scholarly journals Low Molecular Weight Heparin (LMWH) for Venous Thromboembolism (VTE) Prophylaxis in Patients with Primary Central Nervous System Lymphoma (PCNSL)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2993-2993
Author(s):  
Deborah Rund ◽  
Stav Gazal ◽  
Yosef Kalish ◽  
Chen Makranz ◽  
Neta Goldschmidt
Keyword(s):  
Molecular Weight ◽  
Central Nervous System ◽  
Nervous System ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Medical Center ◽  
Bleeding Event ◽  
Central Nervous System Lymphoma ◽  
Low Molecular Weight ◽  
History Of

Abstract Introduction: Venous thromboembolism (VTE) is a frequent, potentially lethal, complication in patients with cancer. Patients with brain tumors are at a particularly high risk for VTE. Primary central nervous system lymphoma (PCNSL) is a rare subtype of diffuse large B-cell lymphoma, involving the cranio-spinal axis. The incidence of VTE in patients with PCNSL is as high as 30-60% in various series, occurring mostly in the early period of therapy. Due to this high incidence, the policy in our medical center since the year 2005, is to treat with prophylactic low molecular weight heparin (LMWH) from the time of PCNSL diagnosis until the end of treatment. We aimed to evaluate the incidence of VTE in patients with PCNSL treated with prophylactic LMWH. Material and methods: All patients ≥18 years who were diagnosed and treated for PCNSL in Hadassah-Hebrew University Medical Center between the years 2005-2017 were included in the study. We retrospectively reviewed their medical records for demographic details and initial disease characteristics (age at diagnosis, sex, performance status, laboratory results such as LDH, cerebrospinal fluid content and location of the growth), for details of risk factors for VTE such as diabetes, smoking or heart failure, and for personal or familial history of thrombosis. Therapeutic details including chemotherapy protocol, response to treatment and supportive care were compiled. Specifically we noted if prophylactic LMWH was given, if any complications developed due to the LMWH treatment and whether a VTE event occurred. Results: Forty four patients were included in the study. Mean age at diagnosis was 60.2 years and there were 27 (61%) females. Three (6.8%) patients had a personal history of thrombosis and 13 (29%) had a history of diabetes or smoking. Thirty two (72%) had an ECOG performance study of 0-1 at diagnosis and seven (16%) had leptomeningeal involvement. Forty one (93%) of patients were treated with a systemic high dose methotrexate (HDMTX) based protocol (mean of 7.6 courses of HDMTX per patient) and thirty two (73%) patients were treated with systemic rituximab. All 44 patients were treated with prophylactic LMWH, mostly at a dose of 40 mg per day (41 patients, 93%). Of the 44 patients, five (11%) discontinued treatment; 2 due to side effects (abnormal liver function tests and subdural hematoma (SDH)) and 3 for an unknown reason. Three (7%) patients had a minor bleeding event (gum, conjunctival, Ommaya reservoir catheter tract). One patient (2.3%) had a major bleeding event (SDH) while on LMWH treatment which was found on routine MRI imaging of the brain as he was asymptomatic. No VTE events (0%) were recorded in patients treated with LMWH. Two patients had a VTE, however both patients were off LMWH treatment at the time of VTE (one stopped LMWH, the other was diagnosed with VTE concurrently with the diagnosis of PCNSL). Conclusions: In our group of 44 PCNSL patients, prophylactic use of LMWH was highly effective, with no VTE events. Two cases of VTE occurred in our patient group, both occurred while the patients were off LMWH treatment. Only one, asymptomatic, intracranial bleed was recorded, indicating the relative safety of this treatment in PCNSL patients. Further prospective studies should be done to support the routine use of this prophylactic strategy. Disclosures No relevant conflicts of interest to declare.

