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Yoon D, Jeong HE, Choi S, Lee D, Shin J, Bang S. Heterogeneous distributions in clinical events preceding anticoagulant treatment nonpersistence in patients with venous thromboembolism stratified by active cancer: A nationwide cohort study. Cancer Med 2023; 12:20538-20543. [PMID: 37882319 PMCID: PMC10660092 DOI: 10.1002/cam4.6626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Nonpersistence in anticoagulation therapy is common and associated with undesirable clinical outcomes in patients with venous thromboembolism (VTE). METHODS We investigated preceding clinical events of treatment nonpersistence (e.g., switching, discontinuing, or restarting) in VTE patients with and without active cancer using Korean claims database. RESULTS Clinically significant events including thromboembolic events, hepatic function change and surgery preceded treatment nonpersistence, but heterogeneous distributions of clinical events were observed in the presence of active cancer. Patients with active cancer had a low rate of clinical events preceding treatment nonpersistence, and new active cancer diagnosis in the nonactive cancer group was most common before the switch to parenteral anticoagulants from warfarin or non-vitamin K antagonist oral anticoagulants (NOACs). CONCLUSION These findings suggest that clinically significant events can precede treatment nonpersistence and largely paralleled current guidelines for patients with VTE, whereas heterogeneous distributions of clinical events were observed in the presence of active cancer.
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Affiliation(s)
- Dongwon Yoon
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonSouth Korea
| | - Han Eol Jeong
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonSouth Korea
| | - Songhwa Choi
- Medical AffairsPfizer Korea Ltd.SeoulSouth Korea
| | - Daye Lee
- Medical AffairsPfizer Korea Ltd.SeoulSouth Korea
| | - Ju‐Young Shin
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonSouth Korea
- Samsung Advanced Institute for Health Sciences & TechnologySungkyunkwan UniversitySeoulSouth Korea
| | - Soo‐Mee Bang
- Division of Hemato‐Oncology, Department of Internal Medicine, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
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Arce-Huamani MA, Barboza JJ, Martínez-Herrera JF, Torres-Roman JS, Maguiña JL. Efficacy and Safety of Apixaban versus Dalteparin as a Treatment for Cancer-Associated Venous Thromboembolism: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1867. [PMID: 37893585 PMCID: PMC10607997 DOI: 10.3390/medicina59101867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Venous thromboembolism (VTE) is common in cancer patients. Anticoagulant therapy with low-molecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs), such as dalteparin and apixaban, have demonstrated efficacy and safety. However, more comparative research of these drugs is still needed. This study aimed to synthesize evidence on the efficacy of apixaban compared to dalteparin in reducing recurrent VTE, major bleeding, and clinically relevant non-major bleeding associated with cancer. Materials and Methods: We systematically searched the PubMed, Scopus, Web of Science, Embase, Cochrane Library, and ClinicalTrials databases up to 5 January 2023, for randomized controlled trials comparing apixaban versus dalteparin as treatment for cancer-associated VTE. Five studies were included. Effects according to meta-analyses were reported as relative risks (RRs) and their 95% confidence intervals (CIs). Results: It was found that 33 of 734 (4.5%) patients treated with apixaban and 56 of 767 (7.3%) with dalteparin had recurrent VTE as the efficacy outcome (RR 0.49, 95% CI 0.15-1.58, I2 38%). Major bleeding occurred in 25 of 734 patients treated with apixaban (3.4%) and 27 of 767 with dalteparin (3.5%) (RR 1.29, 95% CI 0.31-5.27, I2 59%). Likewise, clinically relevant non-major bleeding occurred in 64 of 734 patients treated with apixaban (8.7%) and 46 of 767 (5.9%) with dalteparin (RR 1.52, 95% CI 1.05-2.19, I2 0%). Conclusions: Apixaban showed a lower risk of recurrent VTE than dalteparin in patients with cancer-associated VTE, albeit with no statistical difference. Statistical significance was observed for no major clinically relevant bleeding but not for major bleeding.
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Affiliation(s)
- Miguel A. Arce-Huamani
- Facultad de Ciencias de la Salud, Universidad Cientifica del Sur, Lima 15067, Peru;
- Cancer Research Networking, Universidad Cientifica del Sur, Lima 15067, Peru; (J.F.M.-H.); (J.S.T.-R.)
| | - Joshuan J. Barboza
- Centro de Investigación en Epidemiología y Medicina Basada en Evidencia, Universidad Norbert Wiener, Lima 13007, Peru;
| | - José Fabián Martínez-Herrera
- Cancer Research Networking, Universidad Cientifica del Sur, Lima 15067, Peru; (J.F.M.-H.); (J.S.T.-R.)
- Cancer Center, Medical Center American British Cowdray, Mexico City 01120, Mexico
| | - J. Smith Torres-Roman
- Cancer Research Networking, Universidad Cientifica del Sur, Lima 15067, Peru; (J.F.M.-H.); (J.S.T.-R.)
