Journal articles on the topic 'Thromboembolism Chemotherapy'
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Nitta, Satoshi, Koji Kawai, Tomokazu Kimura, Takashi Kawahara, Shuya Kandori, Akio Hoshi, Takahiro Kojima, and Hiroyuki Nishiyama. "Predictors of venous thromboembolism development before and during chemotherapy for advanced germ cell tumor." Japanese Journal of Clinical Oncology 50, no. 3 (February 9, 2020): 338–43. http://dx.doi.org/10.1093/jjco/hyz177.
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Abstract Objective We retrospectively analyzed the incidence and localization of venous thromboembolism in patients undergoing chemotherapy for advanced germ cell tumor and separately evaluated the risk factors for venous thromboembolism development before and during chemotherapy. Methods We included 121 patients treated with cisplatin-based chemotherapy between 2005 and 2018. Venous thromboembolism was defined as venous thrombosis diagnosed using radiological imaging with or without thromboembolic symptoms. We analyzed the clinical parameters for identifying the possible venous thromboembolism risk factors. Khorana score was used to calculate the venous thromboembolism risk. Results Thirteen patients showed prechemotherapy venous thromboembolism and 13 developed venous thromboembolism during chemotherapy. The most common venous thromboembolism was deep vein thrombosis (10 patients), followed by inferior vena cava thrombus (eight patients) and pulmonary thrombus (six patients). Compared to the group without venous thromboembolism, the group with prechemotherapy venous thromboembolism showed higher proportion of patients with tumors originating in the right testis (10 out of 13), significantly higher lactate dehydrogenase levels (828 IU/L versus 436 IU/L, P = 0.013), significantly higher proportion of patients with retroperitoneal lymph node (RPLN) metastases >5 cm in diameter (76.9% versus 33.7%, P = 0.003) and slightly higher proportion of patients with high-risk Khorana score (≥ 3; 30.8% versus 11.6%). No significant differences were observed between the clinical characteristics of patients with venous thromboembolism developed during chemotherapy and patients without venous thromboembolism. Conclusions We show that both RPLN mass > 5 cm and high lactate dehydrogenase levels are significant risk factors for prechemotherapy venous thromboembolism but not for venous thromboembolism development during chemotherapy.
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Pritchard, K. I., A. H. Paterson, N. A. Paul, B. Zee, S. Fine, and J. Pater. "Increased thromboembolic complications with concurrent tamoxifen and chemotherapy in a randomized trial of adjuvant therapy for women with breast cancer. National Cancer Institute of Canada Clinical Trials Group Breast Cancer Site Group." Journal of Clinical Oncology 14, no. 10 (October 1996): 2731–37. http://dx.doi.org/10.1200/jco.1996.14.10.2731.
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PURPOSE AND METHODS Associations between thromboembolism and malignancy, usually widespread, and between thromboembolism and hormonal and/or chemotherapy have been previously reported. We performed a randomized trial of tamoxifen 30 mg/d for 2 years (T) versus T plus 6 months of intravenous chemotherapy with cyclophosphamide, methotrexate, and fluorouracil (CMF) for postmenopausal women with involved axillary nodes and positive estrogen receptor (ER) or progesterone receptor (PgR) status following primary therapy for breast cancer. RESULTS We observed one or more thromboembolic events in 48 of 353 women (13.6%) allocated to receive T plus CMF in comparison to five of 352 women (2.6%) randomized to receive T alone (P < .0001). Six women in the T plus CMF arm, but none randomized to receive T alone, suffered two thromboembolic events while an study therapy. There were also significantly more women who developed severe (grade 3 to 5) thromboembolic events in the T plus CMF arm than in the T arm (34 v five; P < .0001). Most thromboembolic events (39 of 54) occurred while women were actually receiving chemotherapy (P < .0001). Thromboembolic complications resulted in more days in hospital and more deaths than any other complication of therapy, including infection, in this trial. CONCLUSION Thromboembolism related to the addition of CMF chemotherapy to tamoxifen as adjuvant therapy in this group of women represents a relatively common and serious complication that may outweigh any benefits offered by this additional therapy.
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Salinaro, Julia Rose, Kourtnie McQuillen, Megan Stemple, Robert Boccaccio, Jessie Ehrisman, Amelia M. Lorenzo, Laura Havrilesky, et al. "Incidence of venous thromboembolism among patients receiving neoadjuvant chemotherapy for advanced epithelial ovarian cancer." International Journal of Gynecologic Cancer 30, no. 4 (February 12, 2020): 491–97. http://dx.doi.org/10.1136/ijgc-2019-000980.
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ObjectivesNeoadjuvant chemotherapy may be considered for women with epithelial ovarian cancer who have poor performance status or a disease burden not amenable to primary cytoreductive surgery. Overlap exists between indications for neoadjuvant chemotherapy and known risk factors for venous thromboembolism, including impaired mobility, increasing age, and advanced malignancy. The objective of this study was to determine the rate of venous thromboembolism among women receiving neoadjuvant chemotherapy for epithelial ovarian cancer.MethodsA multi-institutional, observational study of patients receiving neoadjuvant chemotherapy for primary epithelial ovarian, fallopian tube, or peritoneal cancer was conducted. Primary outcome was rate of venous thromboembolism during neoadjuvant chemotherapy. Secondary outcomes included rates of venous thromboembolism at other stages of treatment (diagnosis, following interval debulking surgery, during adjuvant chemotherapy, or during treatment for recurrence) and associations between occurrence of venous thromboembolism during neoadjuvant chemotherapy, subject characteristics, and interval debulking outcomes. Venous thromboembolism was defined as deep vein thrombosis in the upper or lower extremities or in association with peripherally inserted central catheters or ports, pulmonary embolism, or concurrent deep vein thrombosis and pulmonary embolism. Both symptomatic and asymptomatic venous thromboembolism were reported.ResultsA total of 230 patients receiving neoadjuvant chemotherapy were included; 63 (27%) patients overall experienced a venous thromboembolism. The primary outcome of venous thromboembolism during neoadjuvant chemotherapy occurred in 16 (7.7%) patients. Of the remaining venous thromboembolism events, 22 were at diagnosis (9.6%), six post-operatively (3%), five during adjuvant chemotherapy (3%), and 14 during treatment for recurrence (12%). Patients experiencing a venous thromboembolism during neoadjuvant chemotherapy had a longer mean time to interval debulking and were less likely to undergo optimal cytoreduction (50% vs 80.2%, p=0.02).ConclusionsPatients with advanced ovarian cancer are at high risk for venous thromboembolism while receiving neoadjuvant chemotherapy. Consideration of thromboprophylaxis may be warranted.
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Heinrich, Born, Hoebert, Verrel, Simon, Bode, and Fleischhack. "Aortobifemoral embolism in an 18-year old patient following cisplatin and 5-fluorouracil chemotherapy for nasopharyngeal carcinoma." Vasa 39, no. 3 (August 1, 2010): 271–73. http://dx.doi.org/10.1024/0301-1526/a000042.
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After cisplatin / 5-fluorouracil chemotherapy for nasopharyngeal carcinoma, an 18-year female patient developed aortobifemoral embolism. Besides chemotherapy, additional risk factors for arterial thromboembolic events were smoking, contraceptive medication and adjuvant antiemetic treatment with dexamethasone. Thrombophilia screening was negative. Thromboembolic complications during or after cisplatin have been reported in a frequency of 17.6 % in lung cancer patients, and in 8.4 % of patients with germ cell tumors. The incidence of arterial thromboembolic events was 9.3 % and 1.7 %, respectively. The pathogenesis of cisplatin induced thromboembolism is thought to be caused by endothelial damage leading to endothelial cell dysfunction, increased von Willebrand factor plasma levels, and hypomagnesaemia.
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Vathiotis, Ioannis, Evangelos P. Dimakakos, Paraskevi Boura, Angeliki Ntineri, Andiani Charpidou, Grigoris Gerotziafas, and Konstantinos Syrigos. "Khorana Score: Νew Predictor of Early Mortality in Patients With Lung Adenocarcinoma." Clinical and Applied Thrombosis/Hemostasis 24, no. 8 (May 27, 2018): 1347–51. http://dx.doi.org/10.1177/1076029618777153.
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Venous thromboembolism (VTE) is a typical complication in patients with lung cancer. Khorana score is an established tool for thromboembolic risk stratification of ambulatory patients with cancer undergoing outpatient chemotherapy. The aim of this study was to evaluate the predictive value of the Khorana score for VTE and death in patients with lung adenocarcinoma during first-line or adjuvant chemotherapy. Medical records of 130 patients with lung adenocarcinoma receiving first-line or adjuvant chemotherapy were retrospectively studied during the time period June 2013 to May 2015. Venous thromboembolism occurred in 13 (10.0%) patients. Thromboembolic events were significantly correlated with reduced survival during treatment period (hazard ratio [HR]: 3.24; 95% confidence interval [CI]: 1.11-9.49; P = .032). The VTE rates did not present statistically significant difference between different Khorana score groups ( P = .96). In univariate analysis, the risk of death during treatment period (median: 16 weeks) was 3.75 times higher in high-risk versus intermediate-risk patients (HR: 3.75, 95% CI: 1.36-10.36; P = .001) and had 2.25 times higher per point increase in the Khorana score (HR: 2.25, 95% CI: 1.36-3.73; P = .002); the above results were also reproduced in multivariate analysis. Khorana score represents a valuable tool for identifying patients with cancer in low thromboembolic risk but does not preserve its predictive value for higher risk individuals. Khorana score is an independent risk factor for death in patients with lung adenocarcinoma receiving first-line or adjuvant chemotherapy.
