Extended anticoagulation treatment for cancer‐associated thrombosis ‐ rates of recurrence and bleeding beyond 6 months: A systematic review

Abstract Abstract 1097 Background: In patients with cancer and acute venous thromboembolism (VTE), current consensus guidelines recommend anticoagulation therapy for an indefinite duration or until the cancer is resolved. Methods and results: Among 1’247 patients with acute VTE enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER) from 18 hospitals, 315 (25%) had cancer of whom 179 (57%) had metastatic disease, 159 (50%) ongoing or recent chemotherapy, and 83 (26%) tumor surgery within 6 months. Patients with cancer were older (66±14 vs. 60±19 years, p<0.001), more often hospitalized at the time of VTE diagnosis (46% vs. 36%, p=0.001), immobile for >3 days (25% vs. 16%, p<0.001), and more often had thrombocytopenia (6% vs. 1%, p<0.001) than patients without cancer. The 30-day rate of VTE-related death or recurrent VTE was 9% in cancer patients vs. 4% in patients without cancer (p<0.001), and the rates of bleeding requiring medical attention were 5% in both groups (p=0.57). Cancer patients received indefinite-duration anticoagulation treatment more often than patients without cancer (47% vs. 19%, p<0.001), and LMWH mono-therapy during the initial 3 months was prescribed to 45% vs. 8%, p<0.001, respectively. Among patients with cancer, prior VTE (OR 4.0, 95%CI 2.0–8.0), metastatic disease (OR 3.0, 95%CI 1.7–5.2), outpatient status at the time of VTE diagnosis (OR 3.8, 95%CI 1.9–7.6), and inpatient treatment (OR 4.4, 95%CI 2.1–9.2) were independently associated with the prescription of indefinite-duration anticoagulation treatment. Conclusions: Less than half of the cancer patients with acute VTE received a prescription for indefinite-duration anticoagulation treatment. Recurrent VTE, metastatic cancer, outpatient VTE diagnosis, and VTE requiring hospitalization were associated with an increased use of this strategy. Disclosures: Spirk: sanofi-aventis (suisse) sa: Employment.

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Direct oral anticoagulant (DOAC) versus low-molecular-weight heparin (LMWH) for treatment of cancer associated thrombosis (CAT): A systematic review and meta-analysis

Thrombosis Research ◽

10.1016/j.thromres.2018.02.144 ◽

2019 ◽

Vol 173 ◽

pp. 158-163 ◽

Cited By ~ 94

Author(s):

Ang Li ◽

David A. Garcia ◽

Gary H. Lyman ◽

Marc Carrier

Keyword(s):

Systematic Review ◽

Molecular Weight ◽

Oral Anticoagulant ◽

Low Molecular Weight Heparin ◽

Meta Analysis ◽

Low Molecular Weight ◽

Direct Oral Anticoagulant ◽

Cancer Associated Thrombosis

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Efficacy and Safety of Direct Oral Anticoagulants for Secondary Prevention of Cancer-Associated Thrombosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies

Frontiers in Pharmacology ◽

10.3389/fphar.2019.00773 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 3

Author(s):

Yunsong Wang ◽

Haichen Lv ◽

Daobo Li ◽

Cheng Chen ◽

Guangming Gu ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Controlled Trials ◽

Efficacy And Safety ◽

Prospective Cohort Studies ◽

Randomized Controlled ◽

Prevention Of Cancer ◽

Cancer Associated Thrombosis

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The efficacy and safety of DOACs versus LMWH for cancer‐associated thrombosis: A systematic review and meta‐analysis

European Journal Of Haematology ◽

10.1111/ejh.13453 ◽

2020 ◽

Vol 105 (3) ◽

pp. 360-362 ◽

Cited By ~ 2

Author(s):

Derrick L. Tao ◽

Sven R. Olson ◽

Thomas G. DeLoughery ◽

Joseph J. Shatzel

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Efficacy And Safety ◽

Cancer Associated Thrombosis

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Contralateral deep vein thrombosis after stenting across the iliocaval confluence in chronic venous disease – A systematic review

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519889873 ◽

2019 ◽

Vol 35 (4) ◽

pp. 221-230 ◽

Cited By ~ 1

Author(s):

Luis Duarte-Gamas ◽

João P Rocha-Neves ◽

António Pereira-Neves ◽

Marina Dias-Neto ◽

Niels Baekgaard

Keyword(s):

Systematic Review ◽

Deep Vein Thrombosis ◽

Iliac Vein ◽

Venous Disease ◽

Antithrombotic Treatment ◽

Vein Thrombosis ◽

Anticoagulation Treatment ◽

Post Thrombotic Syndrome ◽

Deep Vein

Objective Stenting of the iliac veins is increasingly considered in the presence of symptomatic obstructive chronic lesions in the iliac vein segment. However, it is often necessary to extend the stented zone into the inferior vena cava, increasing the risk of contralateral iliac vein thrombosis. This study aims to review the current literature concerning the incidence of contralateral deep vein thrombosis after stenting across the iliocaval confluence. Methods A systematic review from potentially relevant published articles reporting contralateral deep vein thrombosis after iliac venous stenting between January 2007 and February 2019 was performed. Results A total of 764 references were retrieved initially. Twelve studies reporting events of contralateral deep vein thrombosis were selected for review, with a total of 1864 patients. Contralateral deep vein thrombosis incidence varied between 0% and 15.6%. The post-interventional and follow-up anticoagulation regimens were heterogeneous between studies. The decision to maintain patients on anticoagulation and the duration of treatment was based on the presence of comorbidities, hypercoagulable states, post-thrombotic syndrome and history of recurrent deep vein thrombosis. Patients with non-thrombotic iliac vein lesions were either anticoagulated for three or six months after stenting or received no anticoagulation. Patients with post-thrombotic syndrome were anticoagulated for longer periods. Most studies (eight studies) used an oral vitamin K antagonist agent. The data on compliance with anticoagulation treatment is scarce and few references present data on whether contralateral deep vein thrombosis occurred during anticoagulation treatment. The use of antiplatelet agents in addition to the anticoagulant treatment in the follow-up period was also variable. Conclusion The incidence of contralateral deep vein thrombosis due to iliac vein jailing is not negligible and reported being as high as 15.6%. Large-scale studies on the ideal antithrombotic treatment and its impact are necessary. It is possible that patients with stent crossing the iliocaval confluence might benefit from long-term antithrombotic treatment.

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