Hypercoagulabilty, venous thromboembolism, and death in patients with cancer

2016 ◽  
Vol 115 (04) ◽  
pp. 817-826 ◽  
Author(s):  
Florian Posch ◽  
Julia Riedl ◽  
Eva-Maria Reitter ◽  
Alexandra Kaider ◽  
Christoph Zielinski ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Independent Risk Factor ◽  
Fold Increase ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
One Year ◽  
After Cancer ◽  
D Dimer

SummaryVenous thromboembolism (VTE) is a frequent complication of malignancy. The aim of this study was to investigate whether multi-state modelling may be a useful quantitative approach to dissect the complex epidemiological relationship between hypercoagulability, VTE, and death in cancer patients. We implemented a three-state/three-transition unidirectional illness-death model of cancer-associated VTE in data of 1,685 cancer patients included in a prospective cohort study, the Vienna Cancer and Thrombosis Study (CATS). During the two-year follow-up period, 145 (8.6%) patients developed VTE, 79 (54.5%) died after developing VTE, and 647 (38.4%) died without developing VTE, respectively. VTE events during follow-up were associated with a three-fold increase in the risk of death (Transition Hazard ratio (HR)=2.98, 95% confidence interval [CI]: 2.36-3.77, p< 0.001). This observation was independent of cancer stage. VTE events that occurred later during follow-up exerted a stronger impact on the risk of death than VTE events that occurred at earlier time points (HR for VTE occurrence one year after baseline vs at baseline=2.30, 95% CI: 1.28-4.15, p=0.005). Elevated baseline D-dimer levels emerged as a VTE-independent risk factor for mortality (HR=1.07, 95% CI: 1.05-1.08, p< 0.001), and also predicted mortality risk in patients who developed VTE. A higher Khorana Score predicted both the risk for VTE and death, but did not predict mortality after cancer-associated VTE. In conclusion, multi-state modeling represents a very potent approach to time-to-VTE cohort data in the cancer population, and should be used for both observational and interventional studies on cancer-associated VTE.

scholarly journals Incidence, Characteristics and Outcomes of Patients with Cancer-Associated Venous Thromboembolism: A Retrospective Matched-Pair Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2516-2516
Author(s):  
Piyanuch Kongtim ◽  
Dhosaporn Charoenjit ◽  
Supawee Saengboon ◽  
Hataiwan Ratanabunjerdkul
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Cumulative Incidence ◽  
Hematologic Malignancies ◽  
Matched Pair ◽  
Advanced Stage ◽  
Vein Thrombosis ◽  
Patients With Cancer

