Cancer-Related Venous Thromboembolism: From Pathogenesis to Risk Assessment

2021 ◽  
Author(s):  
José Costa ◽  
António Araújo
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Inflammatory Responses ◽  
Current Knowledge ◽  
Coagulation Activation ◽  
Major Health Problem ◽  
Vte Prophylaxis ◽  
Related Risk

AbstractCancer-related venous thromboembolism (VTE) remains a major health problem, accounting for at least 18% of all cases of VTE. Cancer patients with VTE have worse prognosis than those without VTE. Prophylaxis reduces VTE risk, but it is not feasible for all outpatients with cancer due to an increased bleeding risk. The factors involved in the pathogenesis of cancer-related VTE are direct coagulation activation, platelet activation, induction of inflammatory responses, and inhibition of fibrinolysis. Direct coagulation activation can be due to cancer procoagulant (a cysteine protease), microvesicles, or other prothrombotic abnormalities. Risk factors for developing VTE in cancer patients can be divided into four groups: tumor-related risk factors, patient-related risk factors, treatment-related risk factors, and biomarkers. Cancers of the pancreas, kidney, ovary, lung, and stomach have the highest rates of VTE. Patient-related risk factors such as age, obesity, or the presence of medical comorbidities can contribute to VTE. Platinum-based chemotherapies and antiangiogenesis treatments have also been associated with VTE. Biomarkers identified as risk factors include high platelet count, high leukocyte count, P-selectin, prothrombin fragments, D-dimer, and C-reactive protein. Based on the known risk factors, risk assessment models were developed to stratify patients who would benefit from thromboprophylaxis. The Khorana model was the first and is still the most widely used model. Because of its low sensitivity for certain tumor types, four new models have been developed in recent years. In this review, we describe the current knowledge about the pathogenesis and risk factors for cancer-related VTE, hoping to contribute to further research on the still many obscure aspects of this topic.

Risk of venous thromboembolism and primary prophylaxis in cancer

2012 ◽  
Vol 32 (02) ◽  
pp. 132-137 ◽  
Author(s):  
C. Ay ◽  
I. Pabinger
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Patients ◽  
Prediction Models ◽  
Critical Evaluation ◽  
Primary Prophylaxis ◽  
Vte Prophylaxis ◽  
Related Risk ◽  
Hospitalised Patients

SummaryVenous thromboembolism (VTE) is a common complication in patients with cancer that causes significant morbidity and mortality. Several patient-, tumour-and treatment-related risk factors for VTE in cancer patients have been identified. An effective and safe thromboprophylaxis in cancer patients at high risk of VTE is desirable. Recently, the identification of potential biomarkers and the development of risk scoring models for prediction of cancer-associated VTE have been published. Whether primary VTE prophylaxis based on risk assessment through these biomarkers and risk prediction models might be useful, is currently not yet known. However, thromboprophylaxis is clearly indicated in high-risk situations. While VTE prophylaxis is recommended in cancer patients undergoing surgery and in hospitalised patients with acute disease, studies in ambulatory cancer patients are still rare and evidence for primary VTE prophylaxis is currently limited. In this review, risk factors associated with VTE in cancer patients and current approaches of thromboprophylaxis in different settings, specifically in ambulatory cancer patients are subjected to a critical evaluation.

Risk of venous thromboembolism and primary prophylaxis in cancer

2012 ◽  
Vol 03 (03) ◽  
pp. 115-120
Author(s):  
C. Ay ◽  
I. Pabinger
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Patients ◽  
Prediction Models ◽  
Critical Evaluation ◽  
Primary Prophylaxis ◽  
Vte Prophylaxis ◽  
Related Risk ◽  
Hospitalised Patients

SummaryVenous thromboembolism (VTE) is a common complication in patients with cancer that causes significant morbidity and mortality. Several patient-, tumour- and treatment-related risk factors for VTE in cancer patients have been identified. An effective and safe thromboprophylaxis in cancer patients at high risk of VTE is desirable. Recently, the identification of potential biomarkers and the development of risk scoring models for prediction of cancer-associated VTE have been published. Whether primary VTE prophylaxis based on risk assessment through these biomarkers and risk prediction models might be useful, is currently not yet known. However, thromboprophylaxis is clearly indicated in high-risk situations. While VTE prophylaxis is recommended in cancer patients undergoing surgery and in hospitalised patients with acute disease, studies in ambulatory cancer patients are still rare and evidence for primary VTE prophylaxis is currently limited. In this review, risk factors associated with VTE in cancer patients and current approaches of thromboprophylaxis in different settings, specifically in ambulatory cancer patients are subjected to a critical evaluation.