- Latin American Network for Cancer Research (LAN–CANCER), Lima 11702, Peru
| | - Jorge L. Maguiña
- Facultad de Ciencias de la Salud, Universidad Cientifica del Sur, Lima 15067, Peru;
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Scanlon LR, Khaksari B, Goel S, Nevadunsky NS, Wright JD, Gressel GM. Direct oral anticoagulant (DOACs) prescribing practices of members of the Society of Gynecologic Oncology and American Society of Clinical Oncology. Gynecol Oncol 2023; 173:68-73. [PMID: 37105059 DOI: 10.1016/j.ygyno.2023.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/11/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Cancer associated venous thromboembolism (VTE) is associated with significant morbidity and mortality. Direct oral anticoagulants (DOACs) have emerged as alternatives to injectable medications for both thromboprophylaxis and treatment of VTE. Several recent clinical trials have demonstrated safety and efficacy of DOACs in high risk patients receiving systemic chemotherapy as well as postoperative prophylaxis after surgery for gynecologic cancer. Major consensus guidelines from multiple organizations support the use of DOACs for these indications but prescription practices are not well characterized. METHODS A survey study was sent concurrently to members of the Society of Gynecologic Oncology (SGO) and American Society of Clinical Oncology (ASCO) Research Survey Pool between May and June of 2021. The study was designed to assess DOAC prescription practices amongst members of these societies who routinely prescribe chemotherapy. Bivariate analyses comparing responses from ASCO participants and SGO participants were compared using chi-squared and Fisher exact tests. RESULTS A total of 103 physicians were included in the ASCO group and 139 in the SGO group. A majority of participants in both groups reported familiarity with prescribing DOACs (99% of ASCO and 96% of SGO respondents). ASCO respondents were more likely to consider DOACs as first line therapy for treatment of cancer-associated VTE than SGO members (82% vs 63%, p < 0.01) and SGO members were more likely to consider low molecular weight heparin (LMWH) the standard of care treatment (66% vs 25% p < 0.01). Most respondents in both groups (75%) felt DOACs were equally safe and effective compared to LMWH but more ASCO members felt DOACs were cost effective (70% vs 49%, p < 0.01). More SGO respondents reported having prescribed prophylactic anticoagulation during chemotherapy than ASCO members (53% vs 35%, p < 0.01). CONCLUSION ASCO respondents were more likely to prescribe DOACs for both treatment and prophylaxis of cancer-associated VTE than SGO members. However, SGO members were more likely to prescribe prophylactic anticoagulation to high risk patients initiating chemotherapy compared to ASCO members.
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Affiliation(s)
- Lauren R Scanlon
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY 10461, United States of America
| | - Bijan Khaksari
- North American Science Associates, New York, NY 10007, United States of America
| | - Sanjay Goel
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, United States of America
| | - Nicole S Nevadunsky
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY 10461, United States of America
| | - Jason D Wright
- Division of Gynecologic Oncology, New York Presbyterian/Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Gregory M Gressel
- Division of Gynecologic Oncology, Corewell Health Cancer Center, Grand Rapids, MI 49506, United States of America.
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Shimizu T, Iwama N, Tokunaga H, Endo S, Miyahara S, Toki A, Watanabe Z, Minato J, Hashimoto C, Ishibashi M, Shigeta S, Shimada M, Yaegashi N. Precautions during Direct Oral Anticoagulant Introduction in Gynecologic Malignancies: A Single-Center Retrospective Cohort Study. Cancers (Basel) 2023; 15:cancers15041132. [PMID: 36831475 PMCID: PMC9954552 DOI: 10.3390/cancers15041132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
The risk factors for venous thromboembolism (VTE) recurrence/exacerbation or a change from a direct oral anticoagulant (DOAC) to another anticoagulant in patients with gynecologic cancer using DOACs have not been thoroughly elucidated. Here, we aimed to investigate the risk factors for a composite primary outcome, including VTE recurrence/exacerbation, or a change from a DOAC to another anticoagulant, in this population. A total of 63 patients were analyzed. Risk factors for a primary outcome within 2 years after DOAC initiation were investigated using multiple logistic regression analysis. Among the 63 patients, 10 developed a primary outcome. Clear cell carcinoma of the ovary (adjusted odds ratio (aOR), 18.9; 95% confidence interval (CI), 2.25-350.74), pulmonary embolism (PE) or proximal deep vein thrombosis without PE (aOR, 55.6; 95% CI, 3.29-11,774.66), and D-dimer levels in the third tertile (≥7.6 μg/dL) when VTE was first diagnosed (aOR, 6.37; 95% CI, 1.17-66.61) were associated with increased odds of a primary outcome in patients with gynecologic cancer using DOACs. Patients with one or more risk factors for a primary outcome require careful follow-up after DOAC initiation for the early recognition of treatment failure.
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Affiliation(s)
- Takanori Shimizu
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
| | - Noriyuki Iwama
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Japan
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
- Correspondence: ; Tel.: +81-22-717-7251
| | - Shun Endo
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
| | - Shuko Miyahara
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
- Division of Gynecology, Miyagi Cancer Center, 47-1, Nodayama, Medeshima-Shiode, Natori 981-1293, Japan
| | - Asami Toki
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
| | - Zen Watanabe
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
| | - Junko Minato
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
| | - Chiaki Hashimoto
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
| | - Masumi Ishibashi
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
| | - Shogo Shigeta
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai 980-8574, Japan
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai 980-8573, Japan
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Setiawan B, Budianto W, Sukarnowati TW, Rizky D, Pangarsa EA, Santosa D, Setiabudy RD, Suharti C. Correlation of Inflammation and Coagulation Markers with the Incidence of Deep Vein Thrombosis in Cancer Patients with High Risk of Thrombosis. Int J Gen Med 2022; 15:6215-6226. [PMID: 35898299 PMCID: PMC9309563 DOI: 10.2147/ijgm.s372038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Deep vein thrombosis (DVT) is a common complication and the second leading cause of death in cancer patients. Pro-inflammatory stimuli in the cancer microenvironment induce nuclear factor kappa B (NF-κB) signaling pathway that plays an integral role in immunothrombosis mechanism. Objective To investigate the role of inflammatory and coagulation biomarkers in the development of DVT in cancer patients with high risk of thrombosis (Khorana score ≥2). Subjects and methods This study was a cross-sectional study at Dr. Kariadi General Hospital. The serum levels of proinflammatory cytokines, ie, NF-κB, interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and coagulation biomarkers, ie, tissue factor (TF), prothrombin fragment F1+2 (F1+2), fibrinogen and D-dimer were measured in newlydiagnosed cancer patients with a highrisk of thrombosis. Color duplex sonography was used for DVT screening. Results From January to November 2021, there were 83 eligible patients. DVT was confirmed in 8 subjects (9.63%). Univariate analysis revealed a significant difference between the median age of patients with DVT compared to non-DVT patients, 49.5 years (range: 23–60 years) and 42 years (range: 19–60 years), with p=0.046. D-dimer level was higher in DVT patients [(6.020 µg/L, range 2.090–20.000) vs (1.940 µg/L, range 270–20.000), p=0.005]. Multivariate analysis revealed age and D-dimer were significantly correlated with DVT incidence. In all patients, there were significant positive correlations between several inflammatory and coagulation activation parameters, which were IL-6 with D-dimer and F1+2, CRP with F1+2 and D-dimer as well as TNF-α with F1+2. However, these findings were not shown in DVT patients. Conclusion In cancer patients with a high risk of thrombosis, age and D-dimer level are the significant variables towards the incidence of DVT. In patients with DVT, there was no significant correlation between inflammatory and coagulation activation parameters.