Abstract Introduction Cancer and its treatments are well-recognized risk factors for the development of venous thromboembolism (VTE). The occurrence of VTE has been associated with an increased mortality in patients with cancer. Here we retrospectively reviewed the incidence and characteristics of cancer-associated thrombosis (CAT) in a large cohort of cancer patients treated at our institution as well as compared treatment outcomes of this group of patients with a 1:1 matched pair group of cancer patients without CAT. Methods Data of consecutive patients, 18 years of age or older, with a newly diagnosis of both hematologic malignancies or solid tumors who diagnosed and treated either as an inpatient or outpatient setting at our institution between 2011 to 2015 were included in this analysis. Patients who received anticoagulants for the purpose of either prophylaxis or treatment within 2 weeks before cancer diagnosis and who did not have a histologically confirmed a cancer diagnosis or complete follow up data were excluded from the study. To compare the outcomes of cancer patients with and without CAT, cancer patients who did not experience CAT were randomly selected from the same database and were matched individually (1:1) to cancer patients with CAT based on age, sex, cancer type and stage (limited or advanced) to form a matched cohort of patients as control. Primary outcome was cumulative incidence of CAT at 6 months and 1 year after cancer diagnosis, while incidence of recurrent VTE, major and minor bleeding, relapse, non-relapse mortality (NRM), overall survival (OS) and progression-free survival (PFS) were analyzed as secondary outcomes. CAT was defined as at least 1 site of venous thrombosis confirmed by imaging results, which occurred anytime after the initial diagnosis, during the treatment or follow-up. Results Total 2,291 newly diagnosed cancer patients (633 patients with hematologic malignancies and 1,658 patients with solid cancers) with a median age of 58 years (range 18-93 years) were included in the analysis. CAT was developed in 83 patients (52 females and 31 males) with a median age of 61 year (range 20-85 years). The cumulative incidence of CAT at 6 months and 1 year was 2.7% and 3.4%, respectively. The median time from cancer diagnosis to the diagnosis of CAT was 3.2 months (range 1- 62 months). Sites of VTE were deep vein thrombosis in extremities (N=46; 55.4%), pulmonary embolism (N=6; 7.2%), splanchnic vein thrombosis (N=9; 10.8%) and cerebral venous sinus thrombosis (N=5, 6%). Seventeen patients (20%) developed more than 1 site of VTE. Sixty-nine (83%) cases with CAT were diagnosed in patients with hematologic malignancies including 35, 22 and 12 cases with lymphoma, acute leukemia and myeloproliferative neoplasms, respectively. Overall the incidence was 10.9% in hematologic malignancies and 0.8% in solid tumors. The majority of the CAT cases occurred in advanced stage cancers (66 patients; 79.5%) while 13 cases (15.7%) were diagnosed during ambulatory chemotherapy treatment. None of the patients with CAT received prophylaxis anticoagulant during cancer treatment or follow up period. Characteristics of patients with CAT are summarized in Table 1. Of 83 patients with CAT, 66 patients were treated with anticoagulants, while inferior vena cava filter was used in 8 patients (9.6%). The cumulative incidence of total bleeding events at 1 year was 21.1% whereas cumulative incidence of major bleeding was 6.8%. The cumulative incidence of recurrent thrombosis at 1 year was 8.3%. Cancer patients who developed CAT had both a significantly higher NRM (26.2% vs. 13% at 1 year, p=0.004) (Figure 1A) and relapse rate (63.3% vs. 43.5% at 5 years, p=0.002) (Figure 1B) when compared with control group, which resulted in a significantly lower 5-year OS (24.9% vs. 62.7%; p<0.0001) (Figure 1C) and PFS (16.9% vs. 46%; p<0.0001) (Figure 1D). Advanced stage cancer and development of CAT were associated with poor OS in a multivariable analysis with HR of 6.9 (95%CI 2.7-17.7) and 3.9 (95%CI 2.2-7.0), respectively. Both factors also independently predicted risk of relapse with HR of 4.6 (95%CI 1.8-11.6, p=0.001) and 3.4 (95%CI 1.7-6.8, p<0.0001), respectively. Conclusions Development of CAT is associated with an increased NRM, relapse rate and poor survival in patients with cancer. Effective strategies to prevent CAT especially in high-risk cancer patients are needed to help improve outcomes. Disclosures No relevant conflicts of interest to declare.

scholarly journals Frequency of Arterial Thromboemobolic Events in Patients with Cancer Associated Venous Thromboembolism

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 37-37
Author(s):  
Doaa Attia ◽  
Xuefei Jia ◽  
Mailey L Wilks ◽  
Barbara Tripp ◽  
Christopher D'Andrea ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cumulative Incidence ◽  
Arterial Thrombosis ◽  
Research Funding ◽  
Patients With Cancer ◽  
Peripheral Arterial