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Bamias, Aristotelis, Kimon Tzannis, Roubini Zakopoulou, Minas Sakellakis, John Dimitriadis, Alkistis Papatheodoridi, Loukianos Rallidis, et al. "Risk for Arterial Thromboembolic Events (ATEs) in Patients with Advanced Urinary Tract Cancer (aUTC) Treated with First-Line Chemotherapy: Single-Center, Observational Study." Current Oncology 29, no. 9 (August 24, 2022): 6077–90. http://dx.doi.org/10.3390/curroncol29090478.
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Arterial thromboembolism has been associated with cancer or its treatment. Unlike venous thromboembolism, the incidence and risk factors have not been extensively studied. Here, we investigated the incidence of arterial thromboembolic events (ATEs) in an institutional series of advanced urinary tract cancer (aUTC) treated with cytotoxic chemotherapy. The ATE definition included peripheral arterial embolism/thrombosis, ischemic stroke and coronary events. A total of 354 aUTC patients were analyzed. Most patients (95.2%) received platinum-based chemotherapy. A total of 12 patients (3.4%) suffered an ATE within a median time of 3.6 months from the start of chemotherapy. The most frequent ATE was ischemic stroke (n = 7). Two ATEs were fatal. The 6-month and 24-month incidence were 2.1% (95% confidence interval [CI]: 0.9–4.1) and 3.6% (95% CI: 1.9–6.2), respectively. Perioperative chemotherapy increased the risk for ATE by 5.55-fold. Tumors other than UTC and pure non-transitional cell carcinoma histology were also independent risk factors. No association with the type of chemotherapy was found. Overall, ATEs occur in 4.6% of aUTC patients treated with chemotherapy and represent a clinically relevant manifestation. Perioperative chemotherapy significantly increases the risk for ATE. The role of prophylaxis in high-risk groups should be prospectively studied.
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Labianca, Alice, Tommaso Bosetti, Alice Indini, Giorgia Negrini, and Roberto Francesco Labianca. "Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer." Cancers 12, no. 8 (July 27, 2020): 2070. http://dx.doi.org/10.3390/cancers12082070.
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In the general population, the incidence of thromboembolic events is 117 cases/100,000 inhabitants/year, while in cancer patient incidence, it is four-fold higher, especially in patients who receive chemotherapy and who are affected by pancreatic, lung or gastric cancer. At the basis of venous thromboembolism (VTE) there is the so-called Virchow triad, but tumor cells can activate coagulation pathway by various direct and indirect mechanisms, and chemotherapy can contribute to VTE onset. For these reasons, several studies were conducted in order to assess efficacy and safety of the use of anticoagulant therapy in cancer patients, both in prophylaxis setting and in therapy setting. With this review, we aim to record principal findings and current guidelines about thromboprophylaxis in cancer patients, with particular attention to subjects with additional risk factors such as patients receiving chemotherapy or undergoing surgery, hospitalized patients for acute medical intercurrent event and patients with central venous catheters. Nonetheless we added a brief insight about acute and maintenance therapy of manifested venous thromboembolism in cancer patients.
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Kirwan, C. "Explanations for venous thromboembolism during chemotherapy." European Journal of Cancer 38, no. 11 (March 2002): S131—S132. http://dx.doi.org/10.1016/s0959-8049(02)80428-2.
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Yenidunya, Gulsah, Hande Turna, Mehmet Akif Ozturk, Deniz Tural, Fatih Selcukbiricik, Ozcan Yildiz, Mustafa Ozguroglu, Fuat Demirelli, Evin Buyukunal, and Suheyla Serdengecti. "Thromboembolic complications in cancer patients." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e21143-e21143. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e21143.
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e21143 Background: Thromboembolic events are frequent and important complications causing mortality and morbidity in cancer patients.To determine the charecteristics of these events can help us to determine the patients who have higher risks for thromboembolism. Methods: Characteristics of clinically or radiologically determined thromboembolic events were retrospectively analayzed from files of cancer patients followed up in the outpatient oncology clinic of Cerrahpasa Medical Faculty of Istanbul University. Results: A total of 267 thromboembolic events were analyzed.Events were encountered mostly in the venous system, only 3% were in the form of arterial embolism.Venous events were in the form of deep vein thrombosis (67%), pulmonary embolism (16.5%), vena cava superior thrombosis (2.6%), superficial migratory thrombophlebitis (0.4%) or two different forms occuring concomitantly(10.5%). Thromboembolism was determined most frequently in patients with gastrointestinal tumors (41.9%), lung cancer (22.1%) and gynecological tumors (12.1%). The most frequent histopathology was adenocarcinoma (72.4%).Thromboembolic complications were mostly in the form of lower extremity deep venous thrombosis in patients with gastointestinal, gynecological and urogenital tumors where as in the form of pulmonary embolism and vena cava superior thrombosis in patients with lung cancer. Nearly half of the patients with pulmonary embolism (%48.%) were asymptomatic and were diagnosed incidentally with radiological imaging. Upper extremity thrombosis were frequently encountered in patients with venous port a-cath system Most of the patients (87.7%) had metastatic cancer and were receiving chemotherapy (65.5% ) when the event occured. Cisplatin, 5–FU and gemcitabine were the most frequently used chemotherapy agents.Thromboembolic events related to cancer surgery occured usually (59%) in the first month after surgery.Recurrent thromboembolic events were determined in 8.9% of patients mostly whom had gastrointestnal primary tumors (54%). Conclusions: Characteristics of thromboembolic events can help to determine the patients who have higher risk for thromboembolism and predict types and time of the event and provide anticoagulation without delay.
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Apple, Annie, Lauren Prescott, Marc Robinson, Kendall Shultes, and Alaina Brown. "Provider education program on the Khorana score to promote venous thromboembolism chemoprophylaxis in patients with gynecologic cancer." International Journal of Gynecologic Cancer 32, no. 4 (February 15, 2022): 547–52. http://dx.doi.org/10.1136/ijgc-2021-003125.
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ObjectiveTo evaluate the efficacy of a healthcare improvement initiative to improve provider compliance with the American Society of Clinical Oncology (ASCO) guidelines for venous thromboembolism chemoprophylaxis in patients with gynecologic cancer receiving chemotherapy.MethodsA healthcare improvement initiative was implemented at our institution to improve compliance with American Society of Clinical Oncology venous thromboembolism chemoprophylaxis guidelines in patients receiving chemotherapy with a Khorana score ≥2. Baseline Khorana score and venous thromboembolism data were retrospectively collected for chemotherapy-naïve patients with gynecologic cancer initiating chemotherapy between December 2018 and November 2019. Data for the post-intervention period from December 2019 to December 2020 were captured prospectively. Primary outcome was compliance with American Society of Clinical Oncology guidelines. Secondary outcomes were incidence of venous thromboembolism and complications surrounding venous thromboembolism chemoprophylaxis.ResultsWe identified 62 patients in the pre-implementation cohort. Approximately half had a Khorana score of ≥2 (52%). Median Khorana score was 2 (range 1–4). None of these patients received prophylactic chemoprophylaxis. Seven (11%) of these patients were diagnosed with venous thromboembolism. Multivariate logistic regression showed increasing Khorana score was associated with increased venous thromboembolism risk (OR 4.9, p=0.01). With cut-off Khorana score of 2, there was no significant increase in venous thromboembolism. However, with a cut-off Khorana score of 3, patients were 15 times more likely to have venous thromboembolism (OR 15.2, p=0.04). In the post-intervention cohort, 22 patients were eligible for chemoprophylaxis and 11 patients were given anticoagulation (50% compliance with guidelines), with no incidence of venous thromboembolism or adverse effects of therapy noted among those receiving chemoprophylaxis.ConclusionNotifying providers of a patient’s Khorana score improves compliance with American Society of Clinical Oncology guidelines for venous thromboembolism chemoprophylaxis among chemotherapy patients.
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Kutiyal, Aditya S., Pramila Dharmshaktu, Babita Kataria, and Abhilasha Garg. "A Rare Occurrence of Simultaneous Venous and Arterial Thromboembolic Events – Lower Limb Deep Venous Thrombosis and Pulmonary Thromboembolism as Initial Presentation in Acute Promyelocytic Leukemia." Clinical Medicine Insights: Oncology 10 (January 2016): CMO.S37866. http://dx.doi.org/10.4137/cmo.s37866.
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The development of acute myeloid leukemia has been attributed to various factors, including hereditary, radiation, drugs, and certain occupational exposures. The association between malignancy and venous thromboembolism events is well established. Here, we present a case of a 70-year-old Indian man who had presented with arterial and venous thrombosis, and the patient was later diagnosed with acute promyelocytic leukemia (APL). In our case, the patient presented with right lower limb deep venous thrombosis and pulmonary thromboembolism four months prior to the diagnosis of APL. Although thromboembolic event subsequent to the diagnosis of malignancy, and especially during the chemotherapy has been widely reported, this prior presentation with simultaneous occurrence of both venous and arterial thromboembolism has rarely been reported. We take this opportunity to state the significance of a complete medical evaluation in cases of recurrent or unusual thrombotic events.
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Sousou, T., and A. Khorana. "Inpatient chemotherapy and risk for venous thromboembolism." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 9092. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.9092.
