scholarly journals Thrombosis and bleeding outcomes in the treatment of cerebral venous thrombosis in cancer

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Nadia I Abelhad ◽  
Wei Qiao ◽  
Naveen Garg ◽  
Cristhiam M. Rojas-Hernandez
Keyword(s):  
Venous Thrombosis ◽  
Cancer Patients ◽  
Major Bleeding ◽  
Cerebral Venous Thrombosis ◽  
Adult Population ◽  
Therapeutic Index ◽  
Propagation Rate ◽  
Outcome Data ◽  
Bleeding Complications ◽  
Stepdown Procedure

Abstract Background There is a need for clinical outcome data of cerebral venous thrombosis (CVT) in cancer patients. We examined the recanalization, thrombosis recurrence and major bleeding during CVT treatment in a cancer exclusive adult population. Methods We performed a retrospective review of cancer associated CVT identified through an institutional data warehouse. The primary endpoint was radiological and comprised the evaluation of thrombus recanalization at 12 months. Secondary endpoints were clinical and included rates of bleeding complications and recurrence of CVT. Variables were compared across subgroups of study outcomes. The backward stepdown procedure was used to identify variables for the final logistic model regarding thrombosis and bleeding outcomes. Results The population included forty-five patients, slightly predominant of male adults (55.6%) with a median age of 54.5 years. Solid malignancies comprised 64.4% of cases. A total of 31 cases were treated with anticoagulation. CVT recanalization was documented in almost 60% of cases. The cerebral venous thrombosis recurrence or propagation rate at 12 months was 15.6%. Major bleeding complications were observed in 15 patients. Conclusions Our findings are suggestive of a narrow therapeutic index of anticoagulation in cancer-CVT. Careful monitoring of anticoagulation effect and bleeding complications are of utmost clinical relevance in cancer patients. Further larger and controlled studies are needed to confirm our observations.

Heparin Assays and Bleeding Complications in Treatment of Deep Venous Thrombosis with Particular Reference to Retroperitoneal Bleeding

1985 ◽  
Vol 53 (02) ◽  
pp. 278-281 ◽  
Author(s):  
H Asbjørn Holm ◽  
Ulrich Abildgaard ◽  
Sigmund Kalvenes
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Major Bleeding ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Thrombin Time ◽  
Heparin Infusion ◽  
Retroperitoneal Bleeding ◽  
Heparin Activity ◽  
The Difference

SummaryBleeding complications occurred in 30 (11%) out of 280 patients who received continuous heparin infusion for deep venous thrombosis (DVT). 22 (8%) had minor while 8 patients (3%) had major bleeding complications (1 intrathoracic [fatal], 2 gastrointestinal and 5 retroperitoneal). Heparin activity, in daily drawn blood samples, was determined by four assays (chromogenic substrate [CS] assay, activated partial thromboplastin time [APTT], thrombin time with citrated plasma [CiTT] and thrombin time with recalcified plasma [CaTT]). The differences in median heparin activity between patients with minor bleeding and patients with no bleeding did not reach significance for any of the tests. In patients with major bleeding, the differences were significant with the CS (p = .011) and the CaTT (p = .030) assays. Patients with retroperitoneal bleeding had significantly increased median activity judged by all four assays: CS (p = .002), CaTT (p = .003), APTT (p = .010), CiTT (p = .029). The difference was most pronounced after four days of heparin treatment, but there was a considerable overlap with patients without bleeding.

Predicting recurrences or major bleeding in cancer patients with venous thromboembolism

2008 ◽  
Vol 100 (09) ◽  
pp. 435-439 ◽  
Author(s):  
Javier Trujillo-Santos ◽  
José Nieto ◽  
Gregorio Tiberio ◽  
Andrea Piccioli ◽  
Pierpaolo Micco ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Major Bleeding ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
Recurrent Pulmonary Embolism ◽  
Acute Venous Thromboembolism ◽  
Deep Vein

