Venous thromboembolism syndrome in gynecological cancer

2006 ◽  
Vol 16 (Suppl 1) ◽  
pp. 458-471 ◽  
Author(s):  
X. Wang ◽  
S. Fu ◽  
R. S. Freedman ◽  
J. J. Kavanagh
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Gynecological Cancer ◽  
Coagulation Cascade ◽  
Coagulation System ◽  
Clinical Feature ◽  
Cancer Treatments ◽  
Human Erythropoietin ◽  
Promising Area

Venous thromboembolism (VTE) could be presented as an initial clinical feature in some cancer patients or a complication followed by various cancer treatments, which all indicates a poor outcome. This review focuses on elucidating the relationship of VTE and the main gynecological cancers including ovarian, endometrial, and cervical cancers. First, the general VTE information about gynecological cancer are introduced; second, the risk factors of VTE developing in gynecological cancer were discussed; third, we do a retrospective analysis on a novel treatment targeting coagulation cascade; and last, we analyze VTE as a remarkable complication followed by recombinant human erythropoietin and anti–vascular endothelial growth factor treatment in gynecological cancer patients. In summary, the interaction between the coagulation system and cancer progression is a novel promising area to be explored in the study of VTE in patients with gynecological cancer.

Statins and Venous Thromboembolism In Lung Cancer

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5122-5122
Author(s):  
Moh'd Khushman ◽  
Abdel-ghanie Abu-samra ◽  
Shatha Farhan ◽  
Gordon Jacobsen ◽  
Amr Hanbali ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Conflicts Of Interest ◽  
Statistical Significance ◽  
Lipid Lowering ◽  
Coagulation Cascade ◽  
Controlled Study ◽  
Increased Risk ◽  
Statin Use

Abstract Abstract 5122 Background: Dyslipidemia plays a major role in the pathophysiology of atherosclerosis which may also contributed to an increased risk of and thromboembolism from the injury of the vascular endothelium and its activation of platelets, thereafter, the coagulation cascade. It has been well-established that the use of statins in patients with dyslipidemia reduces cardiovascular events and mortality, therefore, improves survival. In addition to a cholesterol-lowering effect, statins exhibit antithrombotic and anti-inflammatory properties that may confer a protective benefit to an increased risk of thromboembolism in cancer patients. Several case-controlled studies reported that cancer patients receiving long-term statins, but not other non-statin lipid lowering treatment, had a lower incidence of venous thromboembolism. Methods: To investigate any protective benefit from statin use in lung cancer patients, we have conducted this retrospective, case-controlled study. Total of 1548 patients with lung cancer were included from the tumor registery at Henry Ford Health System, Detroit, Michigan, between January 1999 and December 2004. The data were extracted from available electronic medical records of these patients. Statistical analyses were performed and stratified for statin users versus non statin users. Results: Out of 1,548 patients, 315 patients (average age was 68, range 46–90) were statin users at the time of their lung cancer diagnosis. The remaining 1233 patients (average age was 65.9, range 29–94) were non- statin users. After stratifying for statin use, 25 of the 315 statin users developed DVT/PE (7.9%), while 100 of the 1233 non-statin users developed DVT/PE (8.1%). This potential benefit from statin use can also be better visualized from comparing the development of DVT/PE between the statin and non-statin groups in a Kaplan-Meier curve for the probability of freedom from DVT/PE across time. Though statistical significance was not reached (log-rank p-value = 0.377), a trend towards a slightly decreased incidence of DVT/PE onset in the patients who receiving statin as the lipid-lowering agent has been observed. Conclusion: Based on our preliminary data, statin use in patients with lung cancer has demonstrated a weak but favorable protective effect on the development of a venous thromboembolism. The nature as a retrospective study and not well-balanced two group of patients (e.g., the average age of statin users were 2 years older than the non-statin users) may limit our results from reaching statistical significance. In addition, some of the patients who had no clear documentation of their home medications had also been categorized as non-statin users in our study. The results from our final data analysis will be presented. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Decreased platelet reactivity in patients with cancer is associated with high risk of venous thromboembolism and poor prognosis

