Risk of intracranial hemorrhage associated with therapeutic anticoagulation for venous thromboembolism in cancer patients: a systematic review and meta-analysis

Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis. Methods: We performed a systematic review and proportion meta-analysis following PRISMA guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 22/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, we compared the odds of VTE in patients on prophylactic compared to therapeutic anticoagulation. Results: The review comprised of 24 studies and over 2500 patients. The pooled proportion of VTE prevalence was 0.31 (95% CI 0.24, 0.39 I2 94%), of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63 I2 91%), of deep-venous-thrombosis was 0.23 (95% CI 0.14, 0.32 I2 96%), of pulmonary embolism was 0.14 (95% CI 0.09, 0.20 I2 90%). In a subgroup of studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared to therapeutic anticoagulation (OR 5.45; 95% CI 1.90, 15.57 I2 0%). Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages seem to reduce VTE burden in this patient's cohort compared to standard prophylactic anticoagulation; ongoing randomized controlled trials will further confirm this.

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Postoperative bleeding and venous thromboembolism in colorectal cancer patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a systematic review and meta-analysis

International Journal of Colorectal Disease ◽

10.1007/s00384-021-04021-6 ◽

2021 ◽

Author(s):

Mikkel Lundbech ◽

Andreas Engel Krag ◽

Lene Hjerrild Iversen ◽

Anne-Mette Hvas

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Meta Analysis ◽

Postoperative Bleeding ◽

Colorectal Cancer Patients

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Non-Vitamin K Antagonist Oral Anticoagulants and the Treatment of Venous Thromboembolism in Cancer Patients: A Semi Systematic Review and Meta-Analysis of Safety and Efficacy Outcomes

PLoS ONE ◽

10.1371/journal.pone.0114445 ◽

2014 ◽

Vol 9 (12) ◽

pp. e114445 ◽

Cited By ~ 37

Author(s):

Torben Bjerregaard Larsen ◽

Peter Brønnum Nielsen ◽

Flemming Skjøth ◽

Lars Hvilsted Rasmussen ◽

Gregory Y. H. Lip

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Vitamin K ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Vitamin K Antagonist ◽

Safety And Efficacy

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The Impact of ABO Blood Type on Developing Venous Thromboembolism in Cancer Patients: Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10163692 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3692

Author(s):

Fumihiko Urabe ◽

Shoji Kimura ◽

Kosuke Iwatani ◽

Keiji Yasue ◽

Yuhei Koike ◽

...

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Meta Analysis ◽

Multivariate Logistic Regression Analysis ◽

Blood Type ◽

Pelvic Surgery ◽

Cochrane Library ◽

Abo Blood Type ◽

The Impact

The impact of ABO blood type in the development of venous thromboembolism in cancer patients remains controversial. To develop a sense of the current opinion in this area, we conducted a systematic review and meta-analysis. In March 2021, we performed a systematic search of PubMed, the Cochrane library, and Scopus for studies that compared cancer patients who had a blood type of either O or non-O (A, B, and AB). Our objective was to use multivariate logistic regression analysis to determine how ABO blood type was associated with the development of venous thromboembolism. Our selection criteria were met by a total of nine studies in 25,884 patients for the systematic review and five studies in 22,777 patients for the meta-analysis. In cancer patients, we found that non-O blood type was associated with a nearly two-fold increase in risk of venous thromboembolism (pooled OR: 1.74, 95% CI: 1.44–2.10). Additionally, among the eligible patients, 21,889 patients were post-operative urological cancer patients. In these patients, the analysis also showed an association between non-O blood type and increasing risk of venous thromboembolism after pelvic surgery for malignancy (pooled OR: 1.73, 95% CI: 1.36–2.20). Our meta-analysis suggested that non-O blood type is a risk factor for venous thromboembolism among patients with cancer. As blood type is routinely determined preoperatively by objective and standardized methods, we anticipate that our results will be useful for managing venous thromboembolism in cancer patients, especially after pelvic surgery for urological cancers.

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Endovascular Stroke Treatment and Risk of Intracranial Hemorrhage in Anticoagulated Patients

Stroke ◽

10.1161/strokeaha.119.026606 ◽

2020 ◽

Vol 51 (3) ◽

pp. 892-898 ◽

Cited By ~ 8

Author(s):

Thomas R. Meinel ◽

Joachim U. Kniepert ◽

David J. Seiffge ◽

Jan Gralla ◽

Simon Jung ◽

...

Keyword(s):

Systematic Review ◽

Intracranial Hemorrhage ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Multiple Logistic Regression Analysis ◽