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Affiliation(s)
- Budi Setiawan
- Hematology-Medical Oncology Division, Internal Medicine Department, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
| | - Widi Budianto
- Hematology-Medical Oncology Division, Internal Medicine Department, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
| | - Tri Wahyu Sukarnowati
- Hematology-Medical Oncology Division, Internal Medicine Department, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
| | - Daniel Rizky
- Hematology-Medical Oncology Division, Internal Medicine Department, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
| | - Eko Adhi Pangarsa
- Hematology-Medical Oncology Division, Internal Medicine Department, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
| | - Damai Santosa
- Hematology-Medical Oncology Division, Internal Medicine Department, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
| | | | - Catharina Suharti
- Hematology-Medical Oncology Division, Internal Medicine Department, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
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Aramberri M, Benegas M, Sanchez M, Muñoz-Guglielmetti D, Zamora C, García-Villa A, Diaz-Pedroche C, Font C. Saddle Pulmonary Embolism in Patients with Cancer in the Era of Incidental Events: Clinical Findings and Outcomes in a Single Centre Cohort. TH OPEN 2022; 6:e267-e275. [PMID: 36299808 PMCID: PMC9800169 DOI: 10.1055/s-0042-1755605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background There is scarce information regarding the prevalence and clinical impact of saddle pulmonary embolism (PE) in patients with cancer. Objectives This study aimed to assess the prevalence, clinical findings, and short-term outcomes of patients with cancer-related saddle PE including acute symptomatic and unsuspected events. Patients/Methods Consecutive patients with cancer-related PE (March 1, 2006-October 31, 2014) were retrospectively reviewed by a chest radiologist to assess PE burden and signs of right ventricular (RV) overload. The clinical outcomes within 30 days were evaluated according to saddle versus nonsaddle PE. Results Thirty-six (12%) out of 289 patients with newly diagnosed cancer-related PE presented with saddle PE. Saddle PE was found in 21 cases (58%) with acute symptomatic PE and the remaining 15 cases (42%) were found as unsuspected findings. Patients with saddle PE had more frequently experienced a previous thrombotic event (31 vs. 13%; p =0.008), and it occurred more frequently as an acute symptomatic event (58 vs. 39%; p =0.025) compared with those with nonsaddle PE. Signs of RV overload including RV/left ventricle ratio ≥1 (22 vs. 4%; p <0.001) and interventricular septum displacement (53 vs. 20%; p <0.001) were also more common in patients with saddle PE compared with nonsaddle PE. Overall, PE-related mortality, venous thromboembolism recurrence, and major bleeding within 30 days were found to be similar according to saddle versus nonsaddle PE. Conclusion Saddle PE is not uncommon in patients with cancer-related PE including in those with unsuspected PE. Similar 30-day outcomes were found according to saddle versus nonsaddle PE in our cohort.
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Affiliation(s)
- Mario Aramberri
- Department of Internal Medicine, Hospital de Galdakao-Usansolo, Galdakao, Spain
| | - Mariana Benegas
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marcelo Sanchez
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Carles Zamora
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Adrián García-Villa
- Department of Internal Medicine, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain
| | - Carmen Diaz-Pedroche
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carme Font
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
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Ozcan MCH, Snegovskikh V, Adamson GD. Oocyte and embryo cryopreservation before gonadotoxic treatments: Principles of safe ovarian stimulation, a systematic review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221074886. [PMID: 35130799 PMCID: PMC8829712 DOI: 10.1177/17455065221074886] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/10/2021] [Accepted: 01/04/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Review the safety of fertility preservation through ovarian stimulation with oocyte or embryo cryopreservation, including cycle and medication options. EVIDENCE REVIEW A systematic review of peer-reviewed sources revealed 2 applicable randomized control trials and 60 cohort studies as well as 20 additional expert opinions or reviews. RESULTS The capacity for future family building is important for the majority of reproductive age people, despite life-altering medical or oncologic diagnosis. Modern fertility preservation generates a high rate of oocyte yield while utilizing protocols that can be started at multiple points in the menstrual cycle and suppressing supra-physiologic levels of estrogen. Finally, more than one quarter of fertility preservation patients will return to later utilize fertility services. CONCLUSION For most patients, fertility preservation can safely be pursued and completed within 2 weeks without affecting disease severity or long-term survival.