Venous Thromboembolism Prophylaxis with Low-Molecular-Weight Heparin in Primary Central Nervous System Lymphoma

2020 ◽  
pp. 1-6
Author(s):  
Stav Gazal ◽  
Eyal Lebel ◽  
Yosef Kalish ◽  
Chen Makranz ◽  
Moshe E. Gatt ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Central Nervous System ◽  
Nervous System ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Bleeding Event ◽  
Central Nervous System Lymphoma ◽  
B Cell Lymphoma ◽  
Low Molecular Weight ◽  
History Of

<b><i>Background:</i></b> Venous thromboembolism (VTE) is a frequent, potentially lethal complication in individuals with cancer. Patients with brain tumors are at particularly high risk for VTE. Primary central nervous system lymphoma (PCNSL) is a rare subtype of diffuse large B cell lymphoma, involving the craniospinal axis. The incidence of VTE in patients with PCNSL was reported as very high, occurring mostly in the early period of therapy. <b><i>Objectives:</i></b> We aimed to evaluate the efficacy and safety of prophylactic low-molecular-weight heparin (LMWH) throughout the treatment of PCNSL. <b><i>Patients:</i></b> All patients &#x3e;18 years of age diagnosed and treated for PCNSL at our institution in 2005–2017 were included. <b><i>Results:</i></b> There were 44 patients; mean age at diagnosis was 61.5 years. Three patients (6.8%) had a personal history of thrombosis, 11 (25%) had a history of diabetes or smoking, and 32 (72%) had an Eastern Cooperative Oncology Group performance status of 0–1 at diagnosis. During treatment with LMWH, no VTE events were recorded; 2 (4.5%) patients experienced a minor bleeding event and 1 (2.3%) a major bleeding event. <b><i>Conclusions:</i></b> Among our 44 patients with PCNSL treated with prophylactic LMWH, no VTE events were recorded, and only 1 (asymptomatic) intracranial bleed was recorded. Within the limitations of a retrospective nonrandomized study, our findings suggest that VTE prophylaxis may be beneficial for individuals with PCNSL.

Evaluation of rivaroxaban use in patients with gynecologic malignancies at an academic medical center: A pilot study

2017 ◽  
Vol 25 (2) ◽  
pp. 362-368 ◽  
Author(s):  
Jessie R Signorelli ◽  
Arpita S Gandhi
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Medical Center ◽  
Gynecologic Oncology ◽  
Low Molecular Weight ◽  
Efficacy And Safety ◽  
Gynecologic Malignancies ◽  
Oncology Patients ◽  
Safety And Efficacy

Background Patients with gynecologic malignancies are at an increased risk for venous thromboembolism. National guidelines recommend treatment of an acute venous thromboembolism with low molecular weight heparin for 5–10 days followed by long-term secondary prophylaxis with low molecular weight heparin for at least six months. Non-vitamin K oral anticoagulants are not currently recommended to be used in cancer patients for the management of venous thromboembolism because robust data on their efficacy and safety have yet to become available in cancer patients. The objectives of this study were to determine the proportion of gynecologic oncology patients with venous thromboembolism using rivaroxaban compared to warfarin or low molecular weight heparin as well as compare the safety and efficacy of these anticoagulants. Methods This study was a retrospective pilot analysis of adult patients with gynecologic malignancies who received either rivaroxaban, warfarin or low molecular weight heparin for treatment of venous thromboembolism at Augusta University Medical Center from 1 July 2013 to 30 June 2015. Statistical comparisons between the enoxaparin and rivaroxaban group were made using T-tests and Chi-square or Fisher’s exact tests, where appropriate. Results Out of the 49 patients, 37% (18) patients were on rivaroxaban, 53% (26) on enoxaparin, and 10% (5) on warfarin. Only one patient (4%) in the enoxaparin group experienced a recurrent deep vein thrombosis while there were no cases of recurrent venous thromboembolism in the rivaroxaban and warfarin group. The incidence of major bleeding was 17% ( n = 2), 20% ( n = 1), and 8% ( n = 2) in patients receiving rivaroxaban, enoxaparin, and warfarin, respectively. The rate of switching to a different anticoagulant than originally prescribed was 42% ( n = 14) in the enoxaparin arm, and 5.5% ( n = 1) in the rivaroxaban arm. Conclusion A high proportion of our gynecologic oncology patients received rivaroxaban for the management of venous thromboembolism. The sample size of this pilot analysis was too small to draw any conclusions regarding efficacy and safety of rivaroxaban compared with enoxaparin and warfarin. High rate of rivaroxaban use in gynecologic oncology patients at our institution highlights the need for larger, well-designed randomized controlled trials to confirm the safety and efficacy of its use in this population.