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9092 Background: Chemotherapy is a known risk factor for venous thromboembolism (VTE) but contemporary rates and risk factors for chemotherapy-associated VTE are not well described. Furthermore, it is linked to increased hospital length of stay and has negative impact on patient quality of life (QOL). Methods: We used discharge codes to identify all patients admitted to the University of Rochester Medical Center in Rochester, NY from January, 2000 through December, 2005 for chemotherapy and conducted a retrospective chart review to identify those that developed VTE. Inclusion criteria consisted of patients with a malignancy, age greater than eighteen years and no prior history of VTE. VTE was defined as any deep venous thrombosis (DVT) or pulmonary embolism (PE) occurring within 4 weeks of receiving inpatient chemotherapy. Results: A total of 659 patients were admitted for inpatient chemotherapy during the study period. Fifty-four patients developed a DVT and 14 patients developed a PE for a total VTE rate of 9.6%. Median time to developing VTE was 12 days (range, 1 to 28 days). Common sites of cancer among patients who developed VTE included lymphoma (36%) followed by leukemia (28%), multiple myeloma (13%) and gastrointestinal malignancies (8%) among others. Fifteen patients (23%) had stage IV disease. Twelve patients (18%) had a pre-chemotherapy platelet count greater than 350,000/mm3, a known risk factor for chemotherapy-associated VTE. Conclusions: VTE is common in patients receiving chemotherapy, including those with hematologic malignancies and can have significant impacts on patient QOL. The risk for VTE extends beyond the period of inpatient hospitalization. Increased efforts to improve compliance with thromboprophylaxis are warranted to reduce the burden of VTE among cancer patients receiving inpatient chemotherapy. No significant financial relationships to disclose.
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Lepour, Maxence, Grégoire J. F. G. Wieërs, Justine Vereeke, and Aurélien Wauters. "Reversibility of valve regurgitation due to cancer-related non-bacterial thrombotic endocarditis after switching direct oral anticoagulation for heparin." BMJ Case Reports 15, no. 3 (March 2022): e247672. http://dx.doi.org/10.1136/bcr-2021-247672.
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Non-bacterial thrombotic endocarditis (NBTE) is a rare condition related to a state of hypercoagulability in advanced neoplastic disease. Most of the time, arterial thromboembolic event precedes the diagnosis of NBTE. We report here a case of NBTE responsible for multiple ischaemic strokes, which leads to the diagnosis of metastatic pancreatic adenocarcinoma. Aortic and mitral valvular regurgitations secondary to NBTE appeared within 6 weeks despite therapeutic anticoagulation with direct oral anticoagulant (DOAC) in stroke prevention of paroxysmal atrial fibrillation. Bivalvular regurgitations resolved 8 weeks after therapeutic switch to low-molecular-weight heparin (LMWH) and chemotherapy. DOACs are a possible alternative to LMWH for the prevention of venous thromboembolism in patients with active neoplasia. There is a lack of evidence for a clinical efficiency for the prevention of arterial thromboembolism in NBTE. We propose here a short review of the efficacy of anticoagulant therapy for the prevention of arterial thromboembolism in NBTE.
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Losonczy, Hajna, Ágnes Nagy, and Attila Tar. "A kórházi és az ambuláns kemoterápiában részesülő onkológiai betegek vénásthromboembolia-profilaxisának aktuális kérdései." Orvosi Hetilap 157, no. 6 (February 2016): 203–11. http://dx.doi.org/10.1556/650.2016.30357.
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Cancer patients have a 2–7 fold increased risk of venous thromboembolism compared with the general population and, since 1990, this is associated with significant morbidity and mortality. This review summarizes the current knowledge on venous thromboembolism and cancer. Notably, the risk of venous thromboembolism varies depending on the type and stage of cancer. For instance, pancreatic and brain cancer patients have a higher risk of venous thromboembolism than breast and prostate cancer patients. Moreover, patients with metastatic disease have a higher risk than those with localized tumors. Tumor-derived procoagulant factors, cytokines and growth factors may directly and indirectly enhance venous thromboembolism. Chemotherapy produces ~6,5 fold increase in venous thromboembolism incidence in cancer patients compared to the general population. Prevention of this complication is challenging. The authors review the development of guidelines concerning venous thromboembolism prevention in hospitalized and also in ambulatory cancer patients treated with chemotherapy. Current guidelines recommend the use of low-molecular-weight heparin. Understanding the underlying mechanisms may allow the development of new therapies to safely prevent venous thromboembolism in cancer patients. Orv. Hetil., 2016, 157(6), 203–211.
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Seng, Sonia Maria, Ziyue Liu, Sophia Chiu, Tracey Proverbs-Singh, Guru Sonpavde, Toni K. Choueiri, Che-Kai Tsao, et al. "Risk of venous thromboembolism in cancer patients treated with cisplatin: A systematic review and meta-analysis." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e21016-e21016. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e21016.
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e21016 Background: Several reports suggest that cisplatin is associated with an increased risk of thromboembolism (TE). However, patients with solid tumors have multiple risk factors for TE and the excess risk of venous thromboembolic events (VTEs) with cisplatin-based chemotherapy as compared with non-cisplatin-based chemotherapy has not been well described. We performed a systemic review and meta-analysis of randomized controlled trials (RCTs) evaluating the incidence and risk of VTE associated with cisplatin-based chemotherapy. Methods: PubMed was searched for articles published from January 1, 1990 until December 31, 2010.The primary aim was to evaluate the association between treatment with cisplatin and VTEs in patients with cancer. Clinical trials that met the following criteria were included in the meta-analysis: (1) prospective randomized phase 2 and 3 trials of patients with cancer; (2) randomization to treatment with cisplatin versus a non-cisplatin containing chemotherapy regimen (3) available data on venous thromboembolic events. Data on all grade venous thromboembolic events was extracted. Study quality was calculated utilizing Jadad scores. Incidence rates, relative risks, and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses included the impact of publication year, tumor type, and cisplatin dose. Results: A total of 8216 patients with a variety of advanced solid tumors from 38 RCTs were included for analysis. Among patients treated with cisplatin-based chemotherapy, the summary incidence of VTE was 1.64% (95% CI, 1.06–2.25). Patients treated with cisplatin-based chemotherapy had a significantly increased risk of VTE with a relative risk of 1.65 (95% CI, 1.25–2.18; P = .01) compared with controls. Exploratory subgroup analysis revealed the highest relative risk of VTE in patients receiving a weekly equivalent cisplatin dose >30 mg/m2 (2.64; 95% CI, 1.18–5.77; P = .02) and in studies reported during 2000-2010 (1.70; 95% CI, 1.27–2.28; P = .01). Conclusions: Cisplatin chemotherapy is associated with a significant increase in the risk of VTE in patients with advanced solid tumors compared with non-cisplatin chemotherapy.
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Gbolahan, Olumide B., Trista J. Stankowski-Drengler, Abiola Ibraheem, Jessica M. Engel, and Adedayo A. Onitilo. "Management of chemotherapy-induced thromboembolism in breast cancer." Breast Cancer Management 4, no. 4 (September 2015): 187–98. http://dx.doi.org/10.2217/bmt.15.10.
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Arpaia, Guido, Monica Carpenedo, Magda Verga, Ornella Mastrogiacomo, Daniele Fagnani, Mario Lanfredini, Massimo Milani, and Claudio Cimminiello. "D-dimer before chemotherapy might predict venous thromboembolism." Blood Coagulation & Fibrinolysis 20, no. 3 (April 2009): 170–75. http://dx.doi.org/10.1097/mbc.0b013e32831bc2de.
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Dhami, Mandeep S., Robert D. Bona, John A. Calogero, and Richard M. Hellman. "Venous Thromboembolism and High Grade Gliomas." Thrombosis and Haemostasis 70, no. 03 (1993): 393–96. http://dx.doi.org/10.1055/s-0038-1649592.
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SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.
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Zafar, Saman, Rashmika Potdar, Andrew Tiu, Gabor Varadi, and John Leighton. "Acute Left Internal Carotid Artery and Right Popliteal Artery Occlusion Related to Cisplatin-Gemcitabine Based Chemotherapy." Case Reports in Neurological Medicine 2018 (December 17, 2018): 1–4. http://dx.doi.org/10.1155/2018/9281918.
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Objectives. The increased risk of thromboembolic complications with active cancer is well known. We present this case to highlight that chemotherapy may increase the risk of thromboembolic events even further in cancer patients. Methods. We report a case of a 64-year-old male with Diffuse Large B-Cell Non-Hodgkin’s Lymphoma who presented with left-sided headache and right calf pain two weeks after starting Rituximab/Gemcitabine/Cisplatin/Dexamethasone chemotherapy. Neurological examination was normal, but there was an absent right dorsalis pedis pulse. He subsequently developed left vision loss. CT angiogram of the head and neck revealed occlusion of his left internal carotid artery and poor opacification of the left ophthalmic artery. An angiogram of the right leg further revealed acute occlusion of the popliteal artery. Results. The patient underwent intra-arterial Tissue Plasminogen Activator injection to his lower limb and was started on Low Molecular Weight Heparin. His vision gradually recovered with time. His chemotherapy regimen was changed to RICE (Rituximab, Ifosfamide, Carboplatin, Etoposide). Conclusion. Based on literature review, there are numerous similar presentations of arterial thromboembolism in patients on Cisplatin-based chemotherapy. A high index of suspicion for such events should be maintained for patients on chemotherapy presenting with unusual symptoms.
