salomon ML, Zeldis JB, Knight RD, Bwire R. Venous thromboembolism in myelodysplastic syndrome patients receiving lenalidomide: results from postmarketing surveillance and data mining techniques. Clin Drug Investig 2009; 29:161-71. [PMID: 19243209 DOI: 10.2165/00044011-200929030-00003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVES Multiple myeloma treatment with lenalidomide-based regimens is associated with risk of venous thromboembolism (VTE), particularly during concomitant use with erythropoiesis-stimulating agents (ESAs). The risk of VTE in myelodysplastic syndrome (MDS) patients treated with lenalidomide is not well characterized and the background risk in untreated patients is not known. This study set out to determine the reporting rate of VTE in MDS patients on lenalidomide in the two years of postmarketing experience in the US, and to investigate whether there is a disproportional signal of VTE in MDS patients on lenalidomide by screening the US FDA Adverse Event Reporting System (AERS) safety database. METHODS The MDS population exposed to lenalidomide was obtained from RevAssist, the company's proprietary restrictive distribution programme. VTE reports were identified from the company's postmarketing surveillance safety database. The FDA AERS database was used for disproportionality analysis, and signal scores computed using three algorithms: multi-item gamma Poisson shrinker (MGPS), proportional reporting ratio (PRR), and reporting odds ratios (ROR). RESULTS A total of 7764 MDS patients were prescribed lenalidomide during the first two years of commercial use in the US. VTE representing deep vein thrombosis and pulmonary embolism was reported in 41 patients, a reporting rate of 0.53%. The computed signal scores did not exceed the statistical threshold for identification of a significant disproportional signal for VTE in MDS reports involving use of lenalidomide without concomitant use of ESAs. However, a disproportional signal of VTE was detected in MDS reports where lenalidomide was concurrently used with ESAs. CONCLUSION The VTE reporting rate for MDS patients receiving lenalidomide during the first two years of postmarketing exposure was low (0.53%). Disproportionality analysis demonstrated a statistically meaningful association of VTE with lenalidomide concomitantly used with ESAs in MDS patients, but the association was not statistically significant when lenalidomide was used in the absence of ESAs.
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Affiliation(s)
- Xionghu Yang
- Global Drug Safety, Celgene Corporation, Summit, New Jersey, USA
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