Risk of Recurrence of Venous Thromboembolism After Major Surgery for Cancer,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3342-3342
Author(s):  
Aurelien Delluc ◽  
Patrice Crenn ◽  
Emmanuelle Le Moigne ◽  
Francis Couturaud ◽  
Gregoire Le Gal ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Patients ◽  
Conflicts Of Interest ◽  
Lower Limbs ◽  
Surgical Patients ◽  
Cancer Site ◽  
Major Surgery ◽  
Cumulative Probability ◽  
Risk Of Recurrence

Abstract Abstract 3342 Background: In patients with venous thromboembolism (VTE) provoked by major surgery, the risk of recurrence is low during and after the anticoagulation period. Conversely, cancer patients with VTE have a very high risk of VTE recurrence even under anticoagulant therapy. Some cancer patients develop VTE within three months following surgical treatment of their malignancy. It is unknown whether these patients have a low risk of recurrence of VTE, or if they have the high risk of recurrence associated with cancer. Methods: We analyzed data of a single center cohort study conducted at the Brest University Hospital, France. All consecutive cancer patients with pulmonary embolism and/or deep vein thrombosis of the lower limbs diagnosed between January 2000 and July 2009 in our center were followed-up for VTE recurrence. Patients were classified as “surgical” patients if they had major surgery for cancer in the three months before VTE. Probabilities of recurrence of VTE in surgical patients and in non-surgical patients were estimated according to Kaplan-Meier method and were compared by log-rank test. Hazard Ratios (HR) for VTE recurrence and 95% confidence intervals (CI) were obtained using Cox proportional hazard regression models with adjustments on age, sex, past history of VTE, cancer site, and metastases. Results: We followed 220 cancer patients with symptomatic VTE (mean age 69.9 ± 11.0 years, male sex n=127 (57.7%)). Of these patients, 42 (19.1%) had major surgery for cancer three months before the index VTE and 178 (80.9%) were non-surgical cancer patients. Surgical patients were more often men (30/42 (71.4%) vs. 97/178 (54.5%), p=0.05) and had less metastases at baseline (7/42 (16.7%) vs. 61/178 (34.3%), p=0.03) than non-surgical patients. Mean age was not different between surgical and non-surgical patients (70.1±10.5 vs. 69.8±11.2, p=0.90). Most surgical patients discontinued anticoagulation after six months of treatment, whereas non-surgical patients were receiving long term anticoagulation. At two years, 29 patients had a recurrence of VTE (2/44 surgical patients and 27/180 non-surgical patients). The cumulative probability of recurrence of VTE was lower in surgical patients than in non-surgical patients (2.8% (95% CI −2.5 to 8.1) vs. 11.3% (95% CI 5.8 to 16.8) at 6 months (p=0.14), 3.0% (95% CI −2.3 to 8.3) vs. 16.2% (95% CI 9.3 to 23.1) at 1 year (p=0.06), and 9.3% (95% CI −4.0 to 22.6) vs. 27.5% (95% CI 18. To 36.9) at 2 years (p=0.04)). At two years, the adjusted hazard ratio for recurrence of VTE was 0.20 (95% CI 0.05 to 0.91) in surgical patients compared with non-surgical cancer patients. There was a trend for a lower cumulative probability of death in surgical patients than in non-surgical patients after two years of follow-up (40.2% (95% CI 23.0 to 57.4) vs. 57.7% (95% CI 49.5 to 65.9), p=0.06). Conclusion: In this study, patients with cancer who develop VTE after major cancer surgery had a lower risk of recurrence of VTE than non-surgical cancer patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cancer Patients’ Experiences and Understanding of Venous Thromboembolism

2021 ◽  
Vol 17 (3) ◽  
pp. 128-134
Author(s):  
Omar Riyadh Abdullah ◽  
Agnieszka Ignatowicz ◽  
Rania Abdulsalam Mahdi ◽  
Annie M Young
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Patients ◽  
Signs And Symptoms ◽  
Qualitative Studies ◽  
Major Surgery ◽  
Limited Information ◽  
Prophylactic Measures ◽  
Cancer Associated Thrombosis ◽  
Patients Experience

