Modified Khorana risk score for prediction of venous thromboembolic events in cancer patients receiving chemotherapy: An Australian single institution experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20610-e20610
Author(s):  
Wolfgang H Heller ◽  
Alhossain A Khalafallah ◽  
Rebecca Yuan Li ◽  
Anurag Arora ◽  
Maimoona Latif ◽  
...  
Keyword(s):  
Platelet Count ◽  
Cancer Patients ◽  
White Cell Count ◽  
Thromboembolic Events ◽  
Cancer Subtypes ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Breast And Prostate Cancer ◽  
Chemotherapy Patients

e20610 Background: Venous thromboembolic events (VTEs) are a common complication in cancer. The Khorana Score (KS) is widely used for the prediction of VTEs in malignancy. The KS is composed of 5 items: cancer entity, platelet count >350/nL, white cell count (WCC) >11/nL, Hb <100 g/L and body mass index ≥35 (BMI). Scores are grouped into 3 categories indicating the VTE-risk (0=low, 1-2= intermediate, 3 or more points= high-risk). Methods: All ambulatory cancer patients at our institution starting chemotherapy from January 2010 to December 2011 were included. We applied the KS and then modified by adding further cancer subtypes and metastatic status. Results: In 658 of 766 chemotherapy patients, all the data were available for calculating the KS, of whom 52 had a VTE. In multivariate analysis, associations between KS and VTE were found (P≤0.05) in pancreas (p<0.001), lung (p=0.002), stomach (p=0.008), gynaecological cancers (p=0.037), and BMI ≥35 (p=0.004), but not found in lymphoma (p=0.14), high platelet count (p=0.6) and high WCC (p=0.8), or low Hb (p=0.53). There was an increased risk for VTE in some cancers not included in the KS: breast (p=0.01), colorectal (CRC)(p<0.001), prostate (p=0.003) and oesophageal cancer (p= 0.041). The original KS score did not significantly predict VTEs. When adding cases of neoadjuvant/adjuvant (n/a) and/or metastatic (met) CRC, breast, and prostate cancer, significant associations were found, as shown in the Table. Conclusions: The original KS showed only a weak association with VTE occurrence. However, the association was improved by including other cancer entities and / or metastatic status. Major differences between our and other cohorts, such as different proportions of cancer entities and general referral patterns, could explain the discrepancies with other studies. [Table: see text]

Venous thromboembolic events in glioblastoma patients: Common complication but not a major reason for death.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14530-e14530
Author(s):  
Dorothee Gramatzki ◽  
Amanda Eisele ◽  
Katharina Seystahl ◽  
Emilie Le Rhun ◽  
Elisabeth Jane Rushing ◽  
...  
Keyword(s):  
Missing Data ◽  
Cancer Patients ◽  
Major Complication ◽  
Time Frame ◽  
Rank Test ◽  
Karnofsky Performance Score ◽  
Thromboembolic Events ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

e14530 Background: Venous thromboembolic events (VTE) are a major complication in cancer patients. Anticoagulant use is the appropriate treatment for acute VTE in cancer patients, although associated with increased risk for bleeding, especially in brain tumor patients. In glioblastoma patients it remains unclear whether occurrence of VTE is associated with survival and to what extent thromboprophylaxis is necessary and efficient. Methods: Frequency, risk factors, and treatment of VTE as well as its complications were assessed in an epidemiological glioblastoma cohort in the Canton of Zurich, Switzerland, in the years 2005 to 2014. Association of clinical data with survival were retrospectively analyzed using the log rank test. Results: Four-hundred-nineteen patients diagnosed with isocitrate dehydrogenase wildtype glioblastoma were identified in the 10-year time-frame. Median overall survival (OS) was 12.4 months (95% CI 11.4-13.4) with a median follow up of 64.5 months (95% CI 46.6-82.4).VTE were seen in 65 patients (15.7%; 5 patients with missing information on VTE).Median time from diagnosis of glioblastoma to occurrence of VTE was 2.0 months (95% CI 0.8-3.1). A history of VTE was found in 6 patients (9.2%). Thirty-nine patients were on steroids (62.5%; 1 patient with missing data) at time of diagnosis of VTE, and 35 patients (56%; 3 patients with missing data) had a Karnofsky Performance Score of less than 70%. At the time patients were diagnosed with VTE the majority of patients (93.8%) were treated with therapeutic anticoagulation. Complications resulting in stop of anticoagulation occurred in 11 patients (18.0%; 4 patients had no anticoagulation) mainly because of intracranial bleedings (9 patients). OS was not different (p = 0.355) between patients who were diagnosed with VTE and those who were not. Tumor progression (283 patients, 77.3%) was the major reason for death (366 patients with confirmed death) in this patient cohort, only 3 patients (0.8%) died because of confirmed VTE and another 5 patients (1.4%) had an unexpected sudden death. Conclusions: Although VTE was identified in 65 patients (16%) diagnosed with glioblastoma, VTE was no major reason for death. On a population-based level these data do not support the implementation of primary thromboprophylaxis in this cohort of patients.