2017 ◽  
Vol 117 (01) ◽  
pp. 90-98 ◽  
Author(s):  
Julia Riedl ◽  
Alexandra Kaider ◽  
Christine Marosi ◽  
Gerald W. Prager ◽  
Beate Eichelberger ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Poor Prognosis ◽  
Ex Vivo ◽  
Platelet Reactivity ◽  
Platelet Response ◽  
Platelet Surface ◽  
Risk Of Death

SummaryPlatelets are suggested to play a crucial role in cancer progression and the prothrombotic state of cancer patients. Here, we aimed to examine the activation status of platelets in cancer patients and investigate their association with risk of death and occurrence of venous thromboembolism (VTE) in a prospective observational cohort study. We measured platelet surface P-selectin, activated glycoprotein (GP) IIb/IIIa and monocyte-platelet aggregate (MPA) formation in vivo and platelet response to ex vivo stimulation with agonists of protease-activated receptor (PAR) −1, −4, and GPVI, by whole blood flow cytometry, before beginning of chemotherapy and repeatedly during the first six months thereafter (total number of samples analysed: 230). Endpoints of the study were occurrence of death or VTE during a two-year follow-up, respectively. Of 62 patients (median age [interquartile range, IQR]: 63 [54–70] years, 48 % female), 32 (51.6 %) died and nine (14.5 %) developed VTE. Association with a higher risk of death was found for lower platelet surface expression of P-selectin and activated GPIIb/IIIa in vivo and in response to PAR-1, −4 and GPVI activation, but not for MPA formation. Furthermore, reduced platelet responsiveness to PAR-1 and GPVI agonists was associated with higher risk of VTE (hazard ratio per decile increase of percentage P-selectin positive platelets: 0.73 [0.56–0.92, p=0.007] and 0.77 [0.59–0.98, p=0.034], respectively). In conclusion, cancer patients with a poor prognosis showed decreased platelet reactivity, presumably as a consequence of continuous activation. Our data suggest that decreased platelet reactivity is associated with increased mortality and VTE in cancer.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals Prevention and treatment of venous thromboembolism in cancer patients: project of clinical guidelines

2020 ◽  
Vol 27 (3) ◽  
pp. 75-88
Author(s):  
S. M. Kozhukhov ◽  
N. V. Dovganich ◽  
I. I. Smolanka ◽  
I. A. Kryachok ◽  
O. F. Ligirda
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Bleeding Risk ◽  
Treatment Modalities ◽  
Bleeding Events ◽  
Related Factors ◽  
Management Algorithm ◽  
Cancer Associated Thrombosis ◽  
Active Cancer

Cancer-associated thrombosis is an actual issue in the intersection of cardiology and oncology. Active cancer counts for approximately 20 % of the total number of cases of venous thromboembolism (VTE), and VTE is one of the leading cause of death in cancer patients, second only to cancer progression. VTE in cancer has some features that distinguish it from other VTE cases. The combination of cancer-related, treatment-related and patient-related factors increases their overall risk of VTE. The experts of the Cardio-Oncology working group have created a practical approach guideline for the management of VTE in cancer patients based on a multi-disciplinary strategy, ESMO, ASCO recommendations. This document has collected information on VTE, bleeding events and treatment modalities in cancer patients that may be beneficial for clinicians in determining strategies of anticoagulant therapies in these patients. Clinicians of various specialties using these recommendations will be able to determine the most appropriate VTE management algorithm, taking into account the bleeding risk, the type of cancer with its treatment, and drug interactions.