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Ferrante, Noemi, Michele De Tursi, Stefano Iacobelli, Franco Cuccurullo, Harry Büller, Beatrice Feragalli, Ettore Porreca, and Marcello Di Nisio. "Incidental venous thromboembolism in ambulatory cancer patients receiving chemotherapy." Thrombosis and Haemostasis 104, no. 11 (2010): 1049–54. http://dx.doi.org/10.1160/th10-05-0277.
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SummaryWhile the association between cancer and symptomatic venous thromboembolism (VTE) is well established, the incidence and risk factors for incidental VTE in cancer patients remain unclear. The medical records of 1,921 consecutive cancer patients starting chemotherapy from January 2003 up to March 2009 were identified. Patients with a positive history of VTE were excluded. Pre-existing signs of VTE, kind and stage of malignancy, first and subsequent lines of chemotherapy, and all follow-up computed tomography (CT) scans were analysed. The primary outcome was incidental VTE. Overall, there were 101 (5.3%) VTE, 62 (3.2%) incidental and 39 (2.0%) symptomatic during a median of eight months (range 3–72). The incidence on CT scans was 0.58% (95%CI: 0.44–0.74). Incidental VTE included 24 pulmonary embolism, 28 deep venous thrombosis of the extremities, and 10 thromboses of the cava or splanchnic veins. Half of the incidental VTE occurred in the first 3–6 months of chemotherapy with a relatively higher incidence in gyneco-logical and lung cancers. The presence of metastases, high leukocyte count, and platin-based chemotherapy increased the risk up to threefold. All patients with incidental VTE regardless the location received half to full therapeutic doses of low-molecular-weight heparin for a minimum of three months. In summary, incidental VTE is a relative common finding in patients with solid tumours, especially in the first months of chemotherapy. Further research is needed to understand the natural history of incidental thrombosis in order to develop adequate management guidelines.
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Yabeyu, Abdella Birhan, Shemsu Umer Hussen, Wondemagegnhu Tigneh, and Atalay Mulu Fentie. "Incidence and Determinants of Chemotherapy Associated Thromboembolic Events among Ethiopian Patients Treated for Solid Malignancy: A Retrospective Cross-Sectional Study." Clinical and Applied Thrombosis/Hemostasis 28 (January 2022): 107602962210912. http://dx.doi.org/10.1177/10760296221091216.
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Venous thromboembolism is a common problem in patients treated for cancer, although the reported incidence varies widely between studies. This was the first study in its kind in Ethiopia and aimed to assess the incidence and determinants of chemotherapy associated thromboembolic events among patients treated for solid malignancy. An institution-based retrospective cross-sectional study was conducted from 1st March to 1st June, 2019 at adult oncology center of Tikur Anbessa Specialized Hospital. Systematic random sampling technique was employed to recruit 423 study participants. Patients who have received at least a single cycle of any chemotherapy regimen were included in the study. Khorana risk assessment tool was used to predict chemotherapy associated thrombosis. Descriptive statistics were used to summarize the data while multivariable logistic regression was employed to explore associations among variables of interest. The median age of study participants was 43 years, which ranged from 14 to 83 years. Majority of the study participants were treated for breast cancer. Thromboembolic events encountered in 43(10.2%) of patients, from which the commonest one being deep venous thrombosis 36 (85.7%), followed by myocardial infarction 5(11.9%). In multivariable logistic regression, blood transfusion, a primary site of cancer with gastrointestinal malignancy and performance status showed statistically significant association towards the occurrences of thromboembolic events. The incidence of chemotherapy associated thromboembolic events among patients treated for solid malignancy was comparable to other studies. Hence, other prospective randomized trials are needed to see the importance of thrombo-prophylaxis in such high-risk patients.
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Dhami, M. S., D. Goss, and R. Dhami. "Venous thromboembolism in patients with brain tumors." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 12528. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.12528.
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12528 Venous Thromboembolism (VTE) is common in patients undergoing treatment for brain tumors. American College of Chest Physicians (ACCP) 2004 consensus conference recommends routine use of intermittent pneumatic compression devices (IPC), unfractionated heparin (UH) or low molecular weight heparin (LMWH) for VTE prophylaxis in these patients. There, however, continues to be a reluctance on using pharmacologic VTE prophylaxis in these patients. The goal of our study was to determine the incidence of VTE in patients with brain tumors treated at a community hospital and the frequency of use of thromboprophylaxis in these patients. Both electronic and paper charts of all patients treated for brain tumors between 1997 and 2003 were reviewed. Follow up data was obtained by contacting physicians caring for these patients. Forty two patients were identified (Anaplastic astrocytoma 10; Glioblastoma multiforme 16; Meningioma 15; oligodendroglioma 1). Twelve patients were treated with various adjuvant chemotherapy regimens. Only 16 patients (38%) received any form of VTE prophylaxis. UH (12) or LMWH (2) were used with or without IPCs or graduated compression stockings. There were eight episodes of symptomatic VTE among 42 patients (19%). These include 6 episodes of deep vein thrombosis (DVT) and two cases of superficial vein thrombosis. Three patients with DVT also had symptomatic pulmonary embolus (PE). All episodes VTE were seen in patients with malignant gliomas yielding a 29% incidence of VTE in patients with malignant gliomas. None of the 15 patients with meningioma had symptomatic VTE. All but one episode of VTE were associated with administration of systemic chemotherapy. Half of these episodes occured more than six weeks after surgical debulking. We conclude that incidence of VTE with malignant brain tumors is high (29%) and the administration of chemotherpy increases this risk. There continues to be underutilization of VTE prophylaxis in these patients at very high risk of VTE. Efforts should be directed at improving the understanding of type and duration of appropiate VTE prophylaxis in patients with brain tumors. No significant financial relationships to disclose.
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Demirağ, Mustafa Kemal. "Chemotherapy-induced venous thromboembolism in patients with breast cancer." Turkish Journal of Thoracic and Cardiovascular Surgery 21, no. 3 (August 21, 2013): 654–58. http://dx.doi.org/10.5606/tgkdc.dergisi.2013.7552.
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Wright, A., S. Elkins, J. Files, C. Bigelow, V. Herrin, and M. Sample. "THROMBOEMBOLISM IN MULTIPLE MYELOMA PATIENTS RECEIVING THALIDOMIDE COMBINATION CHEMOTHERAPY." Journal of Investigative Medicine 55, no. 1 (January 2007): S302. http://dx.doi.org/10.1097/00042871-200701010-00839.
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Kirwan, Cliona C., C. N. McCollum, G. McDowell, and G. J. Byrne. "Investigation of Proposed Mechanisms of Chemotherapy-Induced Venous Thromboembolism." Clinical and Applied Thrombosis/Hemostasis 21, no. 5 (March 5, 2015): 420–27. http://dx.doi.org/10.1177/1076029615575071.
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Otten, Hans-Martin M. B., Joost Mathijssen, Hugo ten Cate, Marcel Soesan, Marijke Inghels, Dick J. Richel, and Martin H. Prins. "Symptomatic Venous Thromboembolism in Cancer Patients Treated With Chemotherapy." Archives of Internal Medicine 164, no. 2 (January 26, 2004): 190. http://dx.doi.org/10.1001/archinte.164.2.190.
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Dimakakos, Evangelos, Konstantinos Livanios, Ioannis Gkiozos, Adriani Charpidou, Eleutheria Ntalakou, llias Kainis, and Konstantinos Syrigos. "New data for venous thromboembolism in patients with small cell lung cancer: A review." Phlebology: The Journal of Venous Disease 33, no. 8 (October 23, 2017): 517–22. http://dx.doi.org/10.1177/0268355517737670.
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Malignancy is an important predisposing factor for thromboembolic disease. Patients with malignancy display 4 to 10 times greater risk than the general population. As for lung cancer, that risk seems to further increase and become up to 20 times higher. The aim of this article is to review the International literature in order to highlight for the first time, the correlation between thromboembolic disease and small cell lung cancer. PubMed, Medline and Embase databases were searched from 1990 up to 2016, for retrospective and prospective studies that investigate the correlation between thromboembolic disease and small cell lung cancer. The incidence rate of thromboembolic disease found in these studies ranged between 6.8% and 11.5%. Thromboembolic disease is associated with a reduced survival in patients with small cell lung cancer and six factors seemed to increase the risk of thromboembolism: chemotherapy, cisplatin treatment, smoking, extensive disease, the infiltration of the superior vena cava and multiple concomitant diseases. Thromboembolic disease shows an increased incidence in patients with small cell lung cancer and more research with well-designed studies is required in order to study in detail the anticoagulation treatment and the survival in small cell lung cancer patients.
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Silva, Patrícia, Maria Rosales, Maria João Milheiro, and Luísa L. Santos. "Tromboembolismo Pulmonar no Doente Oncológico em Ambulatório." Acta Médica Portuguesa 28, no. 4 (July 6, 2015): 463. http://dx.doi.org/10.20344/amp.5872.