Background:Patients with cancer are at high risk of both venous thromboembolism (VTE) and arterial events, however, little is known about the association between venous and arterial thromboembolic events in patients with cancer. In this study, we evaluated the incidence and relative risk of subsequent arterial thromboembolism in patients with a confirmed diagnosis of acute cancer-associated VTE. Methods:We conducted a retrospective cohort study at the Cleveland Clinic Taussig Cancer Institute of cancer patients with confirmed VTE who were referred to a centralized thrombosis clinic between January 2017-October 2019 with at least 6 months of follow-up. Arterial thrombotic events (ATE), including myocardial infarction, peripheral arterial thrombosis, and ischemic stroke, were identified by manual review of electronic medical records. The cumulative incidence rate of each ATE event was calculated. Results:The study population comprised 294 patients with a median age of (63.5) years (range 27-90), and 49.7 % were male. The cumulative incidence rate of overall ATE during the 6-month, 1-year, and 2-year follow-up period was 3.07%, 3.42%, and 3.42%, respectively. A total of 10 patients who experienced arterial events of whom 7 had ischemic stroke, 2 had myocardial infarction, 2 had peripheral arterial thrombosis where one patient had two arterial events of myocardial infarction and peripheral arterial thrombosis(Table 1 shows the incidence rates of arterial events). Amongst patients with ATE, 30 % were active smokers (n=3), 90% had hypertension (n=9), 20% had diabetes mellitus (n=2), 50% had a family history of coronary artery disease (n=5), 40% were on statin and daily aspirin use (n=4), 40% were obese with BMI &gt;30 (n=4). 40% of ATE patients(n=4) were on a therapeutic anticoagulant therapy at the time of arterial thrombotic event (3 on enoxaparin, 1 on apixaban) Conclusion:Cancer patients with acute VTE have a substantial increased risk of subsequent arterial thromboembolism particularly in the first six months after VTE. Ischemic stroke was the most frequent arterial event and ATE events occured despite therapeutic anticoagulation in a large subset of our cohort. Further prospective studies are needed to better understand the risk of ATE in cancer patients, and further studies should be designed to mitigate the risk of arterial events in this patient population. Disclosures McCrae: Momenta Pharmaceuticals:Consultancy;Novartis:Honoraria;Rigel:Consultancy;Dova:Consultancy.Khorana:Pharmacyclics:Honoraria;Pharmacyte:Honoraria;Seattle Genetics:Honoraria;Leo Pharma:Honoraria;Medscape:Honoraria;Sanofi:Honoraria;Pfizer:Honoraria;Bayer:Honoraria;Janssen:Honoraria;Array:Other: Research funding (to institution);Merck:Research Funding;BMS:Honoraria, Research Funding;Leap:Research Funding.

Failure of the Ottawa Score to Predict the Risk of Recurrent Venous Thromboembolism in Cancer Patients: The Prospective PREDICARE Cohort Study

2021 ◽  
Author(s):  
Philippe Girard ◽  
Silvy LAPORTE ◽  
Céline Chapelle ◽  
Nicolas Falvo ◽  
Lionel Falchero ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Patients ◽  
Risk Groups ◽  
Therapeutic Implications ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
C Statistic ◽  
Recurrent Venous Thromboembolism ◽  
Recurrent Vte

Introduction: Recurrent venous thromboembolism (VTE) despite curative anticoagulation is frequent in patients with cancer. Identifying patients with a high risk of recurrence could have therapeutic implications. A prospective study was designed to validate the Ottawa risk score of recurrent VTE in cancer patients. Methods: In a prospective multicenter observational cohort, adult cancer patients with a recent diagnosis of symptomatic or incidental lower limb deep vein thrombosis or pulmonary embolism were treated with tinzaparin for 6 months. The primary endpoint was the recurrence of symptomatic or asymptomatic VTE within the first 6 months of treatment. All clinical events were centrally reviewed and adjudicated. Time-to-event outcomes were estimated by the Kalbfleisch and Prentice method to take into account the competing risk of death. A C-statistic value >0.70 was needed to validate the Ottawa score. Results: A total of 409 patients were included and analyzed on an intention-to-treat basis. Median age was 68 years, 60.4% of patients had PE, VTE was symptomatic in 271 patients (66.3%). The main primary sites were lung (31.3%), digestive tract (18.3%) and breast (13.9%) cancers. The Ottawa score was high (≥1) in 58% of patients. The 6-month cumulative incidence of recurrent VTE was 7.3% (95% confidence interval [CI]: 4.9-11.1) overall, and 5.0% (95%CI: 2.3-10.8) vs 9.1% (95%CI: 6.1-13.6) in the Ottawa low vs high risk groups, respectively. The C-statistic value was 0.60 (95%CI: 0.55-0.65). Conclusion: In this prospective cohort of patients with cancer receiving tinzaparin for VTE, the Ottawa score failed to accurately predict recurrent VTE.