SummaryCancer patients with acute venous thromboembolism (VTE) have an increased incidence of recurrences and bleeding complications while on anticoagulant therapy. Methods RIETE is an ongoing registry of consecutive patients with acute VTE. We tried to identify which cancer patients are at a higher risk for recurrent pulmonary embolism (PE), deep vein thrombosis (DVT) or major bleeding. Up to May 2007, 3, 805 cancer patients had been enrolled in RIETE. During the first three months of follow-up after the acute, index VTE event, 90 (2.4%) patients developed recurrent PE, 100 (2.6%) recurrent DVT, 156 (4.1%) had major bleeding. Forty patients (44%) died of the recurrent PE,46 (29%) of bleeding. On multivariate analysis, patients aged <65 years (odds ratio [OR]: 3.0; 95% confidence interval [CI]: 1.9–4.9), with PE at entry (OR: 1.9; 95% CI: 1.2–3.1), or with <3 months from cancer diagnosis to VTE (OR: 2.0; 95% CI: 1.2–3.2) had an increased incidence of recurrent PE. Those aged <65 years (OR: 1.6; 95% CI: 1.0–2.4) or with <3 months from cancer diagnosis (OR: 2.4; 95% CI: 1.5–3.6) had an increased incidence of recurrent DVT. Finally, patients with immobility (OR: 1.8; 95% CI: 1.2–2.7), metastases (OR: 1.6; 95% CI: 1.1–2.3), recent bleeding (OR: 2.4; 95% CI: 1.1–5.1), or with creatinine clearance <30 ml/ min (OR: 2.2; 95% CI: 1.5–3.4), had an increased incidence of major bleeding. With some variables available at entry we may identify those cancer patients withVTE at a higher risk for recurrences or major bleeding.

scholarly journals Clinicoepidemiological profile of cerebral venous thrombosis in Algarve, Portugal: A retrospective observational study

2015 ◽  
Vol 06 (04) ◽  
pp. 613-616
Author(s):  
Hipólito Nzwalo ◽  
Fátima Rodrigues ◽  
Patricia Carneiro ◽  
Ana Macedo ◽  
Fátima Ferreira ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Venous Thrombosis ◽  
Rural Areas ◽  
Cerebral Venous Thrombosis ◽  
Adult Population ◽  
Diagnostic Delay ◽  
Clinical Manifestations ◽  
Complete Recovery ◽  
Case Review ◽  
Retrospective Case

ABSTRACT Background: Cerebral venous thrombosis (CVT) is a very uncommon disorder with a wide variety of clinical manifestations. There are few studies describing the clinical and epidemiological profile of CVT in peripheral or rural areas. Over the last decades, the frequency in which this disease is diagnosed has increased due to greater awareness and availability of noninvasive diagnostic techniques. Materials and Methods: A hospital-based retrospective case review of adult (≥15 years) patients with CVT between 2001 and 2012 is described. 31 patients with confirmed imagiological diagnosis of CVT were included. Statistical Analysis Used: Statistical analysis was performed using R version 2.15.2. Incidence rate was computed as number of new cases by time. Confidence interval (CI) was set at 95% and P < 0.05 was considered significant. Results: The average annual incidence was 0.84 (CI: 0.58–1.18) to 0.73 (CI: 0.5–1.02) per 100 000 cases for adult population. There were 23 (74%) women and 8 (26%) men. Predominant initial manifestations were headache, followed by altered mental status and seizures. Median diagnostic delay from onset of illness was 8 days. All patients were treated with unfractionated heparin or low-molecular heparin followed by warfarin. Complete recovery occurred in the majority of cases 22 (78.6%) but two patients died during hospitalization. Conclusions: Albeit with some particularities, the epidemiology and clinical manifestations we found are comparable to what has been reported in western studies.