scholarly journals Identification of risk factors for venous thromboembolism and evaluation of Khorana venous thromboembolism risk assessment in Japanese lung cancer patients

2020 ◽  
Vol 75 (1) ◽  
pp. 110-114
Author(s):  
Makoto Hiraide ◽  
Taro Shiga ◽  
Yuichi Minowa ◽  
Yasuhiro Nakano ◽  
Hidenori Yoshioka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Lung Cancer Patients

scholarly journals Venous Thromboembolism in Cancer Patients Undergoing Major Abdominal Surgery: Prevention and Management

2012 ◽  
Vol 2012 ◽  
pp. 1-22 ◽  
Author(s):  
Bhavana Bhagya Rao ◽  
R. Kalayarasan ◽  
Vikram Kate ◽  
N. Ananthakrishnan
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Abdominal Surgery ◽  
Venous Thrombosis ◽  
Cancer Patients ◽  
Cause Of Death ◽  
Current Knowledge ◽  
Major Abdominal Surgery ◽  
Insight Into

Cancer is an important risk factor for venous thrombosis. Venous thromboembolism is one of the most common complications of cancer and the second leading cause of death in these patients. Recent research has given insight into mechanism and various risk factors in cancer patients which predispose to thromboembolism. The purpose of this review is to summarize the current knowledge on the prophylaxis, diagnosis, and management of venous thromboembolism in these patients.

scholarly journals A Novel Risk Assessment Model to Predict Venous Thromboembolism (VTE) in Cancer Inpatients: The Canclot Score

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1181-1181 ◽  
Author(s):  
Dana E. Angelini ◽  
M. Todd Greene ◽  
Julie N Wietzke ◽  
Scott A Flanders ◽  
Suman L. Sood
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Cancer Patients ◽  
Research Funding ◽  
Assessment Model ◽  
Risk Assessment Model ◽  
Risk Models ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Medical Inpatients

Abstract Background Current guidelines recommend all cancer inpatients receive pharmacologic VTE prophylaxis in the absence of contraindications. This is extrapolated from trials showing the benefit of VTE prophylaxis in general medical inpatients and the known increased risk of VTE in cancer patients. However, given the increased risk of bleeding in cancer patients on anticoagulation (AC), it is vital to better define a subpopulation of cancer inpatients who most benefit from VTE prophylaxis. Current inpatient VTE risk models, including Padua, Caprini and IMPROVE, contain cancer as a variable and thus are not discriminative among cancer patients. Although the Khorana score (KS) stratifies VTE risk by cancer type, it was originally derived for cancer outpatients, and has yet to be validated for inpatients. Using a large multi-center cohort, we developed a novel VTE risk assessment model (RAM) specific to cancer inpatients, the CANclot score. Methods The Michigan Hospital Medicine Safety Consortium, a 49 hospital collaborative, established a multicenter retrospective cohort of medical inpatients > 18 years of age. Exclusion criteria include surgical patients, pregnancy, admission to the ICU or for palliative care, therapeutic AC, diagnosis of acute VTE, history of VTE within 6 months, and length of stay < 2 days. Patient demographics, clinical characteristics, and VTE events (both hospital associated and 90 day post discharge) were recorded. The CANclot risk assessment model was derived from logistic regression analyses of an apriori list of risk factors. Significant risk factors included in the CANclot scale were weighted based on the respective odds ratio estimates and an optimal cut-off was chosen. Model discrimination of the CANclot score was compared with other published risk models. Results Between 7/2012-7/2015, 18,956 cancer admissions were included. 2,464 (13%) had a pre-defined contraindication to prophylaxis (active bleed within 3 months, coagulopathy, or high risk brain metastasis). Of all admissions, 52.8% received VTE prophylaxis. A total of 327 (1.7%) VTE events were observed; 51/327 (15.6%) VTE events occurred during admission and 276/327 (84.4%) within 90 day f/u. When comparing AUC's of different risk models, CANclot ≥ 3 was superior to Padua ≥ 4 (p=0.01), Caprini ≥ 5 (p=0.01) and IMPROVE ≥ 2 (p=0.02). In our dataset 4,695 (25%) of patients had a CANclot score ≥ 3. Conclusion: The CANclot score is a novel VTE risk assessment tool derived specifically for cancer inpatients. Compared to other published risk prediction tools used in the general population, CANclot ≥ 3 shows an improved predictive ability for VTE and good yield, applying to 25% of the population. Improving VTE prediction in hospitalized cancer patients is crucial because targeting only those at highest risk may spare low risk patients from untoward bleeding complications from AC. Additionally, we found the majority of VTE events occurred during the 90 day followup period which calls for further attention to the possible need for extended prophylaxis in this population. Limitations to our study include a low overall rate of VTE, lack of some cancer specific variables, and that risk score values have not yet been corrected for optimism. The CANclot VTE risk score is a promising new tool for cancer inpatients that warrants further validation. 1 Patell R et al. JCO 34, 2016 (suppl; abstr 6598) Disclosures Flanders: Blue Cross Blue Shield: Research Funding; Wiley Publishing: Patents & Royalties. Sood:Bayer: Research Funding.