scholarly journals Identification of Patients with Unprovoked Venous Thromboembolism and a Low Risk of Recurrence Estimated By the Vienna Prediction Model: A Prospective Cohort Management Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 775-775
Author(s):  
Sabine Eichinger ◽  
Lisbeth Eischer ◽  
Hana Šinkovec ◽  
Paul Gressenberger ◽  
Thomas Gary ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Prospective Cohort ◽  
Cumulative Risk ◽  
Recurrence Risk ◽  
Low Risk ◽  
Study Group ◽  
Risk Of Recurrence ◽  
One Year ◽  
D Dimer

Abstract Introduction: Patients with unprovoked venous thromboembolism (VTE) have a high recurrence risk, and, according to guidelines, should receive extended oral anticoagulation (OAC). OAC prevents recurrence in most patients but may cause major bleeding. Patients with a low recurrence risk could therefore benefit from limited OAC duration. The Vienna prediction model (VPM) estimates the recurrence risk of patients with a first unprovoked deep vein thrombosis (DVT) of the leg and/or pulmonary embolism (PE) based on the patient's sex, site of index VTE and D-Dimer measured after stopping OAC (Eichinger et al., Circulation 2010). In a prospective cohort management study, we evaluated whether the VPM can identify patients with an unprovoked VTE at low recurrence risk. Methods: The study was performed between January 2013 and May 2021 at two tertiary Austrian hospitals. Patients &gt;18 years with a first symptomatic DVT of the leg and/or symptomatic PE were eligible. The diagnosis of VTE was established by compression ultrasonography (CUS), spiral computed tomography, or lung scanning. We excluded patients with previous VTE, VTE provoked by a temporary risk factor including surgery, trauma, pregnancy, immobilisation, or female hormone intake, with cancer, OAC duration longer than 7 months or OAC for reasons other than VTE. OAC was discontinued 3 to 7 months after VTE diagnosis. D-Dimer was measured by a quantitative assay 3 weeks later and the probability of recurrence was estimated by the VPM. In patients with &lt;180 risk points (corresponding to a predicted one-year recurrence risk of &lt;4.4%), OAC was not resumed. CUS of both legs was performed at the time of discontinuation of OAC for reference baseline imaging in case of suspected recurrence. Patients were seen after 3, 12 and 24 months or at recurrence. Patients with a high recurrence risk (&gt;180 VPM risk points) were excluded and their management was left to the discretion of their local practitioner. The main outcome measure was independently adjudicated recurrence of symptomatic DVT of the leg and/or symptomatic PE. The study was approved by the local ethics committees and all patients gave written informed consent. Statistical analysis: Baseline characteristics of patients were described by median and interquartile range (IQR) or by absolute frequency and percentage. The cumulative risk of recurrent VTE after discontinuation of OAC was estimated using the Kaplan-Meier method. Recurrence risk was also predicted with the VPM for each patient, and predictions were averaged over the study group. Results: Of 818 eligible patients, 520 (65%) had a risk score of &lt;180 points and were classified as being at low risk of recurrence. They were included in the study and did not resume OAC. Their median age was 52 (42-65) years, and 289 (56%) were men. 226 (43%) patients had PE, 206 (40%) proximal and 88 (17%) distal DVT as index VTE. Median duration of anticoagulation was 3.9 (3.3-5.7) months, and the median time of follow-up was 23.9 (23.8, 23.9) months. Ten (1.9%) patients were lost to follow-up.52 patients (of which 30 were male) had non-fatal recurrent VTE (5.8 events per 100 patient-years, 95% CI 4.4-7.7). 28 (54%) patients had PE, 17 (33%) proximal and 7 (13%) distal DVT at recurrence. The cumulative risk of recurrence at one and two years was 5.2% (95% CI 3.2-7.2) and 11.2% (95% CI 8.3-14), respectively (Figure 1). The corresponding predicted recurrence risk for the study group was 4% and 7%, respectively. Conclusion: The VPM identifies patients with unprovoked VTE at low risk of recurrence. Applying the VPM refines risk stratification which could facilitate treatment decisions on the duration of OAC for patients and physicians. The model was well calibrated at one year. The apparent underestimation of the recurrence risk at two years could be countered by recalibration. Figure 1 Figure 1. Disclosures Eichinger: Takeda: Speakers Bureau; Daiichi-Sankyo: Speakers Bureau; BMS: Speakers Bureau; Bayer: Speakers Bureau; Pfizer: Speakers Bureau; Boehringer-Ingelheim: Speakers Bureau; CSL Behring: Speakers Bureau.