A meta-analysis of anticoagulants as cancer treatment: Impact on survival and bleeding complications

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9071-9071
Author(s):  
N. M. Kuderer ◽  
A. A. Khorana ◽  
G. H. Lyman ◽  
C. W. Francis
Keyword(s):  
Relative Risk ◽  
Cancer Patients ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Bleeding Complications ◽  
Primary Study ◽  
Bleeding Events ◽  
Impact On Survival ◽  
The Impact ◽  
Overall Mortality

9071 Background: There is substantial laboratory evidence that anticoagulants, in particular the low-molecular-weight heparins (LMWH), exert an antitumor effect, while clinical trials have reported conflicting results. This study represents the first comprehensive systematic review and meta-analysis of the evidence from randomized controlled trials (RCTs) evaluating specifically the impact of anticoagulants on survival and safety in cancer patients without venous thromboembolism (VTE). Methods: An exhaustive systematic literature review of RCTs was performed without language restrictions, including a comprehensive search of electronic databases through May 2006 with subsequent weekly updates to the end of 2006 (Medline, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, DARE, and major conference proceedings) and relevant article references. Two reviewers extracted the data independently. Primary study outcomes were 1-year overall mortality and all bleeding complications. Major and fatal bleeding complications were secondary outcomes. The meta- analysis was performed utilizing the Mantel-Haenszel method. Results: All identified 11 RCTs were performed in solid tumor patients. Anticoagulation significantly decreased overall mortality across all studies with a relative risk (RR) of 0.905 (95%CI: 0.847–0.967; p=0.003). The survival improvement appears not to be due to the prevention of fatal VTE. All bleeding complications (RR=2.309; 95%CI: 1.928–2.764; p<0.0001) and major bleeding events (RR=2.598; 95%CI; 1.936–3.488; p<0.0001) occurred more frequently with anticoagulation. The relative risk for mortality was 0.877 (95%CI: 0.789–0.975; p=0.015) with LMWH, compared to warfarin (RR=0.942; 95%CI: 0.854–1.040; p=0.239). Warfarin resulted in higher rates for all and major bleeding complications compared to LMWH (p<0.0001, respectively). Conclusions: Anticoagulants significantly improved overall survival in cancer patients while increasing the risk of bleeding complications. Despite these encouraging findings, given limitations of available data and the potential for life-threatening complications, the use of anticoagulants as antineoplastic therapy cannot be recommended until additional RCTs confirm these results. No significant financial relationships to disclose.

Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis

Blood ◽  
2002 ◽  
Vol 100 (10) ◽  
pp. 3484-3488 ◽  
Author(s):  
Paolo Prandoni ◽  
Anthonie W. A. Lensing ◽  
Andrea Piccioli ◽  
Enrico Bernardi ◽  
Paolo Simioni ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Cancer Patients ◽  
Major Bleeding ◽  
Cumulative Incidence ◽  
Hazard Ratio ◽  
Anticoagulant Treatment ◽  
Thromboembolic Complications ◽  
Patients With Cancer ◽  
Recurrent Venous Thromboembolism

A small proportion of patients with deep vein thrombosis develop recurrent venous thromboembolic complications or bleeding during anticoagulant treatment. These complications may occur more frequently if these patients have concomitant cancer. This prospective follow-up study sought to determine whether in thrombosis patients those with cancer have a higher risk for recurrent venous thromboembolism or bleeding during anticoagulant treatment than those without cancer. Of the 842 included patients, 181 had known cancer at entry. The 12-month cumulative incidence of recurrent thromboembolism in cancer patients was 20.7% (95% CI, 15.6%-25.8%) versus 6.8% (95% CI, 3.9%- 9.7%) in patients without cancer, for a hazard ratio of 3.2 (95% CI, 1.9-5.4) The 12-month cumulative incidence of major bleeding was 12.4% (95% CI, 6.5%-18.2%) in patients with cancer and 4.9% (95% CI, 2.5%-7.4%) in patients without cancer, for a hazard ratio of 2.2 (95% CI, 1.2-4.1). Recurrence and bleeding were both related to cancer severity and occurred predominantly during the first month of anticoagulant therapy but could not be explained by sub- or overanticoagulation. Cancer patients with venous thrombosis are more likely to develop recurrent thromboembolic complications and major bleeding during anticoagulant treatment than those without malignancy. These risks correlate with the extent of cancer. Possibilities for improvement using the current paradigms of anticoagulation seem limited and new treatment strategies should be developed.