Abstract 13145: Differences of Cancer Types in Hospital Mortality in Patients With Venous Thromboembolism

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Okushi Yuichiro ◽  
Kenya Kusunose ◽  
Takayuki Ise ◽  
Takeshi Tobiume ◽  
Koji Yamaguchi ◽  
...  
Keyword(s):  
Big Data ◽  
Venous Thromboembolism ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Biliary Tract ◽  
Gynecological Cancer ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Liver Cancers ◽  
Cancer Types

Introduction: We sought to evaluate the clinical characteristics and outcomes of patients with cancer-associated VTE, compared with the matched cohort without cancer using real-world big data of VTE. Background: Cancer is associated with a high incidence of Venous Thromboembolism (VTE) and there are many guidelines/recommendations about VTE. However, the prognosis of cancer-VTE patients is not well known because of a lack of big data. Moreover, there is also no knowledge on how cancer type is related to prognosis. Methods: This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). We identified 28,247 patients who were first hospitalized with VTE from April 2012 to March 2017. 26.0% were cancer patients. Compared with national statistics of cancer incidence in 2015 from National Cancer Center of Japan, the proportion of gynecological cancer patients was higher, but other cancer types had similar prevalence rates. Propensity score (PS) was estimated with logistic regression model, with cancer as the dependent variable and 18 clinically relevant covariates. Results: We included 24,576 patients after exclusion. The median age was 71years (range: 59-80 years), and 42.0% were male. On PS-matched analysis with 12,418 patients, patients with cancer had higher total in-hospital mortality (9.5% vs. 3.8%, P<0.001; OR, 2.72, 95% CI: 2.33-3.19) and in-hospital mortality within 30days (6.8% vs. 3.2%, P<0.001; OR, 2.20, 95% CI: 1.85-2.62). On analysis for each type of cancer, in-hospital mortality in 10 types of cancer was significantly high, especially pancreas (OR: 9.65, 95%CI: 4.31-21.64), biliary tract (OR: 8.36, 95%CI: 2.42-28.89) and liver (OR: 7.33, 95%CI: 1.92-28.02). Conclusions: Patients with cancer had a higher in-hospital mortality for VTE than those without cancer, especially in pancreatic, biliary tract and liver cancers.

scholarly journals Clinical Course of Cancer Patients with COVID-19: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Naomi Alpert ◽  
Joseph L Rapp ◽  
Bridget Marcellino ◽  
Wil Lieberman-Cribbin ◽  
Raja Flores ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Cancer Treatments ◽  
Patients With Cancer ◽  
Significant Difference

Abstract Background Complications in cancer patients with COVID-19 have not been examined. This analysis aimed to compare characteristics of COVID-19 patients with and without cancer, and assess whether cancer is associated with COVID-19 morbidity or mortality. Methods COVID-19 positive patients with an inpatient or emergency encounter at the Mount Sinai Health System between March 1, 2020 and May 27, 2020 were included, and compared across cancer status on demographics and clinical characteristics. Multivariable logistic regressions were used to model the associations of cancer with sepsis, venous thromboembolism, acute kidney injury, intensive care unit admission, and all-cause mortality. Results There were 5,556 COVID-19 positive patients included; 421 (7.6%) with cancer (325 solid, 96 non-solid). Those with cancer were statistically significantly older, more likely to be non-Hispanic Black and to be admitted to the hospital during their encounter, and had more comorbidities than non-cancer COVID-19 patients. Cancer patients were statistically significantly more likely to develop sepsis (adjusted odds ratio [ORadj]=1.31, 95% confidence interval [CI]=1.06-1.61) and venous thromboembolism (ORadj=1.77, 95% CI = 1.01-3.09); there was no statistically significant difference in acute kidney injury (ORadj=1.10, 95% CI = 0.87-1.39), intensive care unit admissions (ORadj=1.04, 95% CI = 0.80-1.34), or mortality (ORadj=1.02, 95% CI = 0.81-1.29). Conclusions COVID-19 patients with cancer may have a higher risk for adverse outcomes. Although there was no statistically significant difference in mortality, COVID-19 patients with cancer have significantly higher risk of thromboembolism and sepsis. Further research is warranted into the potential effects of cancer treatments on inflammatory and immune responses to COVID-19, and on the efficacy of anticoagulant therapy in these patients.