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<strong>Introduction:</strong> The association between cancer and venous thromboembolism is known, and oncology patients present a risk six to seven times higher than the general population of a thrombotic event. Pulmonary embolism is an important cause of morbidity and mortality in this patients group, presenting an underestimated prevalence.<br /><strong>Material and Methods:</strong> Retrospective study of all episodes of pulmonary embolism referenced in the last five years. We only selected oncologic outpatients and studied their demographics characteristics, risk factors associated with venous thromboembolism, presence of symptoms at diagnosis, risk stratification of venous thromboembolic events by the Khorana model, probability of mortality at 30 days and overall survival. The study is in accordance with the Helsinki declaration.<br /><strong>Results:</strong> From the 186 patients under evaluation, 55.9% were female, with median age of 64 years. The most prevalent cancers were colorectal (24.2%) and lung (17.7%), most of which had metastases (66.1%) or underwent chemotherapy (69.4%). Pulmonary embolism was a radiological finding in 69.4%, whereas no clinical variable was relevant for the presence or absence of symptoms. Mortality at 30 day resulting from pulmonary embolism was 7.5%, and it was found that symptomatic patients had a lower median survival relative to asymptomatic (12 vs. 20 months, p = 0.029). The retrospective application of the Khorana model to those undergoing chemotherapy identified 11% of individuals at high risk.<br /><strong>Discussion:</strong> Pulmonary thromboembolism was an imagiological finding in most patients, with no clinical variable able to predict the presence or absence of symptoms. Asymptomatic patients had a higher survival.<br /><strong>Conclusion:</strong> In our study pulmonary embolism was apparently asymptomatic in most study patients. These data reinforce the need to evaluate the risk of venous thromboembolism in cancer outpatients and consider conducting antithrombotic prophylaxis.
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Li, Xiao, Shu-Ling Hou, Xi Li, Li Li, Ke Lian, Ju-Ya Cui, Gang-Gang Wang, and Tao Yang. "Risk Factors of Thromboembolism in Lymphoma Patients Undergoing Chemotherapy and its Clinical Significance." Clinical and Applied Thrombosis/Hemostasis 27 (January 2021): 107602962110379. http://dx.doi.org/10.1177/10760296211037923.
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This study investigated the risk factors of thromboembolism (TE) in lymphoma patients undergoing chemotherapy and its clinical significance. A total of 304 lymphoma patients who received chemotherapy from January 2012 to July 2019 were retrospectively analyzed, including 111 patients with and 193 patients without TE. The clinical characteristics and related laboratory test results were compared between the 2 groups using univariate analysis, while the risk factors for TE in lymphoma patients undergoing chemotherapy were analyzed using multivariate logistic regression analysis. Univariate analysis revealed an increase in the risk of TE among lymphoma patients with chemotherapy in the following categories: female patients, patients with body mass index <18.5 or > 24, patients aged ≥60 years, those with platelet abnormality before chemotherapy, single hospital-stay patients, and Ann Arbor stage III/IV patients. Multivariate logistic regression analysis revealed that for platelet count abnormality before chemotherapy, Ann Arbor stage III/IV and female patients represented independent risk factors for TE among lymphoma patients after chemotherapy ( P < .05). For lymphoma patients treated with chemotherapy, the risk of TE occurring in women, patients with platelet abnormalities before chemotherapy, and patients at Ann Arbor stage III/IV was significantly higher compared with other patients. For these patients, we recommend prophylactic anticoagulant therapy.
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Brown, Erika N., and Jon D. Herrington. "Review of the Relationship Between Venous Thromboembolism, Malignancy and Its Treatment." Journal of Pharmacy Practice 21, no. 2 (April 2008): 126–37. http://dx.doi.org/10.1177/0897190008315057.
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Venous thromboembolism is a common complication that develops in approximately 20% of patients with cancer. Presence of tumor and other risk factors, such as inflammation, surgery, obesity, and medications, have the potential to alter the intravascular coagulation homeostasis and lead to thrombosis. Although malignancy may predispose patients to venous thromboembolism, many chemotherapy agents also increase the risk. In this article, some of the agents tamoxifen, asparaginase, fluorouracil, thalidomide, lenalidomide, bevacizumab, and hematopoietic growth factors are discussed. Many patients will experience a thrombotic event despite optimal prophylaxis. Thus, this article will address the guidelines for treatment and prophylaxis of venous thromboembolism. In general, the venous thromboembolism risk should be assessed before certain antineoplastic regimens are prescribed to patients with cancer.
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Sun, Ming-Yee, and Sonu M. M. Bhaskar. "Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis." Diagnostics 12, no. 12 (November 25, 2022): 2954. http://dx.doi.org/10.3390/diagnostics12122954.
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Objective: Venous thromboembolism (VTE) is a life-threatening complication that may exacerbate cancer prognosis. Whilst some studies indicate an increased risk of VTE in cancer patients undergoing chemotherapy, the prevalence estimates on the pooled prevalence of VTE in cancer patients undergoing chemotherapy are not known. This study aims to calculate the pooled prevalence of VTE in chemotherapy-treated cancer patients. Methods: Studies on VTE occurrence in cancer patients undergoing chemotherapy were retrieved after database search. The terms used included “cancer”, “chemotherapy”, and “venous thromboembolism”. A random-effects meta-analysis was conducted to obtain a pooled estimate of VTE prevalence in cancer patients undergoing chemotherapy. Results: A total of 102 eligible studies involving 30,671 patients (1773 with VTE, 28,898 without) were included in the meta-analysis. The pooled estimate of VTE prevalence was found to be 6%, ranging from 6% to 7% (ES 6%; 95% CI 6–7%; z = 18.53; p < 0.001). Conclusions: The estimated pooled prevalence rate of VTEs was 6% in cancer patients undergoing CRT, which was higher than the overall crude prevalence rate (5.78%). Comprehensive cancer care should consider stratified VTE risk assessment based on cancer phenotype, given that certain phenotypes of cancer such as bladder, gastric and ovarian posing particularly high risks of VTE.
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Seng, Sonia, Ziyue Liu, Sophia K. Chiu, Tracy Proverbs-Singh, Guru Sonpavde, Toni K. Choueiri, Che-Kai Tsao, et al. "Risk of Venous Thromboembolism in Patients With Cancer Treated With Cisplatin: A Systematic Review and Meta-Analysis." Journal of Clinical Oncology 30, no. 35 (December 10, 2012): 4416–26. http://dx.doi.org/10.1200/jco.2012.42.4358.
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Purpose Several reports suggest that cisplatin is associated with an increased risk of thromboembolism. However, because the excess risk of venous thromboembolic events (VTEs) with cisplatin-based chemotherapy has not been well described, we conducted a systemic review and meta-analysis of randomized controlled trials evaluating the incidence and risk of VTEs associated with cisplatin-based chemotherapy. Methods PubMed was searched for articles published from January 1, 1990, to December 31, 2010. Eligible studies included prospective randomized phase II and III trials evaluating cisplatin-based versus non–cisplatin-based chemotherapy in patients with solid tumors. Data on all-grade VTEs were extracted. Study quality was calculated using Jadad scores. Incidence rates, relative risks (RRs), and 95% CIs were calculated using a random effects model. Results A total of 8,216 patients with various advanced solid tumors from 38 randomized controlled trials were included. The incidence of VTEs was 1.92% (95% CI, 1.07 to 2.76) in patients treated with cisplatin-based chemotherapy and 0.79% (95% CI, 0.45 to 1.13) in patients treated with non–cisplatin-based regimens. Patients receiving cisplatin-based chemotherapy had a significantly increased risk of VTEs (RR, 1.67; 95% CI, 1.25 to 2.23; P = .01). Exploratory subgroup analysis revealed the highest RR of VTEs in patients receiving a weekly equivalent cisplatin dose > 30 mg/m2 (2.71; 95% CI, 1.17 to 6.30; P = .02) and in trials reported during 2000 to 2010 (1.72; 95% CI, 1.27 to 2.34; P = .01). Conclusion Cisplatin is associated with a significant increase in the risk of VTEs in patients with advanced solid tumors when compared with non–cisplatin-based chemotherapy.
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Saccullo, Giorgia, Alessandra Malato, Lucio Lo Coco, Ilenia Barbello, Clementina Caracciolo, Simona Raso, Marco Santoro, et al. "Cancer Patients Requiring Interruption of Long-Term Anticoagulant Therapy: The Use of Fixed Sub-Therapeutic Doses of Low-Molecular Weight Heparin." Blood 118, no. 21 (November 18, 2011): 1244. http://dx.doi.org/10.1182/blood.v118.21.1244.1244.
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Abstract Abstract 1244 Introduction. We tested the efficacy and safety of fixed doses of Low-Molecular Weight Heparin (LMWH) in cancer patients requiring interruption of Vitamin-k Antagonist (VKA) because of invasive procedures (defined as major and non major surgery) or chemotherapy inducing platelets depletion. Methodology. Cancer patients were defined to be at high (atrial fibrillation [AF] with previous stroke, prosthetic mitralic valves and venous thromboembolism [VTE] lasting < 3months) or low risk of thrombosis (AF without previous stroke, VTE lasted > 3 months, and prosthetic aortic valves). They discontinued VKA 5 + 1days before surgery or chemotherapy; in those at low-risk for thrombosis, LMWH was given at a prophylactic dosage of 3.800 U.I. (nadroparin) or 4.000 U.I. (enoxaparin) anti-FXa once daily the night before the procedure or the beginning of chemotherapy. In patients at high-risk for thrombosis, LMWH was started early after VKA cessation (when an INR < 1.5) and given at fixed sub-therapeutic doses (3.800 or 4.000 UI anti-FXa twice daily) until procedure or beginning of chemotherapy. In patients undergoing procedures, LMWH was reinitiated 12 hours after procedure while VKA the day after; in patients receiving chemotherapy, LMWH was reinitiated 12 h after a stable platelet count > 30.000 mmc3 and VKA 12 h after a stable platelet count > 50.000 mmc3. Heparin was continued until a therapeutic INR value was reached. The primary efficacy endpoints were the incidence of thromboembolism and major bleeding from VKA suspension to 30 + 2 days post-procedure or next chemotherapy. Results. A total of 156 patients (68, 53.9% at low-risk and 58, 46.1% at high-risk for thrombosis) were enrolled (Table 1); 44 (28.2%) underwent major surgery, 53 (33.9%) non-major surgery and 29 (18.5%) chemotherapy. Overall, thromboembolic events occurred in 5 patients (3.2%, 95% confidence intervals 0.5–5.9), 4 belonging to high-risk and 1 to low-risk group. Overall, major bleeding occurred in 5 patients (3.2%, 95 CI 0.5–5.9), all belonging to high-risk group (3 during major surgery and 2 during chemotherapy). The mean time of anticoagulation with LMWH was 7.5 days in patients underwent procedures and 13.2 days in those who received chemotherapy. Conclusion. LMWH given at fixed sub-therapeutic doses appears to be a feasible and relatively safe approach for bridging therapy in chronic anticoagulated cancer patients requiring VKA interruption. Disclosures: No relevant conflicts of interest to declare.