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Affiliation(s)
- Meghan CH Ozcan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
| | - Victoria Snegovskikh
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
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Kozhukhov S, Dovganych N. Cardio-Oncology Educational Program: National Survey as the First Step to Start. Front Cardiovasc Med 2021; 8:697240. [PMID: 34409077 PMCID: PMC8364972 DOI: 10.3389/fcvm.2021.697240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022] Open
Abstract
Aim: The collaboration of cardiologists, general practitioners (GPs), and oncologists is crucial in cancer patient management. We carried out a national-based survey-The Ukrainian National Survey (UkrNatSurv)-on behalf of the Cardio-Oncology (CO) Working Group (WG) of the Ukrainian Society of Cardiology to analyze the level of knowledge in cardio-oncology. Methods: A short questionnaire was presented to specialists involved in the management of cancer patients across the country. The questionnaire was made up of eight questions concerning referred cancer patient number, CV complications of cancer therapy, diagnostic methods to detect cardiotoxicity, and drugs used for its treatment. Results: A total of 426 questionnaires of medical specialists from different regions of Ukraine were collected and analyzed; the majority of respondents were cardiologists (190), followed by GPs (177), 40 oncologists (mainly chemotherapists and hematologists), other -19 (imaging specialists, neurologists, endocrinologists, etc.). All responders were equally involved in the management of cancer patients. However, less than half of the patients have been seen before the start of cancer therapy. GPs observe the majority of patients after the end of treatment. All doctors are sufficiently aware of cancer therapy-associated CV complications. However, the necessary diagnostic tools, mostly biomarkers, are not used widely by different specialists. The criteria for cardiotoxicity, in particular, the level of reduction of the left ventricular ejection fraction (LVEF) as a marker of LV dysfunction, are not clearly understood. The specific knowledge in the management of CV complications in cancer is required. Conclusion: UkrNatSurv is the first survey in Ukraine to investigate the awareness of CO care provided to cancer patients with CV diseases (CVD) or developed CV complications. Providing such surveys among doctors involved in CO is an excellent tool to investigate the knowledge gaps in clinical practice. Therefore, the primary task is to develop a national educational CO program.
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Affiliation(s)
- Sergey Kozhukhov
- SI "National Scientific Center "The M.D.Strazhesko Institute of Cardiology, ""Kyiv, Ukraine
| | - Nataliia Dovganych
- SI "National Scientific Center "The M.D.Strazhesko Institute of Cardiology, ""Kyiv, Ukraine
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9
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Mosaad M, Elnaem MH, Cheema E, Ibrahim I, Ab Rahman J, Kori AN, Hin HS. Cancer-Associated Thrombosis: A Clinical Scoping Review of the Risk Assessment Models Across Solid Tumours and Haematological Malignancies. Int J Gen Med 2021; 14:3881-3897. [PMID: 34335052 PMCID: PMC8318782 DOI: 10.2147/ijgm.s320492] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/05/2021] [Indexed: 12/18/2022] Open
Abstract
Cancer-associated thrombosis (CAT) is a leading cause of death in cancer patients receiving outpatient chemotherapy. The latest guidelines emphasize stratifying the patients in terms of CAT risks periodically. Multiple risk assessment models (RAMs) were developed to classify patients and guide thromboprophylaxis to high-risk patients. This study aimed to discuss and highlight different RAMs across various malignancy types with their related advantages and disadvantages. A scoping review was conducted using predefined search terms in three scientific databases, including Google Scholar, Science Direct, and PubMed. The search for studies was restricted to original research articles that reported risk assessment models published in the last thirteen years (between 2008 and 2021) to cover the most recently published evidence following the development of the principal risk assessment score in 2008. Data charting of the relevant trials, scores, advantages, and disadvantages were done iteratively considering the malignancy type. Of the initially identified 1115 studies, 39 studies with over 67,680 patients were included in the review. In solid organ malignancy, nine risk assessment scores were generated. The first and most known Khorana risk score still offers the best available risk assessment model when used for high-risk populations with a threshold of 2 and above. However, KRS has a limitation of failure to stratify low-risk patients. The COMPASS-CAT score showed the best performance in the lung carcinoma patients who have a higher prevalence of thrombosis than other malignancy subtypes. In testicular germ cell tumours, Bezan et al RAM is a validated good discriminatory RAM for this malignancy subtype. CAT in haematological malignancy seems to be under-investigated and has multiple disease-related, and treatment-related confounding factors. AL-Ani et al score performed efficiently in acute leukemia. In multiple myeloma, both SAVED and IMPEDED VTE scores showed good performance. Despite the availability of different disease-specific scores in lymphoma-related thrombosis, the standard of care needs to be redefined.
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Affiliation(s)
- Manar Mosaad
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Ejaz Cheema
- School of Pharmacy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Ismail Ibrahim
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Jamalludin Ab Rahman
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Ahlam Naila Kori
- Haematology Unit, Tengku Ampuan Afzan Hospital, Kuantan, Pahang, Malaysia
| | - How Soon Hin
- Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Gerotziafas GT, Mahé I, Lefkou E, AboElnazar E, Abdel-Razeq H, Taher A, Antic D, Elalamy I, Syrigos K, Van Dreden P. Overview of risk assessment models for venous thromboembolism in ambulatory patients with cancer. Thromb Res 2021; 191 Suppl 1:S50-S57. [PMID: 32736779 DOI: 10.1016/s0049-3848(20)30397-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023]
Abstract
A B S T R A C T Important progress has been made in the development of risk assessment models (RAM) for the identification of outpatients on anticancer treatment at risk of venous thromboembolism (VTE). Since the breakthrough publication of the original Khorana risk score (KRS) more than 10 years ago, a new generation of KRS-based scores have been developed, including the Vienna Cancer and Thrombosis Study, PROTECHT, CONKO, ONCOTEV, TicOnco and the CATS/MICA score. Among these the CATS/MICA score showed that a simplified score composed of only two calibrated predictors, the type of cancer and the D-dimer levels, offers a user-friendly tool for the evaluation of cancer-associated thrombosis (CAT) risk. The COMPASS-CAT score is the first that introduced a more synthetic approach of risk evaluation by combining cancer-related predictors with patient comorbidity in a score which is designed for the types of cancer frequently seen in the community (i.e. breast, lung colon or ovarian cancers) and has been externally validated in independent studies. The Throly score is registered as part of the same group as it has a similar structure to the COMPASS-CAT score and is applicable in patients with lymphoma. The incorporation of specific biomarkers of hypercoagulability to the RAM for CAT offers the possibility to perform a precision medicine approach in the prevention of CAT. The improvement of RAM for CAT with artificial intelligence methodologies and deep learning techniques is the challenge in the near future.