P5587Elevated D-dimer level after 1 month anticoagulant therapy as a predictor for adverse outcomes in patients with venous thromboembolism: 10-year follow-up results

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N M Vorobyeva ◽  
A B Dobrovolsky ◽  
E P Panchenko ◽  
E V Titaeva ◽  
M B Karabasheva ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Anticoagulant Therapy ◽  
Prognostic Value ◽  
Cox Regression ◽  
Fold Increase ◽  
Adverse Outcomes ◽  
Chi Square ◽  
D Dimer

Abstract Background Our previous study showed that elevated D-dimer (D-D) level after 1 month of the anticoagulant therapy was an independent predictor of deep vein thrombosis (DVT) recurrences and combined endpoint (DVT recurrence and/or death from any causes) during 18 months. Prognostic value of elevated D-D level after 1 month of the anticoagulant therapy for the long-term venous thromboembolism (VTE) outcomes is unknown. Purpose To estimate the elevated D-D level influence after 1 month of the anticoagulant therapy on the 10-year prognosis in VTE pts. Methods One hundred and twelve pts (77 men) aged 18–76 (mean 54±14) years with DVT and/or pulmonary embolism were included in the study. Pts received unfractionated or low molecular weight heparin for at least 5 days followed by the long-term warfarin therapy (target international normalized ratio 2,0–3,0). D-D level was measured after 1 month from the start of the anticoagulant therapy by a quantitative assay with an estimated cut-off level of 0,5 ug/ml. The follow-up period was 10 years. Endpoints were VTE recurrence and combined endpoint (VTE recurrence and/or death from any causes). Results In all pts, median of follow-up was 2,77 years (min 2 weeks, max 11,61 years, IQR 1,44 to 10,31 years). Seventy seven (69%) pts had ended the 10-year follow-up period completely or achieved the endpoint. In these pts, median of follow-up was 9,23 years (IQR 1,70 to 10,53 years). Thirty-five cases were censored. During 10 years, the VTE recurrences rate was 27,7%, 14 pts died, the combined endpoint rate was 36,6%. Kaplan-Meier analysis showed that pts with elevated D-D level after 1 month of the anticoagulant therapy had higher 10-year cumulative risk for adverse outcomes (chi-square=6,0, p=0,014 for VTE recurrence; chi-square=13,7, p<0,001 for combined endpoint). Cox regression confirmed that elevated D-D level after 1 month of the anticoagulant therapy was associated with a 2,5-fold increase in the 10-year VTE recurrences risk (HR 2,52; 95% CI 1,18–5,42; p=0,018) and a 3,2-fold increase in the 10-year combined endpoint risk (HR 3,21; 95% CI 1,68–6,15; p<0,001) compared pts with normal D-D level after 1 month of the anticoagulant therapy. Conclusions During 10 years, the VTE recurrences rate was 27,7%, combined endpoint rate (VTE recurrence and/or death from any causes) was 36,6%. Elevated (>0,5 ug/ml) D-D level after 1 month of the anticoagulant therapy had a prognostic value and was associated with the 2,5-fold increase in the 10-year VTE recurrences risk and the 3,2-fold increase in the 10-year adverse outcomes risk.