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Qu, Xiaoyan, Yan Gu, Jianyong Li, and Lijuan Chen. "Clinical Analysis of Thromboembolism Associated with Lenalidomide-Based Regimens for Multiple Myeloma Patients." Blood 126, no. 23 (December 3, 2015): 5368. http://dx.doi.org/10.1182/blood.v126.23.5368.5368.
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Abstract Objective: To investigate and analyze the incidence, risk factors, prophylaxis and treatment of thromboembolism associated with lenalidomide-based regimens for multiple myeloma (MM) patients. Methods: 22 newly diagnosed / relapsed MM patients received lenalidomide-based regimes from May 2013 to May 2015 in our department. All diagnosis of thromboembolism were based on objective clinical symptoms, and confirmed by imaging (lower extremity vascular ultrasound, chest CT angiography (CTA), and two-dimensional echocardiography). Investigatethe incidence of thethromboembolism, and analyze the prophylaxis and treatment for the thromboembolism according to risk factors such as patients' characteristics, disease status, and therapy regimes. Results: Aspirin was used as thromboprophylaxis in 16 patients, low molecular weight heparin (LMWH) in 2 patients, and warfarin in 1 patient, while 3 patients received no thromboprophylaxis. There were 4 cases were diagnosedas thromboembolism with the incident of 18.2%. Threeof them were deep vein thrombosis (DVT), while 1 patient was combined withpulmonary embolism (PE), andthe rest one was found thromboembolism in the left atria. The chemotherapy regimes were lenalidomide plus dexamethasone (≤40mg qw). Other risk factors include: old age, male, immobility, central venous catheter (CVC), surgical history, hypertension, cardiovascularevent, IgG/IgA and light chain type, newly diagnosis, and erythropoietin (EPO). The management of thromboembolism included LMWH, warfarin, venous filter placement, adjustment of chemotherapy regimes and maintenance therapy of antithromboembolism. All the 4 patients were well managedat the last follow-up. Conclusion: Thromboembolism was one of the most common non-hematologic adverse events of lenalidomide-based therapy. Aspirin was an effective option for thromboprophylaxis. More cases will be observed for longer time to optimize further evaluations forantithromboticprophylaxes, which include risk stratification-based prophylacticstrategies, new predictors and specific assessment of all thromboprophylaxis options. Disclosures No relevant conflicts of interest to declare.
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Hull, Russell D. "Semuloparin reduced venous thromboembolism in patients receiving chemotherapy for cancer." Annals of Internal Medicine 156, no. 12 (June 19, 2012): JC6. http://dx.doi.org/10.7326/0003-4819-156-12-201206190-02005.
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Oba, Ayane, Michio Nakamura, Taichi Murai, Chika Matsuda, Kazufumi Itaya, Yuta Koike, Ayana Endo, et al. "Update analysis: Thromboembolism in gastrointestinal tract cancer patients receiving chemotherapy." Journal of Clinical Oncology 34, no. 15_suppl (May 20, 2016): e15156-e15156. http://dx.doi.org/10.1200/jco.2016.34.15_suppl.e15156.
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Khanna, A., A. M. Reece-Smith, M. Cunnell, S. Madhusudan, A. Thomas, D. J. Bowrey, and S. L. Parsons. "Venous thromboembolism in patients receiving perioperative chemotherapy for esophagogastric cancer." Diseases of the Esophagus 27, no. 3 (May 7, 2013): 242–47. http://dx.doi.org/10.1111/dote.12084.
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Ahmed, S., R. K. Shahid, H. Bhatt, R. Lee-Ying, and J. Lim. "Chemotherapy-Related Thrombocytosis: Does It Increase the Risk of Thromboembolism." Oncology 82, no. 6 (2012): 327–32. http://dx.doi.org/10.1159/000337235.
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Metcalf, Robert Lewin, Nicholas Hopley, Thomas Henry, and Jurjees Hasan. "Natural history of venous thromboembolism in gastrointestinal cancers." Journal of Clinical Oncology 32, no. 3_suppl (January 20, 2014): 593. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.593.
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593 Background: Venous thromboembolism (VTE) is a leading cause of mortality in patients with cancer. Characterisation of VTE in cancer will guide prophylactic anti-coagulation of high risk populations. Methods: We performed a retrospective analysis using electronic patient records, of 910 upper GI (UGI) cancer and 1,299 colorectal cancer (CRC) patients referred to a tertiary cancer centre to identify the incidence of VTE, its relationship to chemotherapy and impact on survival. VTE risk scores were calculated using the Khorana index (Khorana AA et al. Blood 2008 May 15;111(10):4902-7). Results: VTE were identified in 88/910 (9.7%) patients with UGI cancer (oesophageal 37%, gastro-oesophageal 24%, gastric 39%), comprising 50 deep vein thromboses (DVT) and 43 pulmonary emboli (PE). 52% were stage I-III and 48% stage IV. 56% of patients received chemotherapy up to 4 weeks before VTE. Median time to VTE from cancer diagnosis was 5.3 months (range -3 to 31.2). No difference in survival was seen for patients with VTE compared to a stage matched control group without VTE (median OS 12.5 v 9.4 months, log rank p=0.2). VTE (DVT:PE, 69:49) affected 115/1299 (8.9%) patients with CRC (25% stage I-III, 75% stage IV). Median time to VTE from CRC diagnosis was 5.4 months (range -4.3 to 54.5) for stage I-III and 8.6 months (range -4.3 to 77) for stage IV CRC. Chemotherapy was received by 41% (stage I-III) and 78% (stage IV) of patients within 4 weeks before VTE. Data to perform VTE risk score were available for 72/115 CRC patients with VTE, which classified 61.1% as low-risk (stage I-III 81.2% (13/16); stage IV 55.3% (31/56)). Again, no difference in survival was seen for patients with VTE compared to a control group without VTE matched for stage and performance status (median OS for stage I-III, 40 vs. 50.3 months p=0.41; stage IV, 20.7 vs. 18.8 months, p=0.52). Conclusions: VTE affects nearly 1 in 10 patients with GI cancer receiving chemotherapy. The peak incidence is in the first 6 months following diagnosis. Most patients have DVT and 36% are asymptomatic. No adverse impact on survival was seen for patients with VTE compared to stage matched controls implying VTE is not a prognosticator of poor outcomes in gastrointestinal cancers. Mature data will be presented at the meeting.
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Labianca, R., G. Gasparini, S. Barni, M. Verso, E. Bonizzoni, M. Brighenti, M. Mandala, et al. "Prediction of venous thromboembolism in ambulatory patients with cancer receiving chemotherapy: An expanded thromboembolic risk score model." Journal of Clinical Oncology 29, no. 15_suppl (May 20, 2011): e19551-e19551. http://dx.doi.org/10.1200/jco.2011.29.15_suppl.e19551.
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Kobayashi, Yusuke, Takashi Kon, Katsuyoshi Shimizu, Daisuke Tanioka, Yosuke Satou, and Tohru Mizutani. "COT-18 TWO CASES OF GLIOBLASTOMA WITH ASYMPTOMATIC PULMONARY ARTERY EMBOLISM AND DEEP VEIN THROMBOSIS FROM ADMISSION TO HOSPITAL." Neuro-Oncology Advances 1, Supplement_2 (December 2019): ii43—ii44. http://dx.doi.org/10.1093/noajnl/vdz039.198.
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Abstract Patients with malignant tumors are susceptible to concurrent venous thromboembolism. We report two cases of glioblastomas that showed asymptomatic pulmonary embolism and deep vein thrombosis on admission. The first case was a 77-year-old male. He was referred to our clinic for a tumor found in the left temporal lobe on computed tomography scan performed when he suffered pneumonia. On admission,he had a Karnofsky performance status (KPS) score of 50 and an elevated D-dimer level (16.46 μg/ml). Pulmonary embolism and deep vein thrombosis were noted on detailed examination. Direct oral anticoagulant (DOAC) therapy resulted in the disappearance of pulmonary embolism. On biopsy,the tumor was diagnosed as glioblastoma. The patient underwent radiation therapy in combination with chemotherapy. The second case was a 71-year-old female. She developed a disorder of consciousness and was admitted to a clinic. Brain magnetic resonance imaging (MRI) revealed a high T2 signal area in the left temporal lobe. The patient was initially diagnosed with encephalitis. Though the consciousness disorder improved quickly,she was referred to our clinic after a hyperintense area was observed on MRI. On admission,she had a KPS score of 100,and an elevated D-dimer level (7.59μg/ml),revealing pulmonary embolism and deep vein thrombosis. She was started on a DOAC and underwent surgical removal of the tumor via craniotomy. She was diagnosed with glioblastoma and underwent radiation therapy in combination with chemotherapy. Approximately 20% of the patients with glioblastomas suffer concurrent symptomatic venous thromboembolism. The incidence of venous thromboembolism is further elevated in patients with a poor KPS score or elderly people. Many patients with glioblastomas suffer asymptomatic venous thromboembolism. In this report,asymptomatic venous thromboembolism was noted in patients with a good KPS score. In glioblastoma patients,it is necessary to test for venous thromboembolism by measuring D-dimer levels before surgery.