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Affiliation(s)
- Grigoris T Gerotziafas
- Research Group "Cancer, Haemostasis and Angiogenesis", INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France; Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France; Department of Hematology and Cell Therapy, Saint Antoine Hospital, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Sorbonne University, Paris, France.
| | - Isabelle Mahé
- Internal Medicine Department, Hôpital Louis Mourier, APHP, Colombes, Inserm UMR_S1140, Université Paris-Diderot Paris7, Paris, France
| | - Eleftheria Lefkou
- Research Group "Cancer, Haemostasis and Angiogenesis", INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
| | | | - Hiqmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Ali Taher
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut, Lebanon
| | - Darko Antic
- Clinic for Hematology, Clinical Center Serbia, University of Belgrade, Belgrade, Serbia
| | - Ismail Elalamy
- Research Group "Cancer, Haemostasis and Angiogenesis", INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France; Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kostas Syrigos
- Oncology Unit, 3(rd) Dept of Medicine, National and Kapodistrian University of Athens, School of Medicine, "Sotiria" General Hospital, Athens, Greece
| | - Patrick Van Dreden
- Research Group "Cancer, Haemostasis and Angiogenesis", INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France; Clinical Research Department, Diagnostica Stago, Gennevilliers, France
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11
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Chindamo MC, Marques MA. Bleeding risk assessment for venous thromboembolism prophylaxis. J Vasc Bras 2021; 20:e20200109. [PMID: 34093680 PMCID: PMC8147884 DOI: 10.1590/1677-5449.200109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022] Open
Abstract
Venous thromboembolism (VTE) is one of the main preventable causes of morbidity and mortality in hospitalized patients and fatal pulmonary embolism (PE) may be its first manifestation. Several national and international guidelines recommend using risk assessment models for prescription of VTE prophylaxis in hospitalized patients. Despite evidence and guidelines supporting VTE prevention, use of VTE prophylaxis in hospitalized patients remains suboptimal, which may be because of low awareness of the benefits of VTE prophylaxis, but might also reflect fear of bleeding complications in these patients, since this constitutes one of the main reasons for underutilization of thromboprophylaxis worldwide. Bleeding risk assessment is therefore necessary for adequate prophylaxis prescription and should be carried out concurrently with assessment of the risk of thrombosis. The purpose of this review is to highlight the importance of jointly assessing risk of VTE and risk of bleeding in hospitalized patients.
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Affiliation(s)
- Maria Chiara Chindamo
- Universidade Federal do Rio de Janeiro – UFRJ, Rio de Janeiro, RJ, Brasil.
- Hospital Barra D'Or - Rede D'Or São Luiz , Rio de Janeiro, RJ, Brasil.
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12
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Li S, Gao P, Qiu J, He X, Mao Y. A modified Khorana score as a risk assessment tool for predicting venous thromboembolism in newly diagnosed advanced lung cancer. J Thromb Thrombolysis 2021; 52:898-903. [PMID: 33599857 DOI: 10.1007/s11239-021-02396-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the Khorana score and modified Khorana score as risk assessment tools for predicting the development of VTE in newly diagnosed advanced lung cancer. Information on the clinical data and laboratory indicators of the study group between 2014 and 2018 and the validation group between January 2019 to June 2020 of newly diagnosed advanced lung cancer patients at The First Affiliated Hospital of Henan University of Science and Technology was collected. We conducted an analysis of the risk factors affecting VTE development and the predictive risk value of the Khorana score and the modified Khorana score for VTE in newly diagnosed advanced lung cancer patients. A total of 124 patients were included in the study group. D-dimer is an independent risk factor for VTE in newly diagnosed advanced lung cancer patients (OR 1.620, 95% CI 1.220, 2.152, p = 0.001). The best cutoff value of D -dimer for the prediction of VTE development risk was 1.14 mg/L. The AUC of the Khorana score to predict the occurrence risk of VTE in newly diagnosed advanced lung cancer patients was 0.706; when the best cutoff value was 2, the sensitivity was 70.83%, and the specificity was 65%. The AUC of the modified Khorana score was 0.870; when the cutoff value was 2, the sensitivity was 100%, and the specificity was 50%. A total of 237 patients were included in the validation group, the AUC of the modified Khorana score for predicting the occurrence risk of VTE was 0.875; when the cutoff value was 2, the sensitivity was 100%, and the specificity was 52.1%. The modified Khorana score after incorporating D-dimer has a higher predictive value for the occurrence risk of VTE in newly diagnosed lung cancer patients; when the score ≥ 2, its sensitivity is higher, and it can more fully identify high-risk groups of VTE.
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Affiliation(s)
- Shuangping Li
- College of Clinical Medicine, The First Affiliated Hospital, Henan University of Science and Technology, Luoyang, Henan, China
| | - Pengfei Gao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Henan University of Science and Technology, Luoyang, Henan, China
| | - Jiayong Qiu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Henan University of Science and Technology, Luoyang, Henan, China
| | - Xuegai He
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Henan University of Science and Technology, Luoyang, Henan, China
| | - Yimin Mao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Henan University of Science and Technology, Luoyang, Henan, China.