The Association between Tissue Factor-Exposing Microparticles and the Activation of the Coagulation System in Cancer Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2589-2589 ◽  
Author(s):  
Ansgar Weltermann ◽  
Gregor Hron ◽  
Marietta Kollars ◽  
Gabriela Kornek ◽  
Peter Quehenberger ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Tissue Factor ◽  
Annexin V ◽  
Coagulation System ◽  
Related Factors ◽  
Cellular Origin ◽  
Cellular Expression ◽  
D Dimer

Abstract Background: Malignancy is a major risk factor of venous thromboembolism. In addition to circumstantial factors such as chemotherapy, the pathogenesis of thrombosis in cancer patients is directly influenced by tumor related factors. In this respect, the expression of tissue factor (TF) on tumor cells is considered to play an important role. Besides its cellular expression, more recent studies focused on TF exposure on circulating microparticles. The role of these TF exposing microparticles with regard to the pathogenesis of VTE in cancer patients, however, has not yet been investigated. We therefore conducted a prospective case control study in order to determine (a) the number and cellular origin of TF exposing microparticles in cancer patients and (b) the association between these microparticles and the activation of the coagulation system. Materials and Methods: A total of 20 patients with advanced colorectal cancer (Dukes D) and 20 healthy, age- and sex-matched controls were included. Microparticles were isolated from plasma, stained with annexin V, cell-specific antibodies and analysed by flow cytometry. The activation of the coagulation system was measured by D-dimer (ELISA). Results: Compared to the controls, the total number of TF exposing microparticles was significantly higher in the patient group (32.5 ± 23.9 vs. 18.1 ± 10.0 k/ml plasma, p = 0.007). These finding was due to a higher number of TF exposing microparticles originating from thrombocytes (12.9 ± 7.9 vs. 6.5 ± 2.9 k/ml plasma, p = 0.017) and from monocytes (9.1 ± 6.5 vs. 5.5 ± 1.4 k/ml plasma, p = 0.11) in cancer patients. Likewise, D-Dimer levels were higher among cancer patients as compared to the controls (1.61 ± 1.58 vs. 0.40 ± 0.36 μg/ml, p = 0.001). The number of TF exposing microparticles correlated with D-dimer (r = 0.67, p &lt; 0.001). Conclusion: Both the significant elevation of TF exposing microparticles in the circulation of cancer patients and the association between these microparticles and the activation of the coagulation system suggest a potential role of TF exposing microparticles in the pathogenesis of venous thromboembolism in cancer patients.

Abnormalities in cancer patients' coagulation system.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e22207-e22207
Author(s):  
Hector Alirio Gonzalez Florez ◽  
M. Rojas ◽  
J. Quiroz ◽  
Y. Mancera
Keyword(s):  
Cancer Patients ◽  
Protein C ◽  
Antithrombin Iii ◽  
Clinical Stage ◽  
Metastatic Carcinoma ◽  
Coagulation Cascade ◽  
Coagulation System ◽  
Control Group ◽  
Prophylactic Measures ◽  
Anticoagulant System