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Basaran, Derman, Jessa Suhner, Dib Sassine, Thomas Boerner, Ying L. Liu, Rachel N. Grisham, William P. Tew, et al. "Risk of venous thromboembolism in patients receiving neoadjuvant chemotherapy for ovarian cancer." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 6073. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.6073.
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6073 Background: To identify the incidence of newly occurring venous thromboembolism (VTE) in patients with ovarian cancer receiving neoadjuvant chemotherapy (NACT). Methods: Using our prospectively maintained ovarian cancer database, we identified all ovarian cancer patients who received NACT at our institution from 4/15-9/18. VTE events included clinically diagnosed deep venous thrombosis (DVT) or pulmonary embolism (PE). Patients who presented with VTE prior to induction of NACT or patients on anticoagulation therapy prior to diagnosis were excluded. The incidence of newly occurring thrombotic events were categorized according to treatment phases, defined as 1) NACT prior to interval debulking surgery (IDS); 2) intraoperative and 30-day post-IDS; and 3) adjuvant chemotherapy. Results: 290 patients underwent NACT during the study period. Thirty-eight patients (13%) who presented with VTE, 12 (4%) on anticoagulation at presentation, and 4 (1.4%) seeking only a second opinion were excluded from analysis. Of the 236 evaluable patients, the overall rate of VTE during all treatment phases was 15% (35/236). In treatment phase I, 11% (27/236) of patients experienced VTE during NACT. In phase II, an additional 2.5% (6/236) developed VTE in the intraoperative and 30-day postoperative period. In phase III, an additional 0.8% (2/236) experienced a thrombotic event >30 days postoperatively. Sevety-seven percent (27/35) of VTE events occured during phase I. Conclusions: Patients receiving NACT for advanced ovarian cancer are at high risk for the development of clinically detectable thromboembolic events. The highest rate of new VTE events was seen during induction of NACT, a phase of treatment traditionally without any prophylactic anticoagulation. Further research regarding the timing of thromboprophylaxis for this patient population is warranted. [Table: see text]
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Pant, Alok, Dachao Liu, Julian Schink, and John Lurain. "Venous Thromboembolism in Advanced Ovarian Cancer Patients Undergoing Frontline Adjuvant Chemotherapy." International Journal of Gynecologic Cancer 24, no. 6 (July 2014): 997–1002. http://dx.doi.org/10.1097/igc.0000000000000164.
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ObjectiveThe aim of this study was to define the incidence and prognostic significance of venous thromboembolism (VTE) in patients with advanced, epithelial ovarian cancer undergoing frontline adjuvant chemotherapy after an extended period (28 days) of postoperative prophylaxis.MethodsA retrospective analysis of patients with advanced, epithelial ovarian cancer who underwent surgery and chemotherapy at a single institution from January 2008 through December 2011 was performed. Exclusion criteria were history of VTE, VTE during the postoperative period, clear cell histology, use of anticoagulation for a different indication, and lack of compliance with 28 days of postoperative prophylaxis with a low-molecular-weight heparin. Baseline patient demographics and oncologic outcomes were analyzed. Clinically symptomatic VTE was identified and confirmed with imaging studies. Otherwise, VTE was identified on imaging studies done to assess disease status at the conclusion of adjuvant chemotherapy.ResultsOne hundred twenty-eight patients met criteria for inclusion. Sixteen patients had a reported VTE during the time they were on frontline chemotherapy (12.5%). Nine patients (7%) had a pulmonary embolus, and 8 (6.3%) had a deep vein thrombus. The mean BMI in the group that developed VTE was 28, and in the group without VTE, it was 26.5 (P = 0.23). Three (23%) of the 16 patients who developed VTE had undergone a suboptimal cytoreduction compared with 12 (11%) of the 112 in the group with no VTE (P = 0.4). Six (37%) of the 16 patients who developed VTE during chemotherapy underwent a bowel resection and/or splenectomy during their cytoreductive surgery compared with 18 (16%) of the 112 patients who did not develop VTE (P = 0.079). Eight of the patients in the VTE group had indwelling venous catheters during chemotherapy (50%) compared with 39 (35%) in the group with no VTE (P = 0.27). In the group that developed VTE, there was a trend toward increased preoperative CA-125, higher rates of bowel resection and/or splenectomy during surgery, decreased use of aspirin, and inferior survival. On multivariate analysis, patients who developed VTE had significantly longer postoperative hospital stays (7 vs 5 days [P = 0.009]) and lower rates of complete response (P = 0.01).ConclusionsA 12.5% risk for VTE merits consideration of prophylaxis during chemotherapy in this cohort. A randomized, controlled trial is needed to clarify whether the benefits of long-term prophylaxis outweigh the risks and costs of such therapy.
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Bryer, Emily Jane, Michael J. Kallan, Ting-Shan Chiu, Katharina M. Scheuba, and David H. Henry. "A retrospective analysis of venous thromboembolism trends in chemotherapy-induced anemia." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e15515-e15515. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e15515.
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e15515 Background: Anemia is a common and unfortunate consequence of chemotherapy. Patients receiving a variety of chemotherapy regimens often develop chemotherapy–induced anemia (CIA), which contributes to poor outcomes, including increased mortality. Prompt and effective treatment of CIA is essential to prevent fewer chemotherapy dose delays and reductions. Despite the baseline coagulopathies present in patients with malignancy, administration of RBC transfusions is associated with venous thromboembolism (VTE). It remains unknown whether the risk of VTE in patients with CIA is greater among patients who receive single or multiple RBC transfusions. Methods: A retrospective study analyzed 10,269 University of Pennsylvania Health System patients with malignancies of various type, stage, and histopathology who developed CIA between 5/1/08-12/31/17. We analyzed rates of VTE development after adjusting for RBC intervention with a 95% confidence interval during the 90 days following CIA diagnosis. Results: Among the 10,269 patients with CIA, 2,008 patients (19.6%) received only RBC transfusion as anemia treatment; of that group, 545 (27.1%) developed a VTE. Transfusion of 2+ units RBC compared with 1 unit of RBC was associated with an increase in VTE development (RR = 1.37, 95% CI 1.09-1.72). The relationship of higher VTE development with increasing number of transfusions is displayed below. Conclusions: While RBC transfusion in patients with CIA is independently associated with VTE, our data further suggests an exponential risk of VTE development with increasing numbers of RBC transfusions. [Table: see text] [Table: see text]
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Cherkashin, Mikhail A., and Natalia A. Berezina. "Venous thromboembolism incidence in radiation oncology: Retrospective trial." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18289-e18289. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18289.
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e18289 Background: Venous thromboembolism (VTE) prevention in oncology patients during external beam radiation therapy (RT) in outpatient setting is the challenging question. We performed analysis of our own data. The aim of study is the clear assessment of VTE incidence in these patients Methods: In retrospective analysis 5134 patients' medical records were included (2612 with RT and 2522 with chemotherapy). Inclusion criteria were: RT in outpatient setting and chemotherapy in outpatient setting. Exclusion criteria: combined radiochemotherapy, hospitalzation, central venous catheter, palliative treatment. 487 patients were selected for the final analysis and stratified in 3 groups: group I (n = 165) 3D-conformal RT for brain tumors or brain metastasis; group II (n = 158) RT for body tumors (abdominal, retroabdominal, pelvic, chest, breast); group III (n = 164) was control –brain and body tumors on chemotherapy. Mean fraction numbers were 25 (11 - 32), mean total dose – 52 Gy (22 - 66). VTE assessment based on clinical data, ultrasound examination (US) and chest CT. Statistical analysis was performed by OpenEpi, Version 3 software pack. Results: Deep vein thrombosis (DVT) was detected in 10 cases (6.06%) in group I, 4 cases in group II and 4 case in control group. VTE patients has a different tumors (astrocytomas, brain trunk tumors, skull basis cancer, rectal cancer, breast cancer). 3 patients were available for long-term outcomes assessment (12 months after radiation therapy). During 1-year period we haven’t detected thrombosis recurrence. One patient on 11th follow-up month was exposed with repeated course of RT without any complications. The difference between VTE incidence for group I and group III characterized by statistical significance (p = 0.018). Risk difference for these groups was 5% (p < 0.05). Conclusions: Based on study results we suggest that external beam radiation therapy is potentially an independent risk factor for VTE development even in outpatient settings. High degree of clinical suspicion and aggressive diagnostic work-up in case of suspicion is necessary. In our opinion low molecular weight heparins prevention should be considered at least during active radiation therapy.
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Zangari, Maurizio, Federica Cavallo, Louis M. Fink, Bart Barlogie, Vanessa Bolejack, Michael J. Burns, Elias Anaissie, et al. "Treatment Associated Venous Thromboembolism (VTE) and Survival in Multiple Myeloma Patients." Blood 108, no. 11 (November 16, 2006): 3573. http://dx.doi.org/10.1182/blood.v108.11.3573.3573.