scholarly journals Improving Rates of Venous Thromboembolism Prophylaxis in Multiple Myeloma Patients on Immunomodulatory Drugs

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2235-2235
Author(s):  
Houry Leblebjian ◽  
Joanna Hamilton ◽  
Sydney Smith ◽  
Jacob Laubach ◽  
Nancy Berliner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Multiple Myeloma ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Low Risk ◽  
Immunomodulatory Drugs ◽  
Vte Prophylaxis ◽  
Nccn Guidelines ◽  
Risk Patients

Abstract BACKGROUND: Multiple myeloma patients who receive immunomodulatory drugs (IMiDs: lenalidomide, thalidomide, and pomalidomide) have an increased risk of developing venous thromboembolism (VTE). Guidelines for thromboprophylaxis are based on additional patient and disease characteristics. We describe our single-institution experience with VTE prophylaxis and an intervention to improve VTE risk assessment and prophylaxis. METHODS: A retrospective review using an internal patient database assessed VTE in multiple myeloma patients being treated with IMiDs from 2000-2016. VTE risk factors for each patient were assessed to determine alignment with thromboprophylaxis guidelines. A Quality Improvement (QI) phase from April 1, 2017 to December 31, 2017 added pharmacy oversight to perform an independent VTE risk assessment. Every patient started on an IMiD during this period underwent a separate VTE risk assessment by a pharmacist or hematologist. Each patient was categorized as high or low VTE risk based on NCCN guidelines. The results and recommendations for VTE prophylaxis were given to the myeloma provider. Results: In the initial retrospective review, 107 patients were identified who developed VTE during treatment of multiple myeloma with an IMiD despite thromboprophylaxis in 91 patients (85% of total; 78% on aspirin). The most common VTE risk factors per NCCN guidelines included cardiac disease (n=70), obesity (n=32), chronic kidney disease (n=27), and prior history of VTE (n=18). Eight patients received anticoagulant-based thromboprophylaxis. In the QI phase, 39 multiple myeloma patients were started on IMiDs. The risk assessment classified 17 as low-risk and 22 as high-risk. Of the high-risk patients, 14 (64%) were placed on an anticoagulant for thromboprophylaxis. Eleven (79%) of the anticoagulants used were direct oral anticoagulants (DOACs), 2 (14%) were a low-molecular weight heparin, one (7%) warfarin. The number of thromboembolic events that occurred were 6 (15%): 4 were high-risk on aspirin and 2 were low-risk on aspirin. The 2 low-risk patients who developed VTE had additional provoking factors (active infection, central line placement, smoking, a long driving trip). Eight high-risk patients were given aspirin. Out of the 8, 3 patients developed VTE and were then switched to anticoagulation. One high-risk patient received aspirin because of moderate thrombocytopenia and subsequently developed a VTE. No patients on anticoagulation developed a VTE. The number of complications attributed to thromboprophylaxis were 2 (5%). Two minor bleeding events occurred in patients who were on DOACs (1 epistaxis and 1 grade 1 GI bleed). Both patients continued DOAC anticoagulation after the event resolved. Conclusions: This two-phase QI study showed that multiple myeloma patients at high risk for VTE benefit from guideline-based thromboprophylaxis facilitated through a pharmacy-based system. DOAC's ease of use offer patients and providers an agreeable option that may improve compliance of VTE guidelines. However, prospective studies with DOACs in multiple myeloma are urgently needed to support this. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