e22207 Background: It is well known cancer patients may present both hemorrhagic and thrombotic abnormalities and these phenomena are difficult to diagnose and treat. Thrombotic phenomena are developed clinicly in 15% in cancer patients and it’s higher in adenocarcinomas and myeloprolipherative disorders. These complications can be the consequence of coagulations factor direct activation or chronic DIC, because of the acquired capacity of neoplastic cells for starting coagulation cascade. Methods: In this study an untreated cancer patients group were compared with another healthy controls group, older than 14 years. Patients before treatment and controls were laboratory tested. A t – test for independent samples was employed. Results: Number: patients group: 66, control group: 73. Median age: patients: 50 (17-78). Controls: 52 (18 -93). Sex: Patients: men: 35%, women: 65%. Controls: men: 52%, women: 48%. Malignancies: breast cancer 9.7%; gastric carcinoma 8.1%; cervical carcinoma 6.5%; NH lymphomas 6.5%, unknown origen metastatic carcinoma 4.8%; oral carcinoma 4.8%. Clinical stages: I: 6.3%; II: 6.3%; III: 22.9%; IV: 62.5% (metastatic) 47.9%. Thrombotic antecedents in patients group: 19.7%. There were significant differences in: Platelets count: patients: 281121, controls: 307745 (p<0.001). Protein C: 0.87 and 3.81 UI/mL, respectively (p < 0.001). Antithrombin III: 97 and 101% (p<0.001). Plasminogen: 92.9 and 101.1% (p < 0.001). Lupus anticoagulant (RVV time): 27 and 25.6” (p<0.001). There were no significant differences in PT: 18.3 and 16.9” and PTT: 31 and 34”. The same significant differences were got when the patients of every clinical stage were compared with control patients. There were no differences when the patients of every clinical stage were compared among themselves, nor between sex. Conclusions: This study shows cancer patients may have many coagulation abnormalities: anticoagulant system defects and fibrinolytic system hipoactivity, demonstrated by the significant differences found in antithrombin III, protein C and plasminogen levels between patients and controls groups. It is suggested to practice these tests to cancer patients, even without clinical coagulation disorders, to stablish prophylactic measures.

Treatment and secondary prevention of venous thromboembolism in cancer patients

2012 ◽  
Vol 03 (03) ◽  
pp. 121-125
Author(s):  
I. Pabinger ◽  
C. Ay
Keyword(s):  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
New Oral Anticoagulants ◽  
Phase Iii ◽  
Patients With Cancer ◽  
Potential Use

SummaryCancer is a major and independent risk factor of venous thromboembolism (VTE). In clinical practice, a high number of VTE events occurs in patients with cancer, and treatment of cancerassociated VTE differs in several aspects from treatment of VTE in the general population. However, treatment in cancer patients remains a major challenge, as the risk of recurrence of VTE as well as the risk of major bleeding during anticoagulation is substantially higher in patients with cancer than in those without cancer. In several clinical trials, different anticoagulants and regimens have been investigated for treatment of acute VTE and secondary prophylaxis in cancer patients to prevent recurrence. Based on the results of these trials, anticoagulant therapy with low-molecular-weight heparins (LMWH) has become the treatment of choice in cancer patients with acute VTE in the initial period and for extended and long-term anticoagulation for 3-6 months. New oral anticoagulants directly inhibiting thrombin or factor Xa, have been developed in the past decade and studied in large phase III clinical trials. Results from currently completed trials are promising and indicate their potential use for treatment of VTE. However, the role of the new oral thrombin and factor Xa inhibitors for VTE treatment in cancer patients still has to be clarified in further studies specifically focusing on cancer-associated VTE. This brief review will summarize the current strategies of initial and long-term VTE treatment in patients with cancer and discuss the potential use of the new oral anticoagulants.

Premature Arterial Disease Associated with Familial Antithrombin III Deficiency

1990 ◽  
Vol 63 (01) ◽  
pp. 013-015 ◽  
Author(s):  
E J Johnson ◽  
C R M Prentice ◽  
L A Parapia
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Potential Risk ◽  
Antithrombin Iii ◽  
Arterial Disease ◽  
Coagulation System ◽  
Early Age ◽  
Arterial Thromboembolism ◽  
Potential Risk Factors ◽  
Antithrombin Iii Deficiency

SummaryAntithrombin III (ATIII) deficiency is one of the few known abnormalities of the coagulation system known to predispose to venous thromboembolism but its relation to arterial disease is not established. We describe two related patients with this disorder, both of whom suffered arterial thrombotic events, at an early age. Both patients had other potential risk factors, though these would normally be considered unlikely to lead to such catastrophic events at such an age. Thrombosis due to ATIII deficiency is potentially preventable, and this diagnosis should be sought more frequently in patients with arterial thromboembolism, particularly if occurring at a young age. In addition, in patients with known ATIII deficiency, other risk factors for arterial disease should be eliminated, if possible. In particular, these patients should be counselled against smoking.

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