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13
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Schaefer JK, Li M, Wu Z, Basu T, Barnes GD, Carrier M, Griggs JJ, Sood SL. Clinical and sociodemographic factors associated with anticoagulant use for cancer associated venous thromboembolism. J Thromb Thrombolysis 2021; 52:214-223. [PMID: 33544284 DOI: 10.1007/s11239-021-02392-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
Cancer associated thrombosis (CAT) is a leading cause of death among patients with cancer. It is not clear if non-clinical factors are associated with anticoagulation receipt. We conducted a retrospective cohort study of Optum's de-identified Clinformatics® Database of adults with cancer diagnosed between 2009 and 2016 who developed CAT, treated with an outpatient anticoagulant (warfarin, low molecular weight heparin (LMWH), or a direct oral anticoagulant (DOAC)). Of 12,622 patients, three months after an episode of CAT, 1,485 (12%) were on LMWH, 1,546 (12%) on DOACs, and 9,591 (76%) were on warfarin. When controlling for other factors, anticoagulant use was significantly associated with socioeconomic factors, region, co-morbidities, type of thrombosis, and cancer subtype. Patients with a bachelor's degree or greater level of education were less likely to receive warfarin (OR: 0.77; 95% CI: [0.59, 0.99]; p < 0.046) or DOACs (OR: 0.67; 95% CI: [0.55, 0.82]; p < 0.001) compared to LMWH. Patients with higher income levels were more likely to receive LMWH or DOACs compared to warfarin, while patients across all income levels were equally likely to receive LMWH or DOACs. Non-clinical factors including income, education, and region, are associated with anticoagulation receipt three months after an episode of CAT. Sociodemographic factors may result in some patients receiving suboptimal care and contribute to non-guideline concordant care for CAT.
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Affiliation(s)
- Jordan K Schaefer
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, C366 Med Inn Building, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Mengbing Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Zhenke Wu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.,Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, USA.,Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Geoffrey D Barnes
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marc Carrier
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada
| | - Jennifer J Griggs
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, C366 Med Inn Building, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Suman L Sood
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, C366 Med Inn Building, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
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14
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Abstract
PURPOSE OF REVIEW As novel therapies are expanding the life expectancy of patients with multiple myeloma, appropriate supportive care has become critical in the management of these patients. This review aims to outline the key principles of supportive care of patients with myeloma, including management of bone disease, renal disease, anemia, peripheral neuropathy, infections, and venous thromboembolism. RECENT FINDINGS The results from large randomized, controlled trials on the use of high-cutoff hemodialysis in the removal of free light chains in renal disease and the use of levofloxacin in the prevention of infections have recently been published. These results, along with updated guidelines from professional societies on the use of bisphosphonates and erythropoietin stimulating agents, have provided guidance on more effective management strategies for myeloma patients. Integration of these updated guidelines and supportive care strategies into clinical practice will help to ensure quality of life for patients with myeloma.
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Affiliation(s)
- Amy Guzdar
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - Caitlin Costello
- University of California San Diego Department of Blood and Marrow Transplant, Moores Cancer Center, 3855 Health Sciences Dr, La Jolla, San Diego, CA, 92037, USA.
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15
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Brown SA, Zaharova S, Mason P, Thompson J, Thapa B, Ishizawar D, Wilkes E, Ahmed G, Rubenstein J, Sanchez J, Joyce D, Kalyanaraman B, Widlansky M. Pandemic Perspective: Commonalities Between COVID-19 and Cardio-Oncology. Front Cardiovasc Med 2020; 7:568720. [PMID: 33344513 PMCID: PMC7746643 DOI: 10.3389/fcvm.2020.568720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022] Open
Abstract
Overlapping commonalities between coronavirus disease of 2019 (COVID-19) and cardio-oncology regarding cardiovascular toxicities (CVT), pathophysiology, and pharmacology are special topics emerging during the pandemic. In this perspective, we consider an array of CVT common to both COVID-19 and cardio-oncology, including cardiomyopathy, ischemia, conduction abnormalities, myopericarditis, and right ventricular (RV) failure. We also emphasize the higher risk of severe COVID-19 illness in patients with cardiovascular disease (CVD) or its risk factors or cancer. We explore commonalities in the underlying pathophysiology observed in COVID-19 and cardio-oncology, including inflammation, cytokine release, the renin-angiotensin-aldosterone-system, coagulopathy, microthrombosis, and endothelial dysfunction. In addition, we examine common pharmacologic management strategies that have been elucidated for CVT from COVID-19 and various cancer therapies. The use of corticosteroids, as well as antibodies and inhibitors of various molecules mediating inflammation and cytokine release syndrome, are discussed. The impact of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is also addressed, since these drugs are used in cardio-oncology and have received considerable attention during the COVID-19 pandemic, since the culprit virus enters human cells via the angiotensin converting enzyme 2 (ACE2) receptor. There are therefore several areas of overlap, similarity, and interaction in the toxicity, pathophysiology, and pharmacology profiles in COVID-19 and cardio-oncology syndromes. Learning more about either will likely provide some level of insight into both. We discuss each of these topics in this viewpoint, as well as what we foresee as evolving future directions to consider in cardio-oncology during the pandemic and beyond. Finally, we highlight commonalities in health disparities in COVID-19 and cardio-oncology and encourage continued development and implementation of innovative solutions to improve equity in health and healing.