scholarly journals Red Cell Distribution Width and Other Red Blood Cell Parameters in Patients with Cancer: Association with Risk of Venous Thromboembolism and Mortality

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2859-2859 ◽  
Author(s):  
Julia Riedl ◽  
Florian Posch ◽  
Eva-Maria Reitter ◽  
Ernst Eigenbauer ◽  
Christine Marosi ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Red Cell Distribution Width ◽  
Study Cohort ◽  
Red Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Cumulative Survival ◽  
Patients With Cancer ◽  
One Year

Abstract Background: Cancer patients are at high risk of developing venous thromboembolism (VTE). However, the actual risk of VTE varies widely between individual patients and therefore in the past years several studies have focused on the identification of risk factors for cancer-associated VTE. Red cell distribution width (RDW) has been reported to be associated with arterial and venous thrombosis in non-cancer patients and with mortality in several diseases. RDW is a parameter of the complete blood count that describes the size variation of red blood cells (RBC). Here, we analyzed the association between RDW and other RBC parameters with risk of VTE and mortality in patients with cancer. Methods: RBC parameters (RDW, hematocrit, hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration) were measured in 1840 patients with cancers of the lung (=309), breast (n=273), brain (n=245), colon/rectum (n=182), prostate (n=157), pancreas (n=130), stomach (=63), kidney (n=42); lymphoma (n=260), multiple myeloma (n=49) and other tumor sites (n=130) that were included in the Vienna Cancer and Thrombosis Study (CATS). CATS is an ongoing prospective, observational cohort study of patients with newly diagnosed or progressive cancer after remission. Primary study outcome is occurrence of symptomatic VTE and secondary outcome is death during a maximum follow-up period of 2 years. Results: During a median follow-up of 706 days, 131 (7.1%) patients developed VTE and 702 (38.2%) died. High RDW (>16%) was not associated with a higher risk of VTE in the total study cohort; in competing risk analysis accounting for death as competing variable the univariable subhazard ratio (SHR) was 1.34 (95% confidence interval [CI]: 0.80-2.23, p=0.269). In patients with high RDW (>16%), the cumulative probability of VTE was 7.5% after 6 months, 8.7% after one year and 9.3% after two years in comparison to a probability of 5.0% after 6 months, 6.2% after one year and 7.2% after two years in those patients who had a lower RDW (Gray's test p=0.267; Figure 1). There was also no significant association between other RBC parameters and risk of VTE. In subgroup analysis of patients with solid tumors only, high RDW (>16%) was associated with an 80% increase in risk of VTE compared to lower RDW (SHR [95% CI]: 1.80 [0.99-3.26], p=0.053). However, in multivariable analyses adjusting for age, sex, hemoglobin, leukocyte and platelet count we did not observe a significant association between RDW and risk of VTE (SHR [95% CI]: 1.57 [0.81-3.04], p=0.182). High RDW was associated with an increased risk of mortality in the total study population (hazard ratio [HR, 95% CI]: 1.72 [1.39-2.12], p<0.001), and this association prevailed after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR [95% CI]: 1.34 [1.06-1.70], p=0.016). The cumulative probability of survival in patients with high RDW (>16%) was 78.5% after 6 months, 66.2% after one year and 41.3% after two years. In comparison, patients with non-elevated RDW levels had a cumulative survival probability of 88.7% after 6 months, 75.1% after one year and 66.2% after two years (Log-rank p<0.001; Figure 2). Conclusions: RDW and other RBC parameters were not independently associated with risk of VTE in patients with cancer and might therefore not be of added value for estimating risk of VTE in patients with cancer. We could confirm that high RDW is an independent predictor of poor overall survival in cancer. Figure 1. Cumulative incidence of venous thromboembolism (VTE), accounting for competing risk (death of any cause) in the total study cohort, grouped into patients with red cell distribution width (RDW) >16% and below, respectively. Figure 1. Cumulative incidence of venous thromboembolism (VTE), accounting for competing risk (death of any cause) in the total study cohort, grouped into patients with red cell distribution width (RDW) >16% and below, respectively. Figure 2. Kaplan-Meier estimates for cumulative survival probability of cancer patients (total study cohort) with red blood cell distribution width (RDW) >16% and below, respectively. Figure 2. Kaplan-Meier estimates for cumulative survival probability of cancer patients (total study cohort) with red blood cell distribution width (RDW) >16% and below, respectively. Disclosures No relevant conflicts of interest to declare.