scholarly journals Risk Asessment and Thromboprophylaxis for Venous Thromboembolism (VTE) in the Antenatal Population in a Tertiary Health Facility in Nigeria

2021 ◽  
pp. 134-142
Author(s):  
Mkpe Abbey ◽  
Green Kinikanwo
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Health Facility ◽  
First Trimester ◽  
Routine Practice ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
Port Harcourt ◽  
Study Population

Aim: To review the venous thromboembolism (VTE) risk assessment and thromboprophylaxis in the antenatal population in a tertiary health facility in Nigeria and to perform a retrospective VTE risk assessment of the patients with a view of determining those patients that would have needed VTE prophylaxis. Design: It was a retrospective cross-sectional study. Place and Duration of Study: The study was carried out at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria from the 1st of February to the 30th of April, 2020. Materials and Methods: The following data were extracted from the hospital notes of 347 consecutive antenatal patients: history/demographic characteristics, risk factors for VTE, thromboprophylaxis, diagnosis and treatment of VTE, using the RCOG guideline 37a of 2015 as a benchmark for comparison. Data was analysed with the aid of a Statistical Package for Social Science (SPSS) software, version 18. Results: VTE risk assessment and thromboprophylaxis  was not a routine practice at the UPTH. Apart from antenatal admission, the most frequent VTE risk factors in pregnancy were  BMI ≥30, Parity ≥ 3, Age > 5 years and current pre-eclampsia at 48.48%, 41.04%, 36.04% and 15.56% of the study population respectively. 131 (37.75%) of the 347 antenatal population fulfilled the criteria for venous thromboprophylaxis with low molecular weight heparin (LMWH) but they were not assessed and the drug was not given. 63 (18.16%) of the study population was to receive LMWH from 28 weeks of pregnancy while 68 (19.60%) of them were to be given from the first trimester. The prevalence of VTE was however very low at 0.02% (1 patient out of the 347 maternities), irrespective of the fact that 41 (11.82%) of the patients had symptoms and signs of VTE. Conclusion: 131 (37.75%) out of the total 347 antenatal patients fulfilled the criteria to be given thromboprophylaxis but the prevalence of VTE was low at 0.02%. It was therefore recommended that a unified Nigerian national guideline should be written.

MELISSE, a large multicentric observational study to determine risk factors of venous thromboembolism in patients with multiple myeloma treated with immunomodulatory drugs

2013 ◽  
Vol 110 (10) ◽  
pp. 844-851 ◽  
Author(s):  
Philippe Rodon ◽  
Cyrille Hulin ◽  
Laurent Daley ◽  
Charles Dauriac ◽  
Maya Hacini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Multiple Myeloma ◽  
Venous Thromboembolism ◽  
Observational Study ◽  
Vitamin K Antagonists ◽  
Real Life ◽  
Immunomodulatory Drugs ◽  
Vte Prophylaxis ◽  
Increased Risk