Cost-effectiveness of prophylactic low molecular weight heparin in pregnant women with a prior history of venous thromboembolism

2005 ◽  
Vol 118 (5) ◽  
pp. 503-514 ◽  
Author(s):  
Joseph A. Johnston ◽  
Patrick Brill-Edwards ◽  
Jeffrey S. Ginsberg ◽  
Stephen G. Pauker ◽  
Mark H. Eckman
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Cost Effectiveness ◽  
Pregnant Women ◽  
Low Molecular Weight Heparin ◽  
Prior History ◽  
Low Molecular Weight ◽  
History Of

scholarly journals Recurrent VTE in Pregnant Woman with Previous Personal History of VTE: A Systematic Review and Meta-Analysis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2125-2125
Author(s):  
Eman M. Mansory ◽  
Lotus Alphonsus ◽  
Janine Hutson ◽  
Barbra de Vrijer ◽  
Alejandro Lazo-Langner
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Pregnancy Outcomes ◽  
Low Molecular Weight Heparin ◽  
Post Partum ◽  
Meta Analysis ◽  
Personal History ◽  
Low Molecular Weight ◽  
History Of

Abstract Introduction: Venous thromboembolism (VTE) is one of the leading causes of morbidity and mortality during pregnancy and the postpartum periods. Despite that, the prevention and management of VTEs in pregnant patients remains an area of great debate, particularly among those with a personal VTE history. There is no solid evidence behind the current practice guidelines on the prevention of VTE in pregnancy as most data comes from studies focusing on non-pregnant patients or from small studies. It has been suggested that without low molecular weight heparin (LMWH) thromboprophylaxis, women with a personal history of VTE may have a 2% to 10% absolute risk of developing recurrent VTE during a subsequent pregnancy. We conducted a systematic review to evaluate the risk of VTE recurrence during pregnancy for pregnant patients with prior personal history of VTE and the effect of LMWH on such risk. Materials and Methods: MEDLINE and EMBASE were searched between January 2000 to December 2020. We included studies that evaluated pregnant patients with previous personal VTE history (deep vein thrombosis (DVT) and pulmonary embolism (PE) only) that assessed venous thromboembolism recurrence and/or bleeding complication and/or pregnancy outcomes. Study selection and data extraction was conducted by 3 reviewers and discrepancies resolved by consensus. A meta-analysis of proportions was done through a Freeman-Tukey transformation using random effect models. Groups were analyzed according to prophylaxis strategy. Heterogeneity between studies was assessed by Cochrane Q and Higgins I 2 analyses. Publication bias was assessed using Eggers' tests and funnel plot. Results. Of 6934 potential studies, 27 were included in this systematic review. The studies included 3631 pregnant patients with a previous history of DVT or PE, regardless of the presence of thrombophilia. We found a wide variability in thromboprophylaxis practices which included mostly low molecular weight heparin using weight-based, risk category-based, anti-Xa based, fixed, or trimester-adjusted doses . In studies that categorized patients into provoked, estrogen associated and unprovoked, most patients had an estrogen-associated previous VTE. The estimated pooled proportions of VTE recurrence were 2.7% (95% CI 1.8-3.7; I 2 55.5%) in patients who were consistently on anticoagulation during pregnancy (pre- and post-partum), 2.6% (95% CI 0.6-5.9; I 2 not estimable) in patients who received anticoagulation in the postpartum period only, and 25.3% (95% CI 8.9-46.6; I 2 93.2%) in patients who were not on anticoagulation. No comparison could be done on the different dosage strategies due to the limited number of studies and wide variety of strategies. Due to limited data available, bleeding complications and pregnancy outcomes could not be assessed. Conclusion. In patients with a previous VTE history receiving prophylactic anticoagulation (either both pre- and post-partum or post-partum only), the estimates of VTE recurrence were significantly lower than that for patients who did not receive prophylaxis, however, a direct comparison was not possible. The optimal thromboprophylaxis strategy remains unknown. Disclosures No relevant conflicts of interest to declare.

scholarly journals Severe antithrombin deficiency in pregnancy: Achieving adequate anticoagulation