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.

Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

2020 ◽  
Author(s):  
David Spirk ◽  
Tim Sebastian ◽  
Stefano Barco ◽  
Martin Banyai ◽  
Jürg H. Beer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Mortality Rate ◽  
Recurrence Rate ◽  
Anticoagulation Therapy ◽  
Early Mortality ◽  
Recurrence Rates ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Objective In patients with cancer-associated venous thromboembolism (VTE), the risk of recurrence is similar after incidental and symptomatic events. It is unknown whether the same applies to incidental VTE not associated with cancer. Methods and Results We compared baseline characteristics, anticoagulation therapy, all-cause mortality, and VTE recurrence rates at 90 days between patients with incidental (n = 131; 52% without cancer) and symptomatic (n = 1,931) VTE included in the SWIss Venous ThromboEmbolism Registry (SWIVTER). After incidental VTE, 114 (87%) patients received anticoagulation therapy for at least 3 months. The mortality rate was 9.2% after incidental and 8.4% after symptomatic VTE for hazard ratio (HR) 1.10 (95% confidence interval [CI] 0.49–2.50). After adjustment for competing risk of death, recurrence rate was 3.1 versus 2.8%, respectively, for sub-HR 1.07 (95% CI 0.39–2.93). These results were consistent among cancer (mortality: 15.9% vs. 12.6%; HR 1.32, 95% CI 0.67–2.59; recurrence: 4.8% vs. 4.7%; HR 1.02, 95% CI 0.30–3.42) and noncancer patients (mortality: 2.9% vs. 2.1%; HR 1.37, 95% CI 0.33–5.73; recurrence: 1.5% vs. 2.3%; HR 0.63, 95% CI 0.09–4.58). Patients with incidental VTE who received anticoagulation therapy for at least 3 months had lower mortality (4% vs. 41%) and recurrence rate (1% vs. 18%) compared with those who did not. Conclusion In SWIVTER, more than half of incidental VTE events occurred in noncancer patients who often received anticoagulation therapy. Among noncancer patients, early mortality and recurrence rates were similar after incidental versus symptomatic VTE. Our findings suggest that anticoagulation therapy for incidental VTE may be beneficial regardless of the presence of cancer.

scholarly journals Current management of cancer-associated venous thromboembolism in patients with thrombocytopenia: a retrospective cohort study

2021 ◽  
Author(s):  
Alessandro Squizzato ◽  
Silvia Galliazzo ◽  
Elena Rancan ◽  
Marina Di Pilla ◽  
Giorgia Micucci ◽  
...  
Keyword(s):  
Platelet Count ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cerebral Metastasis ◽  
Bleeding Complications ◽  
Severe Thrombocytopenia ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Current Management