Oncological and Hematological Neoplasms: Concomitant Oral Anticoagulation Therapy

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4059-4059
Author(s):  
Serena Rupoli ◽  
Lidia Da Lio ◽  
Anna Rita Scortechini ◽  
Francesca Ravaglia ◽  
Stefano Pulini ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Major Bleeding ◽  
Anticoagulation Therapy ◽  
Bleeding Complications ◽  
High Dose ◽  
Central Vein ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
Haematological Patients ◽  
Anticoagulation Control

Abstract The oral anticoagulant therapy (OAT) in oncologic patient is often problematic because both the haemorragic risk and the thrombotic risk, i.e. the recurrence of venous thromboembolism, are increased. Many studies have been conducted in patient with solid neoplasms; it remains still unclear whether these results could be entirely extrapolated to patients with haematological malignancies. Our aim was to analyse the clinical outcomes and the control of anticoagulation, measured as % time in target INR range, in the patients with cancer compared to patients without cancer; moreover we focused on patients with haematological neoplasms. A total of 500 patients were recruited in 6 years, regardless of the indication for OAT; 146 (29%) of them were affected by cancer (47 haematological and 99 solid neoplasms); those being treated with warfarin for less than 1 month were excluded from this analysis. It resulted that patients affected with cancer had a worse anticoagulation control, compared to those without cancer (55% vs 60%; p&lt;0.001). The rate of thrombosis was similar (6/146=4.1% vs 14/354=3.9%; OR 1.1); moreover the former had a tendency toward a higher rate of major bleeding complications (3/146=2.1% and 5/354=1.4% respectively; OR 1.5). As regarding hematologic patients we noted that the quality of anticoagulation control did not differ compared with solid malignancies (54% vs 55%, p = ns); no significant differences were found in the major bleeding (1/47=2.1% and 2/99=2.0% respectively; OR 1.05) and thrombotic complications (2/47=4.3% and 4/99=4.1% respectively; OR 1.05). The cancer patients discontinued warfarin primarily for surgical, endoscopic diagnostic or therapeutic procedures (32% vs 19%; p&lt;0.001); in particular the surgical procedures more frequently were the reason for discontinuation (27% vs 4% of the haematological patients, p&lt;0.001). The 47 haematological patients showed a younger median age compared to those with solid neoplasms (67 vs 72 years, p&lt;0.001), and discontinued OAT often because of invasive procedures (45% vs 26% of cancer patients, p&lt;0.02). In this experience the haematological patients seem not to have an increased risk of thrombosis recurrence and bleeding during OAT. Such a result probably reflects a good management of OAT even in presence of risk factors like central vein catheter or thrombocytopenia. Moreover, an appropriate initial decision of employing low-molecular-weight heparins (LMWH) rather than OAT in particular subsets of haematological patients (for example those with life-expectancy less than 2–3 months or undergoing high-dose chemotherapy for stem cell transplantation) can reduce the hemorragic risk.

scholarly journals Outcomes in the Secondary Prevention of Cerebral Venous Thrombosis in Cancer Only Population

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5063-5063
Author(s):  
Nadia Isabel Abelhad
Keyword(s):  
Venous Thrombosis ◽  
Major Bleeding ◽  
Cerebral Venous Thrombosis ◽  
Conflicts Of Interest ◽  
Anticoagulation Therapy ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Bleeding Events ◽  
Major Bleeding Events ◽  
The Impact