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Abstract Background: Venous thromboembolism (VTE) is a well known cancer complication generally associated with poor survival. We have analyzed the prognostic impact of the development of a thrombotic episode in newly diagnosed multiple myeloma (MM). Methods: Newly diagnosed patients with symptomatic MM were eligible for enrollment. At registration, patients were randomly assigned to Thalidomide (Thal) or not; both arms received otherwise identical chemotherapy. A total of 668 patients entered the study. The two study arms were well balanced, in terms of age, Ig Subtype, cytogenetic, B2 microglobulin vs CRP. Baseline patients and disease characteristics were well balanced between those individuals who experienced VTE and the others. VTE patients were treated with LMWH followed by coumadin for at least 6 months. A 12 month landmark for VTE was used; group comparisons were performed for EFS and OS using the log rank test. Results: With a median follow up of 53 months a total of 155 (23%) patients experienced VTE during treatment, 98 (30%) patients in the Thal arm and 57 (16%) in the non Thal arm. The development of thrombotic episode was not a negative factor for EFS (p=.1) or OS (p=0.1) (Figure 1) for the entire group as well as for the Thal/chemotherapy treated group (EF p=0.7, OS p=0.6). Patients who received only chemotherapy and developed a thrombotic episode experienced a significantly longer EFS (p=0.02) (Figure 2), and a similar trend in OS. Conclusions: OS and EFS survival of myeloma patients treated with chemotherapy ± thalidomide is not affected by VTE development. Patients treated with chemotherapy (but not Thalidomide) who developed thrombosis during treatment experienced significantly longer EFS. Our observation supports a survival benefit associated with anticoagulation therapy in multiple myeloma patients. Figure 1: OS from 12 months post VAD by VTE Figure 1:. OS from 12 months post VAD by VTE Figure 2: EFS from 12 months post VAD by VTE in the Non Thalidomide arm Figure 2:. EFS from 12 months post VAD by VTE in the Non Thalidomide arm
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Marcus, Ellen, Dennis Yi-Shin Kuo, Nicole Suzanne Nevadunsky, and Gregory M. Gressel. "Association of the Khorana Score with development of venous thromboembolism in ovarian cancer." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 5555. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.5555.
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5555 Background: The Khorana score is a previously validated method to identify patients at high risk of VTE during chemotherapy who would potentially benefit from thromboprophylaxis. The objectives of our study were to evaluate risk factors and timing associated with VTE in a large cohort of ovarian cancer patients and to assess the predictive ability of the Khorana score in this population. Methods: After IRB approval, a retrospective analysis was performed of all patients with ovarian cancer in the Albert Einstein Tumor Registry who received treatment between 2000 and 2020. Demographic, clinical, surgical and histologic data and information regarding timing of VTE were abstracted from the medical record. Khorana scores were retrospectively calculated for all patients who received chemotherapy based on their pre-chemotherapy laboratory indices. Bivariate analysis and multivariable logistic regression were used to examine the association between Khorana score and VTE. Results: A total of 472 patients were included over a median follow-up time of 33.7 (13.3, 61.1) months of whom 142 (31%) underwent diagnostic imaging to rule out VTE. A total of 62 patients (15%) were diagnosed with VTE with a median time from presentation to VTE of 8.7 (2.7, 30.3) months. Individual covariates which were significantly associated with VTE included stage III-IV disease, epithelial histology, open surgery, radical tumor debulking, and presence of residual disease after surgery. Of the 254 patients who received chemotherapy for their disease, 36 (14%) developed VTE within 3 weeks of receiving chemotherapy. Patients with Khorana scores of 2 (OR 1.73 95% CI 0.88-3.42) or 3 (OR 0.89 95% CI 0.33-2.44) were not significantly more likely to develop VTE during chemotherapy compared to patients with a score of 1. However, patients with a score of 4 were 6.74 times more likely to develop a VTE during chemotherapy (95% CI 1.39 - 32.73). Overall, a Khorana score of 2 or higher conferred no significant increased risk of developing VTE during chemotherapy than a score of 1 (OR 1.61 95% CI 0.85- 3.02). In a multivariable model, the Khorana score was not significantly associated with risk of VTE and a Khorana score of 2 or higher could explain only 0.86% of the variability in predicting VTE. The only variables significantly associated with VTE after adjustment were stage III-IV disease and hyperlipidemia. Conclusions: Patients with ovarian cancer are at high risk of developing VTE many months after diagnosis and initiation of chemotherapy. Current ASCO and SGO guidelines recommend thromboprophylaxis for those initiating chemotherapy with a Khorana score of 2 or higher, however our study found that these patients are not at increased risk compared to those with a score of 1. Future models should be developed and validated in large population-based cohorts to determine if there is a more accurate strategy to identify women with ovarian cancer who are at risk for VTE.
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Pavlova, M. G., I. I. Amergulov, N. V. Likhodey, I. A. Kurkina, I. V. Glinkina, O. G. Zheludkova, and M. Yu Gilyarov. "Approaches for the prevention and treatment of venous thromboembolism in a patient with anaplastic astrocytoma: a case report." Sechenov Medical Journal 12, no. 1 (September 15, 2021): 74–82. http://dx.doi.org/10.47093/2218-7332.2021.12.1.74-82.
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Venous thromboembolism occurs in 48–200 out of 1,000 patients with brain cancer per year, which is significantly more frequent than in general population.Case report. A female patient had surgical treatment of anaplastic astrocytoma following radiotherapy and chemotherapy (temozolomide, irinotecan, bevacizumab) at the age of 17 years old. She also received dexamethasone. At the age of 20 years, she developed cancer recurrence, that required chemotherapy. After chemotherapy had been initiated, the patient developed deep vein thrombosis of the legs. Rivaroxaban 20 mg/d for 2.5 months with the subsequent switch to enoxaparin 60 mg/d showed no recanalization. Enoxaparin dose increasing up to 160 mg/d demonstrated incomplete recanalization, however, superficial venous thrombosis of the legs developed. Combination therapy with enoxaparin plus warfarin resulted in further deep and superficial veins recanalization.Discussion. In cancer-associated venous thromboembolism that is resistant to low molecular weight heparin monotherapy, short-term combination therapy with low molecular weight heparin and vitamin K antagonists can be considered. However, in recurrent cancer standard treatment protocols can be ineffective.
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Pant, Alok, and Julian C. Schink. "Venous thromboembolism in advanced ovarian cancer patients undergoing front-line adjuvant chemotherapy." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 5570. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.5570.
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5570 Background: To define the incidence and prognostic significance of venous thromboembolism (VTE) in patients with advanced, epithelial ovarian cancer undergoing front-line adjuvant chemotherapy after extended period (28 day) post-operative prophylaxis. Methods: A retrospective analysis of patients with advanced, epithelial ovarian cancer who underwent surgery and chemotherapy at a single institution from January 2008 through December 2011 was performed. Exclusion criteria were prior history of VTE, VTE during the post-operative period, clear cell histology, use of anti-coagulation for a different indication, and lack of compliance with 28 days of post-operative prophylaxis with a low molecular weight heparin. Results: 128 patients met criteria for inclusion. Sixteen patients had a reported VTE during the time they were on front line chemotherapy (12.5%). Nine patients (7%) had a pulmonary embolus (PE) and 8 (6.3%) had a deep vein thrombus (DVT). The average BMI in the group that developed VTE was 28 and in the group without VTE was 26.5 (p = 0.23). Three out of 16 (23%) patients who developed VTE had undergone a suboptimal cytoreduction compared to 12/112 (11%) in the group with no VTE (p = 0.4). Six of the 16 (37%) patients who developed VTE during chemotherapy underwent a bowel resection and/or splenectomy during their cytoreductive surgery compared to 18 of 112 (16%) patients who did not develop VTE (p=0.079). Eight of the patients in the VTE group had indwelling venous catheters during chemotherapy (50%) compared to 39 (35%) in the group with no VTE (p = 0.27). In the group that developed VTE, there was a trend towards increased pre-operative CA-125, higher rates of bowel resection and/or splenectomy during surgery, decreased use of aspirin, and inferior survival. On multivariate analysis, patients who developed VTE had significantly longer post-operative hospital stays (7 vs 5 days [p = 0.009]) and lower rates of complete response (p = 0.01). Conclusions: A 12.5% risk of VTE merits consideration of prophylaxis during chemotherapy in this cohort. A randomized, controlled trial is needed to clarify whether the benefits of long term prophylaxis outweigh the risks and costs of such therapy.
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Angelini, Dana, and Alok Khorana. "Risk Assessment Scores for Cancer-Associated Venous Thromboembolic Disease." Seminars in Thrombosis and Hemostasis 43, no. 05 (March 6, 2017): 469–78. http://dx.doi.org/10.1055/s-0036-1597281.
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AbstractCurrent guidelines recommend that patients with cancer be assessed for venous thromboembolism (VTE) risk at the time of chemotherapy initiation and periodically thereafter. Rates of VTE vary substantially among cancer patients. Multiple clinical factors contribute to VTE risk, including the primary site of cancer, extent of disease, interventions including major surgery, hospitalization, and systemic therapy. However, risk of VTE cannot reliably be predicted based on a single risk factor or biomarker. Within the last decade, risk assessment scores have been developed in cancer patients to more reliably predict thromboembolic events. This review provides an overview of evidence supporting the use of such tools for both primary and recurrent cancer-associated VTE. Potential applications of risk assessment tools as well as current knowledge gaps are outlined.