2018 ◽  
Vol 12 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Ben Pearson-Stuttard ◽  
Catherine Bagot ◽  
Etienne Ciantar ◽  
Bethan Myers ◽  
Rosalyn Davies ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Case Series ◽  
Low Molecular Weight ◽  
Factor X ◽  
Antithrombin Deficiency ◽  
History Of ◽  
High Doses ◽  
Elective Termination

Antithrombin deficiency is identified as one of the most potent risk factors for venous thromboembolism during pregnancy. Therapeutic low molecular weight heparin is recommended, but it can be difficult to attain sufficient anticoagulation since low molecular weight heparin requires antithrombin to exert its anticoagulant effect. We carried out a multicentre case-series assessing the dose of low molecular weight heparin required to achieve therapeutic anti-activated factor X levels in pregnant women with antithrombin deficiency. We assessed 27 pregnancies in 18 women with severe antithrombin deficiency, which we defined as an antithrombin level of <0.55 IU/ml (with or without prior venous thromboembolism) or an antithrombin level < 0.8 IU/ml and a personal history of venous thromboembolism. Our data illustrate the need for high doses of low molecular weight heparin to achieve therapeutic anti-activated factor X levels (average 20,220 IU/day). All pregnancies ended in live birth (excluding one elective termination), although intrauterine growth restriction occurred in five (18%).

Prevention of Venous Thromboembolism (VTE) Associated with Pregnancy in Women with a Past History of VTE.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3132-3132 ◽  
Author(s):  
Camilla Rozanski ◽  
Alejandro Lazo-Langner ◽  
Michael J. Kovacs
Keyword(s):  
Molecular Weight ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Past History ◽  
Low Molecular Weight ◽  
Major Hemorrhage ◽  
Previous Event ◽  
History Of ◽  
Recurrent Vte

Abstract Abstract 3132 Poster Board III-69 Women with a past history of venous thrombosis are at higher risk for venous thromboembolism (VTE) during and after pregnancy. The highest risk period is the first four weeks post partum. For a woman whose previous event was secondary to a major transient risk factor the antepartum risk of recurrent VTE is low whereas for women whose previous event was idiopathic the antepartum risk is higher. In our institution, for women whose previous event was secondary to a major transient risk factor, standard treatment is to follow closely with no thromboprophylaxis antepartum and then receive either prophylactic low molecular weight heparin (LMWH) or warfarin for six weeks postpartum. For women whose previous event was idiopathic or who were on warfarin at the time of becoming pregnant they receive prophylactic LMWH antepartum with a scheduled delivery and are put back on warfarin if they have long term anticoagulation needs or LMWH for six weeks if they don't have longterm anticoagulation needs. We report the outcome for our patients from 1997 to 2008. All patients were followed for the duration of pregnancy and for 6 weeks postpartum for pregnancy outcome, recurrent VTE, and major bleeding in the thrombosis clinic of London Health Sciences Centre. There were a total of 90 women; 30 women (mean age 30.6 years) with a history of previous secondary thrombosis with 37 pregnancies and 60 women (mean age 29.5 years) with past idiopathic thrombosis with 99 pregnancies. For the secondary group there was 1 episode (2.70%; 95% CI 0.48-13.82) of antepartum recurrent VTE whereas for the idiopathic group there were 3 episodes (3.03%; 95% CI 1.04-8.53). There was no statistical difference between groups (p=1.0). There were no episodes of postpartum VTE recurrence or major hemorrhage for either group. For the secondary group there was 1 fetal loss at 23 weeks (2.7%; 95% CI 0.48-13.82) whereas for the idiopathic group there were 6 fetal losses at 8, 10, 10, 11, 22, 37 weeks gestation (6.06%; 95% CI 2.81-12.60). There was no statistically significant difference between groups (p=0.77). This retrospective review suggests that for pregnant women with a past history of VTE, a strategy of no antepartum prophylaxis for previous secondary thrombosis and antepartum prophylactic LMWH for previous idiopathic thrombosis as well as prophylactic LMWH or warfarin postpartum is efficacious and safe. Disclosures Off Label Use: low molecular weight heparin for prevention of VTE in pregnancy.

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