Abstract BACKGROUND AND PURPOSE: There are scant data on the outcomes of cerebral venous thrombosis (CVT) in the cancer only population. Current anticoagulation guidelines exist for the general population but the effect of these strategies in cancer subgroups are not known. We examined the clinical outcomes such as recanalization, thrombosis recurrence and major bleeding during cerebral venous thrombosis treatment in an exclusively cancer population. METHODS: A retrospective cohort study of cancer only patients with cerebral venous thrombosis identified through an institutional data warehouse at MD Anderson Cancer Center between January 2002 and June 2017. Patients with other indications for long term anticoagulation, chronic cerebrovascular thrombosis or less than 12 month follow up were excluded from the primary analysis. The primary end point was thrombus recanalization. Secondary end points were major bleeding and recurrence of cerebral or venous thrombosis. Demographic data, cancer diagnosis and cancer-therapy was also obtained at the time of initial CVT for further analysis. Chi-square test or Fisher exact test were used to assess the association between categorical variables. RESULTS: The population comprised predominantly male adults (55.6%) with median age 54.5 years, IQR [41.5 to 62.4]. The underlying malignancies were non-hematologic in 64.4% of cases. Anticoagulation was used in the treatment of 73.3% of cases, predominantly low molecular weight heparin (LMWH), and a median duration of 7.9 months, IQR [3.1 to 30.8]. Partial and complete recanalization were achieved in 33.3% and 17.8% of cases, respectively. The CVT recurrence rate at 12 months was 15.6% and 31% of patients suffered major bleeding. Most of the major bleeding events (71.1%) occurred outside the brain. Anticoagulation therapy with LWMH showed a trend to a higher rate of thrombus recanalization (p=0.196) without an increment in the overall bleeding events. We observed a lower rate of major bleeding events in patients treated with LWMH when compared with oral anticoagulation (5/14 versus 18/31, respectively; p=0.049). CONCLUSIONS: Our findings suggest that LMWH might represent an effective and safe strategy for the management of CVT in cancer patients. The findings are consistent with results from large randomized trials for outcomes of cancer associated venous thrombosis in other anatomical locations. The impact of thrombus recanalization in recurrent thrombosis and bleeding outcomes deserves further exploration. Limitations to our study are the retrospective and non-randomized design for the adjudication of treatment agents. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Novel Oral Anticoagulants (NOACs) for the Treatment of Cerebral Venous Thrombosis: A Case Study of 32 Vietnamese Patients

2021 ◽  
pp. 251660852110461
Author(s):  
Thang H. Nguyen ◽  
Triet M. Ngo ◽  
Bau V. Phan ◽  
Binh N. Pham ◽  
Nha T. T. Dao ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants ◽  
Bleeding Complications ◽  
Safety Outcome ◽  
Randomized Controlled Studies ◽  
Clinical Presentations ◽  
Clinical Benefits

Background and Purpose: Cerebral venous thrombosis (CVT) is a rare cause of cerebral infarction with diverse clinical presentations and outcomes. Novel oral anticoagulants (NOACs) provide an alternative option of systemic anticoagulation in various thromboembolic conditions, but uncertainty exists over the use of NOACs among patients with CVT. We present our initial experience with the use of NOACs for CVT in Vietnam. Methods: We included consecutive patients diagnosed with CVT presenting to 115 People’s Hospital in Vietnam between May 2016 and July 2017 and who were treated with NOACs. Data on patient demographics, vascular risk factors, clinical presentations, and outcomes at 180 days follow-up were obtained and analyzed. Modified Rankin scale (mRS) scores on admission, at discharge, and 180 days were assessed. Recanalization was assessed using magnetic resonance venography at 180 days follow-up. Venous thrombo-embolism events were defined as primary outcome, while bleeding complications were defined as safety outcome. Results: Among 32 patients with CVT (72% females; mean age: 40 ± 9.7 years), 15 were treated with rivaroxaban and 17 with dabigatran. A common risk factor was the usage of oral contraception (70%) on presentation. The mean mRS score on admission was 3.1 points (± 1.4). At FUP (median 8.5 months, IQR 5.5-9.5), clinical outcome (mRS ≤ 1) was excellent in most patients. All patients had at least partial recanalization and half of them achieved complete recanalization at 180 days follow-up. There were no bleeding complications. Conclusion: NOACs may offer clinical benefits with minimal complications in the treatment of CVT. Further prospective assessment with randomized controlled studies is warranted.

Upper Extremity Deep Venous Thrombosis in Cancer Patients with Venous Access Devices - Prophylaxis with a Low Molecular Weight Heparin (Fragmin)

1996 ◽  
Vol 75 (02) ◽  
pp. 251-253 ◽  
Author(s):  
Manuel Monreal ◽  
Antoni Alastrue ◽  
Miquel Rull ◽  
Xavier Mira ◽  
Jordi Muxart ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Upper Extremity ◽  
Statistical Significance ◽  
Central Venous Access ◽  
Venous Access ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
Central Venous ◽  
True Incidence ◽  
Venous Access Devices

SummaryCentral venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism.We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily for 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested.On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% Cl: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 ±145 vs 207 ±81 X 109/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

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