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Affiliation(s)
- Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Svetlana Zaharova
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Peter Mason
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jonathan Thompson
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Bicky Thapa
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - David Ishizawar
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Erin Wilkes
- Department of Pharmacy, Froedtert Health and Medical College of Wisconsin, Milwaukee, WI, United States
| | - Gulrayz Ahmed
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jason Rubenstein
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joyce Sanchez
- Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, United States
| | - David Joyce
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Michael Widlansky
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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16
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Gressel GM, Marcus JZ, Mullen MM, Sinno AK. Direct oral anticoagulant use in gynecologic oncology: A Society of Gynecologic Oncology Clinical Practice Statement. Gynecol Oncol 2020; 160:312-321. [PMID: 33257014 DOI: 10.1016/j.ygyno.2020.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022]
Abstract
Venous thromboembolism (VTE) is a common cause of morbidity and mortality in women with gynecologic malignancies. This practice statement provides clinical data and overall quality of evidence regarding the use of direct oral anticoagulants (DOACs) in this patient population. Specifically, it reviews patient selection, safety measures, and nuances of perioperative use of these medications. The scope of this document is limited to DOAC use in gynecologic oncology rather than a broad discussion of VTE prophylaxis and management in general. The following recommendations and examination of extant data are based on DOAC trials conducted primarily in mixed populations with different cancer subtypes. Many of these trials include few, or no, women with gynecologic cancer. However, because there is very limited data in gynecologic cancer-specific populations, the results of these studies represent the best available evidence to support treatment recommendations in our patients. The members of the Society of Gynecologic Oncology (SGO) Clinical Practice Committee believe that the results of these studies may be extrapolated, with caution, to VTE treatment and prophylaxis for patients with gynecologic cancer.
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Affiliation(s)
- Gregory M Gressel
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States of America.
| | - Jenna Z Marcus
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - Mary M Mullen
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Abdulrahman K Sinno
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
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17
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Cerebral Venous Thrombosis in the Setting of Malignancy: Case Report and Review of the Literature. Case Rep Hematol 2020; 2020:8849252. [PMID: 33014481 PMCID: PMC7519989 DOI: 10.1155/2020/8849252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/28/2020] [Indexed: 01/27/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare condition that can be difficult to diagnose due to its vague and nonspecific symptoms. It is even more unusual to identify CVT in association with malignancy. Given the rarity of this disease, treatment and management of CVT in the setting of malignancy is not well defined. This case report and review of the literature addresses the epidemiology, pathophysiology, and medical treatment for malignancy-related CVT.
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18
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Samaranayake CB, Anderson J, McCabe C, Zahir SF, Upham J, Keir G. Direct oral anticoagulants for cancer associated venous thromboembolisms: a systematic review and network meta‐analysis. Intern Med J 2020; 52:272-281. [DOI: 10.1111/imj.15049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/06/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Chinthaka B Samaranayake
- Faculty of Medicine University of Queensland Brisbane Australia
- Princess Alexandra Hospital Brisbane Queensland Australia
| | - James Anderson
- Sunshine Coast University Hospital Queensland Australia
- School of Medicine Griffith University Queensland Australia
| | - Colm McCabe
- Royal Brompton & Harefield National Health Service Trust London UK
- National Heart and Lung Institute Imperial College London UK
| | - Syeda Farah Zahir
- QFAB Bioinformatics, Institute for Molecular Bioscience University of Queensland Australia
| | - John Upham
- Faculty of Medicine University of Queensland Brisbane Australia
- Princess Alexandra Hospital Brisbane Queensland Australia
| | - Gregory Keir
- Faculty of Medicine University of Queensland Brisbane Australia
- Princess Alexandra Hospital Brisbane Queensland Australia
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19
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Holmes CE, Ades S, Gilchrist S, Douce D, Libby K, Rogala B, Parenteau E, Cushman M, Holm AK. Successful Model for Guideline Implementation to Prevent Cancer-Associated Thrombosis: Venous Thromboembolism Prevention in the Ambulatory Cancer Clinic. JCO Oncol Pract 2020; 16:e868-e874. [PMID: 32267798 PMCID: PMC7489490 DOI: 10.1200/jop.19.00697] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Guidelines recommend venous thromboembolism (VTE) risk assessment in outpatients with cancer and pharmacologic thromboprophylaxis in selected patients at high risk for VTE. Although validated risk stratification tools are available, < 10% of oncologists use a risk assessment tool, and rates of VTE prophylaxis in high-risk patients are low in practice. We hypothesized that implementation of a systems-based program that uses the electronic health record (EHR) and offers personalized VTE prophylaxis recommendations would increase VTE risk assessment rates in patients initiating outpatient chemotherapy. PATIENTS AND METHODS Venous Thromboembolism Prevention in the Ambulatory Cancer Clinic (VTEPACC) was a multidisciplinary program implemented by nurses, oncologists, pharmacists, hematologists, advanced practice providers, and quality partners. We prospectively identified high-risk patients using the Khorana and Protecht scores (≥ 3 points) via an EHR-based risk assessment tool. Patients with a predicted high risk of VTE during treatment were offered a hematology consultation to consider VTE prophylaxis. Results of the consultation were communicated to the treating oncologist, and clinical outcomes were tracked. RESULTS A total of 918 outpatients with cancer initiating cancer-directed therapy were evaluated. VTE monthly education rates increased from < 5% before VTEPACC to 81.6% (standard deviation [SD], 11.9; range, 63.6%-97.7%) during the implementation phase and 94.7% (SD, 4.9; range, 82.1%-100%) for the full 2-year postimplementation phase. In the postimplementation phase, 213 patients (23.2%) were identified as being at high risk for developing a VTE. Referrals to hematology were offered to 151 patients (71%), with 141 patients (93%) being assessed and 93.8% receiving VTE prophylaxis. CONCLUSION VTEPACC is a successful model for guideline implementation to provide VTE risk assessment and prophylaxis to prevent cancer-associated thrombosis in outpatients. Methods applied can readily translate into practice and overcome the current implementation gaps between guidelines and clinical practice.