Sensitivity Analyses ◽

Control Group ◽

Stroke Treatment ◽

Therapeutic Anticoagulation ◽

Increased Risk

Background and Purpose— We aimed to determine the safety and mortality after mechanical thrombectomy in patients taking vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). Methods— In a multicenter observational cohort study, we used multiple logistic regression analysis to evaluate associations of symptomatic intracranial hemorrhage (sICH) with VKA or DOAC prescription before thrombectomy as compared with no anticoagulation. The primary outcomes were the rate of sICH and all-cause mortality at 90 days, incorporating sensitivity analysis regarding confirmed therapeutic anticoagulation. Additionally, we performed a systematic review and meta-analysis of literature on this topic. Results— Altogether, 1932 patients were included (VKA, n=222; DOAC, n=98; no anticoagulation, n=1612); median age, 74 years (interquartile range, 62–82); 49.6% women. VKA prescription was associated with increased odds for sICH and mortality (adjusted odds ratio [aOR], 2.55 [95% CI, 1.35–4.84] and 1.64 [95% CI, 1.09–2.47]) as compared with the control group, whereas no association with DOAC intake was observed (aOR, 0.98 [95% CI, 0.29–3.35] and 1.35 [95% CI, 0.72–2.53]). Sensitivity analyses considering only patients within the confirmed therapeutic anticoagulation range did not alter the findings. A study-level meta-analysis incorporating data from 7462 patients (855 VKAs, 318 DOACs, and 6289 controls) from 15 observational cohorts corroborated these observations, yielding an increased rate of sICH in VKA patients (aOR, 1.62 [95% CI, 1.22–2.17]) but not in DOAC patients (aOR, 1.03 [95% CI, 0.60–1.80]). Conclusions— Patients taking VKA have an increased risk of sICH and mortality after mechanical thrombectomy. The lower risk of sICH associated with DOAC may also be noticeable in the acute setting. Improved selection might be advisable in VKA-treated patients. Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT03496064. Systematic Review and Meta-Analysis: CRD42019127464.

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Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-020-02235-z ◽

2020 ◽

Vol 50 (4) ◽

pp. 814-821 ◽

Cited By ~ 8

Author(s):

Syed Shahzad Hasan ◽

Sam Radford ◽

Chia Siang Kow ◽

Syed Tabish Razi Zaidi

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Venous Thromboembolism ◽

Intensive Care Units ◽

Meta Analysis ◽

Previous History ◽

Therapeutic Anticoagulation ◽

Pooled Prevalence ◽

Venous Thromboembolic Events ◽

Prophylactic Anticoagulation

Abstract Many aspects of care such as management of hypercoagulable state in COVID-19 patients, especially those admitted to intensive care units is challenging in the rapidly evolving pandemic of novel coronavirus disease 2019 (COVID-19). We seek to systematically review the available evidence regarding the anticoagulation approach to prevent venous thromboembolism (VTE) among COVID-19 patients admitted to intensive care units. Electronic databases were searched for studies reporting venous thromboembolic events in patients admitted to the intensive care unit receiving any type of anticoagulation (prophylactic or therapeutic). The pooled prevalence (and 95% confidence interval [CI]) of VTE among patients receiving anticoagulant were calculated using the random-effects model. Subgroup pooled analyses were performed with studies reported prophylactic anticoagulation alone and with studies reported mixed prophylactic and therapeutic anticoagulation. We included twelve studies (8 Europe; 2 UK; 1 each from the US and China) in our systematic review and meta-analysis. All studies utilized LMWH or unfractionated heparin as their pharmacologic thromboprophylaxis, either prophylactic doses or therapeutic doses. Seven studies reported on the proportion of patients with the previous history of VTE (range 0–10%). The pooled prevalence of VTE among ICU patients receiving prophylactic or therapeutic anticoagulation across all studies was 31% (95% CI 20–43%). Subgroup pooled analysis limited to studies reported prophylactic anticoagulation alone and mixed (therapeutic and prophylactic anticoagulation) reported pooled prevalences of VTE of 38% (95% CI 10–70%) and 27% (95% CI 17–40%) respectively. With a high prevalence of thromboprophylaxis failure among COVID-19 patients admitted to intensive care units, individualised rather than protocolised VTE thromboprophylaxis would appear prudent at interim.

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Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta‐analysis

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.14930 ◽

2020 ◽

Vol 18 (9) ◽

pp. 2253-2273

Author(s):

Meng Jiang ◽

Chang‐Li Li ◽

Chun‐Qiu Pan ◽

Xin‐Wu Cui ◽

Christoph F. Dietrich

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Meta Analysis ◽

Venous Access

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Risk of Thrombo-Embolic Events in Ovarian Cancer: Does Bevacizumab Tilt the Scale? A Systematic Review and Meta-Analysis

Cancers ◽

10.3390/cancers13184603 ◽

2021 ◽

Vol 13 (18) ◽

pp. 4603

Author(s):

Michael Saerens ◽

Emiel A. De Jaeghere ◽

Heini Kanervo ◽

Nele Vandemaele ◽

Hannelore Denys ◽

...

Keyword(s):

Systematic Review ◽

Ovarian Cancer ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Absolute Risk ◽

Meta Analysis ◽

Additional Risk Factor ◽

The Absolute

Thromboembolic events are the second cause of death in cancer patients. In ovarian cancer, 3–10% of patients present with venous thromboembolism (VTE), but the incidence may rise to 36% along the disease course. Bevacizumab is a monoclonal antibody directed against vascular endothelial-derived growth factor, and in in vitro studies it showed a predisposition to hemostasis perturbation, including thrombosis. However, in vivo and clinical studies have shown conflicting results for its use as a treatment for ovarian cancer, so we conducted a systematic review and meta-analysis on the risk of arterial thromboembolism (ATE) and VTE in ovarian cancer patients treated with bevacizumab. The review comprised 14 trials with 6221 patients: ATE incidence was reported in 5 (4811 patients) where the absolute risk was 2.4% with bevacizumab vs. 1.1% without (RR 2.45; 95% CI 1.27–4.27, p = 0.008). VTE incidence was reported in 9 trials (5121 patients) where the absolute risk was 5.4% with bevacizumab vs. 3.7% without (RR 1.32; 95% CI 1.02–1.79, p = 0.04). Our analysis showed that the risk of arterial and venous thromboembolism increased in patients treated with bevacizumab. Thrombolic events (TEs) are probably underreported, and studies should discriminate between ATE and VTE. Bevacizumab can be considered as an additional risk factor when selecting patients for primary prophylaxis with anticoagulants.

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