Development of Venous Thromboembolic Events in Cancer Patients with Elevated Levels of Tissue Factor-Bearing Microparticles

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3832-3832
Author(s):  
Jeffrey Zwicker ◽  
Howard A. Liebman ◽  
Donna Neuberg ◽  
Kenneth Bauer ◽  
Furie Barbara ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Tissue Factor ◽  
Thrombus Formation ◽  
P Value ◽  
Prospective Clinical Study ◽  
Thromboembolic Events ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Abstract Cancer cells shed procoagulant vesicles containing tissue factor, and these tissue factor-bearing microparticles (TFMP) may play a role in thrombus formation in vivo. Using impedance-based flow cytometry to quantify microparticles and a high affinity monoclonal antibody specific for tissue factor, we previously demonstrated the presence of tissue factor-bearing microparticles in platelet-poor plasma in cancer patients. In this case control study, tissue factor-bearing microparticles represented a 4-fold risk factor for venous thromboembolic events (VTE) in cancer patients with acute VTE compared to age, stage, sex, diagnosis-matched controls with cancer but without acute VTE. To further assess the relationship between tissue factor-bearing microparticles and VTE, we performed a retrospective analysis of deep venous thrombosis or pulmonary emboli diagnosed in cancer patients initially enrolled without evidence of VTE. All radiographic reports for the cancer-no VTE group in the 2 years following enrollment were analyzed by a reviewer blinded to microparticle status. Only documented evidence of a new proximal extremity deep vein thrombosis or pulmonary embolism was included in the analysis. The TFMP and no-TFMP groups did not differ significantly for age, sex, active cancer treatment, smoking status, diabetes, or the presence of metastatic disease at time of enrollment. Sixteen of the 60 patients in this group had measurable tissue factor-bearing microparticles, 4 (4/16; 25%) of which subsequently developed radiographic evidence of VTE within 12 months of enrollment. No thrombotic events were recorded among the 44 patients without detectable tissue factor-bearing microparticles within the initial 12 months; however, one patient developed a pulmonary embolism 17 months following enrollment. Identifying death without VTE as a competing risk, the one-year estimate of the rate of VTE in cancer patients with detectable tissue factor-bearing microparticles was 34.8%; among the same group without detectable tissue factor-bearing microparticles, the 1-year rate was 0% (Log Rank p-value=0.002). The presence of tissue factor-bearing microparticles in cancer patients initially thrombosis-free predicted a 7-fold increased risk of thrombosis over cancer patients who were negative for tissue factor-bearing microparticles (OR 7.00, 95% CI 0.85–82.74, P=0.02). These tissue factor-bearing microparticles appear to be derived from the underlying malignancy since samples analyzed from patients with pancreatic cancer demonstrated co-expression of both tissue factor and MUC-1, a transmembrane glycoprotein overexpressed in epithelial malignancies. These data further support the role of tissue factor-bearing microparticles in the pathogenesis of cancer-associated thrombosis and as a biomarker for the prediction of cancer patients at risk of thrombosis. A prospective clinical study, currently being initiated, is required to evaluate this biomarker for the prediction of VTE risk in cancer patients and the utility of thromboprophylaxis in patients with elevated numbers of tissue factor-bearing microparticles.

scholarly journals Extended thromboprophylaxis for medically ill patients with cancer: a systemic review and meta-analysis

2021 ◽  
Vol 5 (8) ◽  
pp. 2055-2062
Author(s):  
Soravis Osataphan ◽  
Rushad Patell ◽  
Thita Chiasakul ◽  
Alok A. Khorana ◽  
Jeffrey I. Zwicker
Keyword(s):  
Meta Analysis ◽  
Thromboembolic Events ◽  
Medically Ill ◽  
Patients With Cancer ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Extended Duration ◽  
Medically Ill Patients

Abstract Hospitalized medically ill patients with cancer are at increased risk of both venous thromboembolism and bleeding. The safety and efficacy of extended thromboprophylaxis in patients with cancer are unclear. We conducted a systematic review and meta-analysis of the literature using of MEDLINE, EMBASE, and the Cochrane CENTRAL databases to identify cancer subgroups enrolled in randomized controlled trials evaluating extended thromboprophylaxis following hospitalization. The primary outcomes were symptomatic and incidental venous thromboembolic events and hemorrhage (major hemorrhage and clinically relevant nonmajor bleeding). Four randomized controlled trials reported the outcomes of extended thromboprophylaxis in 3655 medically ill patients with active or history of cancer. The rates of venous thromboembolic events were similar between the extended-duration and standard-duration groups (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.61-1.18; I2 = 0%). However, major and clinically relevant nonmajor bleeding occurred significantly more frequently in the extended-duration thromboprophylaxis group (OR, 2.10; 95% CI, 1.33-3.35; I2 = 8%). Extended thromboprophylaxis in hospitalized medically ill patients with cancer was not associated with a reduced rate of venous thromboembolic events but was associated with increased risk of hemorrhage. This study protocol was registered on PROSPERO as #CRD42020209333.