SummaryImmunomodulatory drugs (IMiDs) are associated with an increased risk of venous thromboembolism (VTE) in multiple myeloma (MM) patients. We designed MELISSE, a multicentre prospective observational study, to evaluate VTE incidence and identify risk factors in IMiDstreated MM. Our objective was to determine the real-life practice of VTE prophylaxis strategy. A total of 524 MM patients were included, and we planned to collect information at baseline, at four and at 12 months, on MM therapy, on VTE risk factors and management. VTE incidence was 7% (n=31), including 2.5% pulmonary embolism (PE) (n=11), similar at four or 12 months. VTE was observed at all risk assessment levels, although the increased risk assessment level correlated to a lower rate of VTE, maybe due to the implemented thromboprophylaxis strategy. VTE occurred in 7% on aspirin vs 3% on lowmolecular- weight heparin (LMWH) prophylaxis, and none on vitamin K antagonists (VKA). New risk factors for VTE in IMiDs-treated MM were identified. In conclusion, VTE prophylaxis is compulsory in IMiDstreated MM, based on individualised VTE risk assessment. Anticoagulation prophylaxis with LMWH should clearly be prioritised in MM patients with high VTE risk, along with VKA. Further prospective studies will identify most relevant VTE risk factors in IMiDs-treated MM to select accurately which MM patients should receive LMWH prophylaxis and for which duration to optimise VTE risk reduction.

scholarly journals Efficacy and safety of 5 mg olanzapine for nausea and vomiting management in cancer patients receiving carboplatin: integrated study of three prospective multicenter phase II trials

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Senri Yamamoto ◽  
Hirotoshi Iihara ◽  
Ryuji Uozumi ◽  
Hitoshi Kawazoe ◽  
Kazuki Tanaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cancer Patients ◽  
Phase Ii ◽  
Low Dose ◽  
Nausea And Vomiting ◽  
Efficacy And Safety ◽  
Multivariable Logistic Regression ◽  
Related Risk ◽  
Total Control

Abstract Background The efficacy of olanzapine as an antiemetic agent in cancer chemotherapy has been demonstrated. However, few high-quality reports are available on the evaluation of olanzapine’s efficacy and safety at a low dose of 5 mg among patients treated with carboplatin regimens. Therefore, in this study, we investigated the efficacy and safety of 5 mg olanzapine for managing nausea and vomiting in cancer patients receiving carboplatin regimens and identified patient-related risk factors for carboplatin regimen-induced nausea and vomiting treated with 5 mg olanzapine. Methods Data were pooled for 140 patients from three multicenter, prospective, single-arm, open-label phase II studies evaluating the efficacy and safety of olanzapine for managing nausea and vomiting induced by carboplatin-based chemotherapy. Multivariable logistic regression analyses were performed to determine the patient-related risk factors. Results Regarding the endpoints of carboplatin regimen-induced nausea and vomiting control, the complete response, complete control, and total control rates during the overall study period were 87.9, 86.4, and 72.9%, respectively. No treatment-related adverse events of grade 3 or higher were observed. The multivariable logistic regression models revealed that only younger age was significantly associated with an increased risk of non-total control. Surprisingly, there was no significant difference in CINV control between the patients treated with or without neurokinin-1 receptor antagonist. Conclusions The findings suggest that antiemetic regimens containing low-dose (5 mg) olanzapine could be effective and safe for patients receiving carboplatin-based chemotherapy.

scholarly journals Risk Factors and Prediction Models for Venous Thromboembolism in Ambulatory Patients with Lung Cancer

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 778
Author(s):  
Ann-Rong Yan ◽  
Indira Samarawickrema ◽  
Mark Naunton ◽  
Gregory M. Peterson ◽  
Desmond Yip ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Prediction Models ◽  
Poor Performance ◽  
Risk Models ◽  
Related Risk ◽  
Wide Range ◽  
Ambulatory Patients

Venous thromboembolism (VTE) is a significant cause of mortality in patients with lung cancer. Despite the availability of a wide range of anticoagulants to help prevent thrombosis, thromboprophylaxis in ambulatory patients is a challenge due to its associated risk of haemorrhage. As a result, anticoagulation is only recommended in patients with a relatively high risk of VTE. Efforts have been made to develop predictive models for VTE risk assessment in cancer patients, but the availability of a reliable predictive model for ambulate patients with lung cancer is unclear. We have analysed the latest information on this topic, with a focus on the lung cancer-related risk factors for VTE, and risk prediction models developed and validated in this group of patients. The existing risk models, such as the Khorana score, the PROTECHT score and the CONKO score, have shown poor performance in external validations, failing to identify many high-risk individuals. Some of the newly developed and updated models may be promising, but their further validation is needed.

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