Background: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), presents an extra challenge in the management of patients with cancer, given the increase in morbidity and mortality in having both conditions. Cancer patients are well known to have a high risk of VTE; particularly; those who have had major surgery, chemotherapy and/or hormonal therapy. These groups of patients need to understand the risk factors and the prophylactic measures to prevent developing VTE. This review aims to provide an overview of the literature on cancer patients’ understanding of VTE and their experiences of cancer-associated thrombosis (CAT). Method: A scoping review was carried map the literature and explore the types of evidence available. A structured electronic search was conducted in Embase, Scopus and Medline in June 2020. All titles and abstracts from the search were evaluated independently by two reviewers and disagreements were resolved by a third arbitrator. Eligible papers were qualitative studies and reviews of adult patients' experience of cancer-associated thrombosis. Results:  Ten articles met the inclusion criteria, nine primary qualitative studies and one systematic review that explored cancer patients’ experiences of living with CAT. Participants had various cancer types. Most had advanced disease and were receiving palliative care. Four major themes emerged from the data: Lack of meaningful information on CAT, cancer patients unaware of signs and symptoms of VTE, limited awareness of CAT amongst HCPs and acceptability of anticoagulant. Conclusion: All the studies explored patients’ experience of VTE in the cancer context, and all included studies showed that participants had limited information about VTE, VTE risk and VTEs’ signs and symptoms. However, no qualitative studies explored patients' understanding of VTE in prophylactic settings in high-risk cancer patients.

Improvement In Venous Thromboembolism (VTE) Prophylaxis In Hospitalized Cancer Patients with a Continuing Medical Educational Program In a University Hospital In South America

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2565-2565
Author(s):  
Guillermo Conte ◽  
Gaston Figueroa ◽  
Sandra Aranda ◽  
Daniel Araos ◽  
Nestor Gonzalez ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Patients ◽  
Educational Program ◽  
Conflicts Of Interest ◽  
High Risk Population ◽  
Internal Medicine Residents ◽  
Increased Risk ◽  
Medical Interns

Abstract Abstract 2565 Introduction: Cancer patients have a 4 to 6-fold higher risk of suffering Venous Thromboembolism (VTE), the second cause of death in hospitalized cancer patients. These patients are considered as high risk for VTE by the ACCP guidelines, so the pharmacological prophylaxis is indicated if there is no contraindication. A study carried out at our hospital between 2003 and 2004 showed a low use of thromboprophylaxis in this group of patients. The implementation of diverse strategies may improve this prophylaxis. A continuing medical education program was introduced to medical interns and internal medicine residents between 2005 and 2009 with this purpose. The objective of this study was to evaluate changes in the use of thromboprophylaxis in cancer patients hospitalized between 2008 and 2009. Methods: A six-month seminar program was implemented for medical interns and internal medicine residents enhanced by daily visits to the patient rooms by the medical staff who supervised the correct use of thromboprophylaxis. The results were based on a retrospective analysis of clinical data of medical and surgical patients diagnosed with cancer hospitalized at the University of Chile Clinical Hospital in the 2003–2004 period (Group A) and in the period 2008–2009 (Group B) (Table 1). Exclusion Criteria at Admission: VTE diagnosis, use of anticoagulants, thromboprophylaxis contraindication and age <18 years. Conclusion: The risk for VTE is very high in hospitalized cancer patients and is associated with an increased risk of recurrent thrombosis. Several international medical organizations (NCCN, ASCO, ESMO, ASH) call for improving thromboprophylaxis in this high-risk population. The introduction of an active medical educational program addressed to medical interns and internal medicine residents resulted in a significant increase in the proportion of hospitalized cancer patients who received appropriate prophylaxis in accordance with the ACCP guidelines from 65.8% at the start of the study to 86.4% (p< 0.001) after 24 months. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement

2011 ◽  
pp. 191-204
Author(s):  
Alpesh N. Amin ◽  
Steven B. Deitelzweig
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Assessment Model ◽  
Major Surgery ◽  
Medical Illness ◽  
Patients With Cancer ◽  
Increased Risk ◽  
National Quality ◽  
American Society

Venous thromboembolism (VTE), a common complication in patients with cancer, is associated with increased risk of morbidity, mortality, and recurrent VTE. Risk factors for VTE in cancer patients include the type and stage of cancer, comorbidities, age, major surgery, and active chemotherapy. Evidence-based guidelines for thromboprophylaxis in cancer patients have been published: the National Comprehensive Cancer Network and American Society for Clinical Oncology guidelines recommend thromboprophylaxis for hospitalized cancer patients, while the American College of Chest Physician guidelines recommend thromboprophylaxis for surgical patients with cancer and bedridden cancer patients with an acute medical illness. Guidelines do not generally recommend routine thromboprophylaxis in ambulatory patients during chemotherapy, but there is evidence that some of these patients are at risk of VTE; some may be at higher risk while on active chemotherapy. Approaches are needed to identify those patients most likely to benefit from thromboprophylaxis, and, to this end, a risk assessment model has been developed and validated. Despite the benefits, many at-risk patients do not receive any thromboprophylaxis, or receive prophylaxis that is not compliant with guideline recommendations. Quality improvement initiatives have been developed by the Centers for Medicare and Medicaid Services, National Quality Forum, and Joint Commission to encourage closure of the gap between guideline recommendations and clinical practice for prevention, diagnosis, and treatment of VTE in hospitalized patients. Health-care institutions and providers need to take seriously the burden of VTE, improve prophylaxis rates in patients with cancer, and address the need for prophylaxis across the patient continuum.

scholarly journals Success of Online CME at Improving Knowledge and Confidence Around Guideline-Directed Management of Cancer-Associated Thrombosis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 13-13
Author(s):  
Caroline Padbury ◽  
Margaret Harris ◽  
Michael LaCouture ◽  
Jelena Spyropoulos
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Treatment Guidelines ◽  
Conflicts Of Interest ◽  
Oral Anticoagulants ◽  
Roundtable Discussion ◽  
Patients With Cancer ◽  
Cancer Associated Thrombosis ◽  
Post Assessment

Title:Success of Online CME at Improving Knowledge and Confidence Around Guideline-Directed Management of Cancer-Associated Thrombosis Study Objectives:Recent guidance statements recommend the use of direct oral anticoagulants (DOACs) as primary thromboprophylaxis in ambulatory patients with cancer who are starting chemotherapy and in patients with cancer and acute venous thromboembolism at low risk of bleeding and no drug-drug interactions.[Farge 2019; Key 2020] Yet, many clinicians lack knowledge and confidence with integrating DOACs into management strategies for patients with cancer in accordance to guideline recommendations.[Cushman 2015; Khorana 2016] We sought to determine if online continuing medical education (CME) could improve the knowledge and confidence of hematologists/oncologists regarding guideline-directed use of DOACs in the management of cancer-associated thrombosis. Methods:This CME intervention comprised of a 30-minute online video-based roundtable discussion among experts in the field of cancer-associated thrombosis management. Responses to 3 multiple-choice, knowledge questions and 1 self-efficacy, 5-point Likert scale confidence question were analyzed using a repeated pairs pre-/post-assessment study design. A chi-square test (P &lt;.05 is considered significant) assessed pre- to post-activity change . The activity launched December 23, 2019, and data were collected through February 24, 2020. Results:In total, 71 Hematologists/Oncologists were included in this study. Overall, there were knowledge and confidence improvements seen among all groups from pre- to post-assessment: 27% of hematologists/oncologists (P&lt;.01) improved at identifying guideline-directed therapy regarding recommended thromboprophylaxis in patients with cancer per guideline recommendations.27% of hematologists/oncologists (P&lt;.01) improved at selecting guideline-appropriate treatment options for cancer-associated thrombosis.44% of hematologists/oncologists had an increase in confidence in managing thrombosis in patients with cancer. Continued educational gaps: 25% of hematologists/oncologists failed to select guideline recommended DOAC therapy for thromboprophylaxis in cancer patients.45% of hematologists/oncologists failed to select guideline recommended DOAC therapy for treatment of thrombosis in cancer patients.66% of hematologists/oncologists still remain at only a rating of 1 to 3 on a scale of 1 to 5 in their confidence managing thrombosis in patients with cancer. Conclusion:This study demonstrates the success of online, CME-accredited, video-based roundtable discussion with experts in the field on significantly improving knowledge and confidence of hematologists/oncologists related to the guideline-recommended use of DOACs in the management of cancer-associated thrombosis. Continued gaps were also identified for future educational targets. Sources of support: Developed through an independent educational grant from Janssen in partnership with the University of Chicago. References: Cushman M, Creager MA. Improving awareness and outcomes related to venous thromboembolism. JAMA. 2015;314(18):1913-4. Farge D, Frere C, Connors JM, et al. 2019 International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. The Lancet Oncology. 2019;20(10):e566-581. Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020 Feb 10;38(5):496-520. Khorana AA, Yannicelli D, McCrae KR, et al. Evaluation of US prescription patterns: are treatment guidelines for cancer-associated venous thromboembolism being followed? Thromb Res. 2016 Sep;145:51-3. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement

2011 ◽  
Vol 5 (3) ◽  
pp. 191
Author(s):  
Alpesh N. Amin ◽  
Steven B. Deitelzweig
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Assessment Model ◽  
Major Surgery ◽  
Medical Illness ◽  
Patients With Cancer ◽  
Increased Risk ◽  
National Quality ◽  
American Society

Venous thromboembolism (VTE), a common complication in patients with cancer, is associated with increased risk of morbidity, mortality, and recurrent VTE. Risk factors for VTE in cancer patients include the type and stage of cancer, comorbidities, age, major surgery, and active chemotherapy. Evidence-based guidelines for thromboprophylaxis in cancer patients have been published: the National Comprehensive Cancer Network and American Society for Clinical Oncology guidelines recommend thromboprophylaxis for hospitalized cancer patients, while the American College of Chest Physician guidelines recommend thromboprophylaxis for surgical patients with cancer and bedridden cancer patients with an acute medical illness. Guidelines do not generally recommend routine thromboprophylaxis in ambulatory patients during chemotherapy, but there is evidence that some of these patients are at risk of VTE; some may be at higher risk while on active chemotherapy. Approaches are needed to identify those patients most likely to benefit from thromboprophylaxis, and, to this end, a risk assessment model has been developed and validated. Despite the benefits, many at-risk patients do not receive any thromboprophylaxis, or receive prophylaxis that is not compliant with guideline recommendations. Quality improvement initiatives have been developed by the Centers for Medicare and Medicaid Services, National Quality Forum, and Joint Commission to encourage closure of the gap between guideline recommendations and clinical practice for prevention, diagnosis, and treatment of VTE in hospitalized patients. Health-care institutions and providers need to take seriously the burden of VTE, improve prophylaxis rates in patients with cancer, and address the need for prophylaxis across the patient continuum.

OC-11 - Anticoagulation therapy in selected cancer patients at risk of recurrence of venous thromboembolism

2016 ◽  
Vol 140 ◽  
pp. S172-S173 ◽  
Author(s):  
A. Young ◽  
J. Phillips ◽  
H. Hancocks ◽  
C. Hill ◽  
N. Joshi ◽  
...  
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Anticoagulation Therapy ◽  
Risk Of Recurrence ◽  
Patients At Risk

Abstract 2097: AI powered platform to identify primary prostate cancer patients with high risk of recurrence

2020 ◽  
Author(s):  
Wei Huang ◽  
Parag Jain ◽  
Raman Randhawa ◽  
Bijay Jaiswal ◽  
Samuel Hubbard ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Risk Of Recurrence ◽  
Primary Prostate Cancer

