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Hilton R, Hayes M, Somers E, Brooten J, Gabbard J. Anticoagulation for Nonvalvular Diseases in Patients with a Limited Prognosis #461. J Palliat Med 2023; 26:1147-1149. [PMID: 37579237 PMCID: PMC10440644 DOI: 10.1089/jpm.2023.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Ryan Hilton
- Address correspondence to: Ryan Hilton, BS, Bowman Gray Center for Medical Education, School of Medicine, Wake Forest University, 475 Vine Street, 1st Floor, Winston-Salem, NC 27101, USA
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Polesello S, Georgescu S, Malagón T, Bouchard S. Evaluation of the Use of Anticoagulotherapy in Cancer Patients in Palliative Care Residence. Palliat Med Rep 2023; 4:41-48. [PMID: 36910454 PMCID: PMC9994444 DOI: 10.1089/pmr.2022.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/23/2023] Open
Abstract
Background Several patients admitted to palliative care residences are on anticoagulotherapy (AC). Given the risks of venous thromboembolism (VTE) and bleeding, the decision to continue or stop AC on admission remains clinically challenging. Objectives To determine the prevalence of AC use and incidence of suspected VTE and bleeding events in palliative care patients. Methods Retrospective cohort study including all deceased patients at a Canadian palliative care residence over two years. Results Among the 453 patients' charts reviewed (369 with cancer), 183 (40%) were on AC at admission or <30 days earlier. Only 64 (35%) continued AC, with 78% discontinuing it during their stay. Demographic parameters were similar in the AC and non-AC groups. The incidence of suspected VTE was lower in patients pursuing AC post-admission than in those who stopped: (4.6% vs. 6.7%) and, conversely, the incidence of bleeding was higher in patients on AC: (10.8% vs. 7.6%), though these differences were not statistically significant. The risk of death in cancer patients within 72 hours of suspected VTE or bleeding event was 80% and 30%, respectively. Patients on AC had a 33% reduced risk of VTE but a 44% increased risk of bleeding. Conclusion This study provides information on the AC use in palliative care patients. In term of survivorship, it suggests a possible advantage to continue AC to prevent a symptomatic or distressing death. Given the low incidence of events, larger powered studies will be necessary to further characterize the risks/benefits of pursuing AC in patients in palliative care residences.
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Affiliation(s)
- Stefano Polesello
- Department of Palliative Medicine, McGill University, Montreal, Quebec, Canada
| | - Sebastian Georgescu
- Department of Palliative Medicine, McGill University, Montreal, Quebec, Canada
| | - Talía Malagón
- Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Sylvie Bouchard
- Montreal Institute for Palliative Care/Teresa Dellar Palliative Care Residence, Department of Oncology, McGill University, Montreal, Quebec, Canada
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Matzdorff A. Venous Thromboembolism in Women with Cancer with an Additional Focus on Breast and Gynecological Cancers. Hamostaseologie 2022; 42:309-319. [DOI: 10.1055/a-1913-2873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractCancer-associated venous thromboembolism (VTE) is common in women with cancer. Many clinical practice guidelines provide guidance for prevention and treatment; however, there are no specific recommendations for women. This is unfortunate because the proportion of women with breast- and gynecological cancers is high among patients with cancer-associated VTE. Thromboembolism often heralds cancer progression and poor prognosis and should—besides adequate anticoagulant management—also prompt reassessment and, if necessary, changes in cancer treatment. Recently, the new class of direct-acting oral anticoagulants (DOACs) has started to replace low-molecular-weight heparin as standard thromboprophylaxis and therapy in cancer patients. They are very effective, but they also carry a relevant risk of bleeding. Therefore, despite their ease of use, not every tumor patient qualifies for a DOAC, and this is especially true for gynecological tumor patients. Each prescription must be weighed individually. This review addresses specific aspects of VTE prophylaxis and management in women with cancer. Every physician who treats breast and gynecological cancers should be familiar with prophylaxis, diagnosis, and therapy of cancer-associated VTE. At the same time, patients should be informed by their physician what symptoms to look for and whom to contact if these symptoms occur, even outside of office hours and on weekends.