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Affiliation(s)
- Chris E. Holmes
- Department of Medicine, University of Vermont Cancer Center, University of Vermont, Burlington, VT
| | - Steven Ades
- Department of Medicine, University of Vermont Cancer Center, University of Vermont, Burlington, VT
| | | | | | - Karen Libby
- Department of Medicine, University of Vermont, Burlington, VT
| | - Britny Rogala
- College of Pharmacy, University of Rhode Island, Kingston, RI
| | - Emily Parenteau
- Department of Medicine, University of Vermont, Burlington, VT
| | - Mary Cushman
- Department of Medicine, University of Vermont Cancer Center, University of Vermont, Burlington, VT
| | - Allison Kaigle Holm
- Data Management Office, University of Vermont Health Network, Burlington, VT
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21
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Moik F, Ay C, Pabinger I. Risk prediction for cancer-associated thrombosis in ambulatory patients with cancer: past, present and future. Thromb Res 2020; 191 Suppl 1:S3-S11. [DOI: 10.1016/s0049-3848(20)30389-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/14/2019] [Accepted: 12/23/2019] [Indexed: 01/29/2023]
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Patel H, Sun H, Hussain AN, Vakde T. Advances in the Diagnosis of Venous Thromboembolism: A Literature Review. Diagnostics (Basel) 2020; 10:E365. [PMID: 32498355 PMCID: PMC7345080 DOI: 10.3390/diagnostics10060365] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 12/14/2022] Open
Abstract
The incidence of venous thromboembolism (VTE), including lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) is increasing. The increase in suspicion for VTE has lowered the threshold for performing imaging studies to confirm diagnosis of VTE. However, only 20% of suspected cases have a confirmed diagnosis of VTE. Development of pulmonary embolism rule-out criteria (PERC) and update in pre-test probability have changed the paradigm of ruling-out patient with low index of suspicion. The D-dimer test in conjunction to the pre-test probability has been utilized in VTE diagnosis. The age appropriate D-dimer cutoff and inclusion of YEARS algorithm (signs of the DVT, hemoptysis and whether PE is the likely diagnosis) for the D-dimer cutoff have been recent updates in the evaluation of suspected PE. Multi-detector computed tomography pulmonary angiography (CTPA) and compression ultrasound (CUS) are the preferred imaging modality to diagnose PE and DVT respectively. The VTE diagnostic algorithm do differ in pregnant individuals. The prerequisite of avoiding excessive radiation has recruited planar ventilation-perfusion (V/Q) scan as preferred in pregnant patients to evaluate for PE. The modification of CUS protocol with addition of the Valsalva maneuver should be performed while evaluating DVT in pregnant individual.
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Affiliation(s)
- Harish Patel
- Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA; (H.S.); (A.N.H.); (T.V.)
| | - Haozhe Sun
- Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA; (H.S.); (A.N.H.); (T.V.)
| | - Ali N. Hussain
- Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA; (H.S.); (A.N.H.); (T.V.)
| | - Trupti Vakde
- Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA; (H.S.); (A.N.H.); (T.V.)
- Division of the Pulmonary and Critical Care, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, Bronx, NY 10457, USA
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23
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Diver E. Apixaban vs Enoxaparin for Postoperative Prophylaxis: Safety of an Oral Alternative for the Prevention of Venous Thromboembolism. JAMA Netw Open 2020; 3:e208019. [PMID: 32589227 DOI: 10.1001/jamanetworkopen.2020.8019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Elisabeth Diver
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
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Rossel A, Robert-Ebadi H, Marti C. Preventing Venous Thromboembolism in Ambulatory Patients with Cancer: A Narrative Review. Cancers (Basel) 2020; 12:E612. [PMID: 32155855 PMCID: PMC7139813 DOI: 10.3390/cancers12030612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 12/17/2022] Open
Abstract
Venous thromboembolism (VTE) is frequent among patients with cancer. Ambulatory cancer patients starting chemotherapy have a 5% to 10% risk of cancer associated thrombosis (CAT) within the first year after cancer diagnosis. This risk may vary according to patient characteristics, cancer location, cancer stage, or the type of chemotherapeutic regimen. Landmark studies evaluating thrombophrophylaxis with low molecular weight heparin (LMWH) for ambulatory cancer patients have shown a relative reduction in the rate of symptomatic VTE of about one half. However, the absolute risk reduction is modest among unselected patients given a rather low risk of events resulting in a number needed to treat (NNT) of 40 to 50. Moreover, this modest benefit is mitigated by a trend towards an increased risk of bleeding, and the economic and patient burden due to daily injections of LMWH. For these reasons, routine thromboprophylaxis is not recommended by expert societies. Advances in VTE risk stratification among cancer patients, and growing evidence regarding efficacy and safety of direct oral anticoagulants (DOACs) for the treatment and prevention of CAT have led to reconsider the paradigms of this risk-benefit assessment. This narrative review aims to summarize the recent evidence provided by randomized trials comparing DOACs to placebo in ambulatory cancer patients and its impact on expert recommendations and clinical practice.
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Affiliation(s)
- Anne Rossel
- Division of General Internal Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland;
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland;
| | - Helia Robert-Ebadi
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland;
- Division of Angiology and Haemostasis, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Christophe Marti
- Division of General Internal Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland;
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland;
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Gurung PMS, Messing EM, Joseph JV, Wu G. EDITORIAL COMMENT. Urology 2020; 136:110-111. [PMID: 32033663 DOI: 10.1016/j.urology.2019.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Pratik M S Gurung
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Edward M Messing
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, NY
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Hajdenberg J. Review: In patients with cancer, prophylactic anticoagulants reduce VTE and do not increase major bleeding. Ann Intern Med 2019; 171:JC65. [PMID: 31842223 DOI: 10.7326/acpj201912170-065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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