P3850Impact of sex and risk factors for venous thromboembolism on the clinical course of first acute venous thromboembolism. Insights from the PREFER in VTE

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Giustozzi ◽  
S Barco ◽  
L Valerio ◽  
F A Klok ◽  
M C Vedovati ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Baseline Risk ◽  
Major Surgery ◽  
First Episode ◽  
Risk Of Recurrence ◽  
Recurrent Vte ◽  
The Impact

Abstract Introduction The interaction between sex and specific provoking risk factors for venous thromboembolism (VTE) may influence initial presentation and prognosis. Purpose We investigated the impact of sex on the risk of recurrence across subgroups of patients with first VTE classified according to baseline risk factors. Methods PREFER in VTE was an international, non-interventional registry (2013–2015) including patients with a first episode of acute symptomatic objectively diagnosed VTE. We studied the risk of recurrence in patients classified according to baseline provoking risk factors for VTE consisted of i) major transient (major surgery/trauma, >5 days in bed), ii) minor transient (pregnancy or puerperium, estroprogestinic therapy, prolonged immobilization, current infection or bone fracture/soft tissue trauma); iii) unprovoked events, iv) active cancer-associated VTE. Results A total of 3,455 patients diagnosed with first acute VTE were identified, of whom 1,623 (47%) were women. The percentage of patients with a major transient risk factor was 22.2% among women and 19.7% among men. Minor transient risk factors were present in 21.3% and 12.4%, unprovoked VTE in 51.6% and 61.6%, cancer-associated VTE in 4.9% of women and 6.3% of men, respectively. The proportions of cases treated with Vitamin-K antagonists (VKAs) and direct oral anticoagulants (DOACs) were similar between sexes. Median length of treatment of VKAs was 181.5 and 182.0 days and of DOACs was 113.0 and 155.0 days in women and men, respectively. At 12-months of follow-up, VTE recurrence was reported in 74 (4.8%) women and 80 (4.5%) men. Table 1 shows the sex-specific proportion of recurrences by VTE risk factor categories. Table 1 Major Transient (n=722) Minor transient (n=573) Cancer-associated (n=195) Unprovoked (1965) Women (361) Men (361) OR (95% CI) Women (346) Men (227) OR (95% CI) Women (79) Men (116) OR (95% CI) Women (837) Men (1128) OR (95% CI) One-year follow-up, n (N%)   Recurrent VTE, 21 (6.2) 10 (2.9) 0.46 (0.2; 0.9) 9 (2.7) 12 (5.4) 2.09 (0.9; 5.0) 6 (8.0) 5 (4.5) 0.54 (0.2; 1.9) 38 (4.7) 53 (4.7) 1.03 (0.7; 1.6)   Major bleeding, 6 (1.8) 5 (1.5) 0.83 (0.3; 2.7) 5 (1.5) 1 (0.5) 0.30 (0.1; 2.6) 1 (1.3) 3 (2.7) 2.07 (0.2; 20) 10 (1.2) 15 (1.4) 1.11 (0.6; 2.4)   All-cause death, 37 (10.2) 31 (8.5) 0.82 (0.5; 1.4) 10 (2.9) 14 (6.2) 2.21 (0.9; 5.1) 26 (32.9) 49 (42.2) 1.49 (0.8; 2.7) 33 (3.9) 30 (2.7) 0.66 (0.4; 1.1) Conclusions The proportion of patients with recurrent VTE events after first acute symptomatic VTE provoked by transient risk factors was not negligible during the first year of follow-up during in both women and men. These results may have implications on the decision whether to consider extended anticoagulant therapy in selected patients with provoked events. Acknowledgement/Funding This study was funded by Daiichi Sankyo.

Venous Thromboembolism in Cancer Patients Undergoing Major Surgery

2008 ◽  
Vol 15 (12) ◽  
pp. 3567-3578 ◽  
Author(s):  
Nicolas H. Osborne ◽  
Thomas W. Wakefield ◽  
Peter K. Henke
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Major Surgery
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