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Affiliation(s)
- Axel Matzdorff
- Department of Internal Medicine II, Asklepios Clinic Uckermark, Schwedt, Germany
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Al‐Ansari AM, Abd‐El‐Gawad WM, AboSerea SM, Ali AA, Abdullah MM, Ali FA, ElShereafy EE, Bahnasy MA. Thromboprophylaxis for Inpatient with Advanced Cancer Receiving Palliative Care: A Retrospective study. Eur J Haematol 2022; 109:494-503. [DOI: 10.1111/ejh.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Wafaa Mostafa Abd‐El‐Gawad
- Geriatrics and Gerontology Department, Faculty of Medicine Ain Shams University, Al‐Abbaseya Cairo Egypt
| | | | - Ali Adli Ali
- Palliative Care Center, Al‐Sabah Medical Area Al‐Shuwaikh Kuwait
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Dickson K, Koom-Dadzie K, Brito-Dellan N, Escalante C. Risks, diagnosis, and management of recurrent cancer-associated thrombosis (CAT): a narrative review. Support Care Cancer 2022; 30:8539-8545. [PMID: 35699781 DOI: 10.1007/s00520-022-07160-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Abstract
This paper aims to provide a narrative review of the risks, diagnosis, and management of recurrent venous thromboembolism (VTE) in cancer patients. There is an established association between cancer and VTE, with cancer being a major risk factor for VTE. A history of VTE, short duration of oral anticoagulation, and a proximal DVT are all associated with increased risk for recurrent VTE. Studies have shown that certain cancers (e.g., metastatic genitourinary, lung, and colorectal cancers) are associated with recurrent VTE. Published literature shows that cancer is prothrombotic, and various mechanisms have been postulated as pathways for increased thrombogenesis and hence recurrent VTE in cancer. The symptoms, signs, laboratory information, and imaging results for the diagnosis of recurrent VTE are similar to those of an initial VTE. Management of recurrent VTE involves using low molecular weight heparin (LMWH) or a direct oral anticoagulant (DOAC). Vitamin K antagonists (VKA) or inferior vena cava (IVC) filters are less commonly used.
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Affiliation(s)
- Kodwo Dickson
- Department of Hospital Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Kwame Koom-Dadzie
- Department of Hospital Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Norman Brito-Dellan
- Department of Hospital Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carmen Escalante
- Department of General Internal Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Overvad TF, Larsen TB, Søgaard M, Albertsen IE, Ording AG, Noble S, Højen AA, Nielsen PB. Cancer-associated venous thromboembolism and the non-vitamin K antagonist oral anticoagulants: a review of clinical outcomes and patient perspectives. Expert Rev Cardiovasc Ther 2020; 18:791-800. [PMID: 32909840 DOI: 10.1080/14779072.2020.1822167] [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] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cancer-associated venous thromboembolism remains an important but challenging aspect in the treatment of patients with cancer. Recently, alternatives to injection of low-molecular-weight heparin (LMWH) have been introduced, the non-vitamin K antagonist oral anticoagulants (NOACs), which could potentially alleviate patients from burdensome daily injections. AREAS COVERED This review discusses the available evidence exploring the role of NOACs in the treatment and secondary prevention of cancer-associated venous thromboembolism, from randomized trials, observational data, contemporary guideline recommendations, and patient perspectives. EXPERT OPINION Edoxaban, rivaroxaban, and apixaban have proven attractive alternatives to LMWH for the treatment of cancer-associated venous thromboembolism. Contemporary guidelines have promptly endorsed the use of NOACs in patients with most cancer types. Nonetheless, issues remain regarding bleeding risk, interactions with medical cancer treatment, and the effectiveness and safety for extended treatment periods. There are head-to-head comparisons of the NOACs, and therefore no data favoring the use of one NOAC over the others. Patient's preferences are highly diverse and should be part of routine considerations when weighing risks and benefits associated with various available anticoagulant drugs.
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Affiliation(s)
- Thure Filskov Overvad
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University , Aalborg, Denmark.,Department of Oncology, Aalborg University Hospital , Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University , Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital , Aalborg, Denmark
| | - Mette Søgaard
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University , Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital , Aalborg, Denmark
| | - Ida Ehlers Albertsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University , Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital , Aalborg, Denmark
| | - Anne Gulbech Ording
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University , Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital , Aalborg, Denmark
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University , Cardiff, UK
| | - Anette Arbjerg Højen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University , Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital , Aalborg, Denmark
| | - Peter Brønnum Nielsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University , Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital , Aalborg, Denmark
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