AbstractOptimal management of venous thromboembolism (VTE) in cancer patients with thrombocytopenia is uncertain. We described current management and clinical outcomes of these patients. We retrospectively included a cohort of cancer patients with acute VTE and concomitant mild (platelet count 100,000–150,000/mm3), moderate (50,000–99,000/mm3), or severe thrombocytopenia (< 50,000/mm3). Univariate and multivariate logistic regression analyses explored the association between different therapeutic strategies and thrombocytopenia. The incidence of VTE and bleeding complications was collected at a 3-month follow-up. A total of 194 patients of whom 122 (62.89%) had mild, 51 (26.29%) moderate, and 22 (11.34%) severe thrombocytopenia were involved. At VTE diagnosis, a full therapeutic dose of LMWH was administered in 79.3, 62.8 and 4.6% of patients, respectively. Moderate (OR 0.30; 95% CI 0.12–0.75), severe thrombocytopenia (OR 0.01; 95% CI 0.00–0.08), and the presence of cerebral metastasis (OR 0.06; 95% CI 0.01–0.30) were independently associated with the prescription of subtherapeutic LMWH doses. Symptomatic VTE (OR 4.46; 95% CI 1.85–10.80) and pulmonary embolism (OR 2.76; 95% CI 1.09–6.94) were associated with the prescription of full therapeutic LMWH doses. Three-month incidence of VTE was 3.9% (95% CI 1.3–10.1), 8.5% (95% CI 2.8–21.3), 0% (95% CI 0.0–20.0) in patients with mild, moderate, and severe thrombocytopenia, respectively. The corresponding values for major bleeding and mortality were 1.9% (95% CI 0.3–7.4), 6.4% (95% CI 1.7–18.6), 0% (95% CI 0.0–20.0) and 9.6% (95% CI 5.0–17.4), 48.2% (95% CI 16.1–42.9), 20% (95% CI 6.6–44.3). In the absence of sound evidence, anticoagulation strategy of VTE in cancer patients with thrombocytopenia was tailored on an individual basis, taking into account not only the platelet count but also VTE presentation and the presence of cerebral metastasis.

scholarly journals Prognostic Value of D-dimer in patients with acute coronary syndrome treated by percutaneous coronary intervention: a retrospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Runzhen Chen ◽  
Chen Liu ◽  
Peng Zhou ◽  
Yu Tan ◽  
Zhaoxue Sheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Prognostic Value ◽  
Coronary Intervention ◽  
Risk Scores ◽  
Risk Of Death ◽  
Clinical Risk ◽  
Percutaneous Coronary ◽  
D Dimer

Abstract Background Associations between D-dimer and outcomes of patients with acute coronary syndromes (ACS) remain controversial. This study aimed to investigate the prognostic value of D-dimer in ACS patients treated by percutaneous coronary intervention (PCI). Methods In this observational study, 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The X-tile program was used to determine the optimal D-dimer thresholds for risk stratifications. Cox regression with multiple adjustments was used for outcome analysis. Restricted cubic spline (RCS) analysis was performed to assess the dose-response association between D-dimer and outcomes. The C-index was calculated to evaluate the additional prognostic value of D-dimer when added to clinical risk factors and commonly used clinical risk scores, with internal validations using bootstrapping methods. The primary outcome was all-cause death. Results During a median follow-up of 720 days, 225 deaths occurred. Based on the thresholds generated by X-tile, ACS-PCI patients with median (420–1150 ng/mL, hazard ratio [HR]: 1.58, 95 % confidence interval [CI]: 1.14–2.20, P = 0.007) and high (≥ 1150 ng/mL, HR: 1.98, 95 % CI: 1.36–2.89, P < 0.001) levels of D-dimer showed substantially higher risk of death compared to those with low D-dimer (< 420 ng/mL). RCS analysis depicted a constant relation between D-dimer and various outcomes. The addition of D-dimer levels significantly improved risk predictions for all-cause death when combined with the fully adjusted models (C-index: 0.853 vs. 0.845, P difference = 0.021), the GRACE score (C-index: 0.826 vs. 0.814, P difference = 0.027), and the TIMI score (C-index: 0.804 vs. 0.776, P difference < 0.001). The predicted mortality at the median follow-up (two years) was 1.7 %, 5.2 %, and 10.9 % for patients with low, median, and high D-dimer, respectively, which was well matched with the observed mortality (low D-dimer group: 1.2 %, median D-dimer group: 5.2 %, and high D-dimer group: 12.6 %). Conclusions For ACS patients treated by PCI, D-dimer level was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and risk scores. Risk stratifications based on D-dimer was plausible to differentiate ACS-PCI patients with higher risk of death.

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