Statins, aspirin and risk of venous thromboembolic events in breast cancer patients

2013 ◽  
Vol 38 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Ayelet Shai ◽  
Hedy S. Rennert ◽  
Ofer Lavie ◽  
Muona Ballan-Haj ◽  
Arie Bitterman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Thromboembolic Events ◽  
Breast Cancer Patients ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients?

2004 ◽  
Vol 91 (03) ◽  
pp. 538-543 ◽  
Author(s):  
Ora Paltiel ◽  
Michael Bursztyn ◽  
Moshe Gatt
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Early Period ◽  
Thromboembolic Events ◽  
Historical Cohort ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Prolonged Immobilization ◽  
The Impact

SummaryProlonged immobilization and advanced age are considered to be important risk factors for venous thromboembolism (VTE). Nevertheless, the need for VTE prophylaxis in long-term bedridden patients is not known. To assess whether very prolonged immobilization (i.e. over three months) carries an increased risk for clinically apparent VTE, we performed a historical-cohort study of nursing home residents during a ten-year period. Data concerning patient’s mobility and incidence of overt deep vein thrombosis or pulmonary embolism were registered. The mean resident age was 85 ± 8.4 years. Eighteen mobile and eight immobile patients were diagnosed with clinically significant thromboembolic events, during 1137 and 573 patient-years of follow up, respectively. The incidence of venous thromboembolic events was similar in both chronically immobilized and mobile patient groups, 13.9 and 15.8 per thousand patient years, respectively (p = 0.77). The rate ratio for having a VTE event in the immobilized patient group as compared with the mobile group was 0.88 (95% Confidence Interval (CI) 0.33 to 2.13). When taking into account baseline characteristics, risk factors and death rates by various causes, no differences were found between the two groups. In conclusion, chronically immobile bedridden patients are no more prone to clinically overt venous thromboembolic events than institutionalized mobile patients. Until further studies are performed concerning the impact of very prolonged immobilization on the risk of VTE, there is no evidence to support primary prevention after the first three months of immobilization. Evidence for efficacy or cost effectiveness beyond this early period is not available.

Risk of venous thromboembolism in cancer patients treated with cisplatin: A systematic review and meta-analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21016-e21016
Author(s):  
Sonia Maria Seng ◽  
Ziyue Liu ◽  
Sophia Chiu ◽  
Tracey Proverbs-Singh ◽  
Guru Sonpavde ◽  
...  
Keyword(s):  
Relative Risk ◽  
Solid Tumors ◽  
Meta Analysis ◽  
Systemic Review ◽  
Advanced Solid Tumors ◽  
Thromboembolic Events ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

e21016 Background: Several reports suggest that cisplatin is associated with an increased risk of thromboembolism (TE). However, patients with solid tumors have multiple risk factors for TE and the excess risk of venous thromboembolic events (VTEs) with cisplatin-based chemotherapy as compared with non-cisplatin-based chemotherapy has not been well described. We performed a systemic review and meta-analysis of randomized controlled trials (RCTs) evaluating the incidence and risk of VTE associated with cisplatin-based chemotherapy. Methods: PubMed was searched for articles published from January 1, 1990 until December 31, 2010.The primary aim was to evaluate the association between treatment with cisplatin and VTEs in patients with cancer. Clinical trials that met the following criteria were included in the meta-analysis: (1) prospective randomized phase 2 and 3 trials of patients with cancer; (2) randomization to treatment with cisplatin versus a non-cisplatin containing chemotherapy regimen (3) available data on venous thromboembolic events. Data on all grade venous thromboembolic events was extracted. Study quality was calculated utilizing Jadad scores. Incidence rates, relative risks, and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses included the impact of publication year, tumor type, and cisplatin dose. Results: A total of 8216 patients with a variety of advanced solid tumors from 38 RCTs were included for analysis. Among patients treated with cisplatin-based chemotherapy, the summary incidence of VTE was 1.64% (95% CI, 1.06–2.25). Patients treated with cisplatin-based chemotherapy had a significantly increased risk of VTE with a relative risk of 1.65 (95% CI, 1.25–2.18; P = .01) compared with controls. Exploratory subgroup analysis revealed the highest relative risk of VTE in patients receiving a weekly equivalent cisplatin dose >30 mg/m2 (2.64; 95% CI, 1.18–5.77; P = .02) and in studies reported during 2000-2010 (1.70; 95% CI, 1.27–2.28; P = .01). Conclusions: Cisplatin chemotherapy is associated with a significant increase in the risk of VTE in patients with advanced solid tumors compared with non-cisplatin chemotherapy.

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