Anticoagulation prescribing patterns in patients with cancer

Xiang, Elaine; Ahuja, Tania; Raco, Veronica; Cirrone, Frank; Papadopoulos, John

doi:10.1007/s11239-017-1558-1

Cited by 26 publications

(14 citation statements)

References 31 publications

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“…Consistent with literature [14,15], LMWH and UFH were the most common anticoagulants used to treat CAT during an inpatient or ED visit (35.2% and 27.4%, respectively; Fig. 2).…”

Section: Discussionsupporting

confidence: 83%

Inpatient and outpatient treatment patterns of cancer-associated thrombosis in the United States

Guo

Hlavacek

Poretta

et al. 2020

J Thromb Thrombolysis

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Low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are among the recommended treatment options for cancer-associated thrombosis (CAT) in the 2019 National Comprehensive Care Network guidelines. Little is known about the current utilization of DOACs in CAT patients, particularly on the inpatient to outpatient therapy transition. This study assessed real-world treatment patterns of CAT in hospital/ED in adult cancer patients (≥ 18 years) diagnosed with CAT during a hospital visit in IQVIA's Hospital Charge Data Master database between July 1, 2015 and April 30, 2018, and followed their outpatient medical and pharmacy claims to evaluate the initial inpatient/ED and outpatient anticoagulants received within 3 months post-discharge. Results showed that LMWH and unfractionated heparin (UFH) were the most common initial inpatient/ED CAT treatments (35.2% and 27.4%, respectively), followed by DOACs (9.6%); 20.8% of patients received no anticoagulants. Most DOAC patients remained on DOACs from inpatient/ED to outpatient settings (71.4%), while 24.1%, 43.5%, and 0.1% of patients treated with LMWH, warfarin, or UFH respectively, remained on the same therapy after discharge. In addition, DOACs were the most common initial post-discharge outpatient therapy. Outpatient treatment persistence and adherence appeared higher in patients using DOACs or warfarin versus LMWH or UFH. This study shows that DOACs are used as an inpatient/ED treatment option for CAT, and are associated with less post-discharge treatment switching and higher persistence and adherence. Further research generating real-world evidence on the role of DOACs to help inform the complex CAT clinical treatment decisions is warranted.

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“…Consistent with literature [14,15], LMWH and UFH were the most common anticoagulants used to treat CAT during an inpatient or ED visit (35.2% and 27.4%, respectively; Fig. 2).…”

Section: Discussionsupporting

confidence: 83%

Inpatient and outpatient treatment patterns of cancer-associated thrombosis in the United States

Guo

Hlavacek

Poretta

et al. 2020

J Thromb Thrombolysis

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“…In the recent study by Uppuluri et al [ 134 ], direct acting anticoagulants-DOACs were reported to be as safe and effective as low molecular weight heparins-LMWH in cancer subjects with thromboembolism. Similar data were reported by others [ 135 – 137 ]. Melloni et al [ 138 ].…”

Section: Vegfr and Hypertensionsupporting

confidence: 92%

Hypertension in malignancy-an underappreciated problem

Małyszko

Kozłowski³

et al. 2018

Oncotarget

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Hypertension is one of the most common comorbidities in cancer patients with malignancy, in particular, in the elderly. On the other hand, hypertension is a long-term consequence of antineoplastic treatment, including both chemotherapy and targeted agents. Several chemotherapeutics and targeted drugs may be responsible for development or worsening of the hypertension. The most common side effect of anti-VEGF (vascular endothelial growth factor) treatment is hypertension. However, pathogenesis of hypertension in patients receiving this therapy appears to be associated with multiple pathways and is not yet fully understood. Development of hypertension was associated with improved antitumor efficacy in patients treated with anti-antiangiogenic drugs in some but not in all studies. Drugs used commonly as adjuvants such as steroids, erythropoietin stimulating agents etc, may also cause rise in blood pressure or exacerbate preexisiting hypertension. Hypotensive therapy is crucial to manage hypertension during certain antineoplastic treatment. The choice and dose of antihypertensive drugs depend upon the presence of organ dysfunction, comorbidities, and/or adverse effects. In addition, severity of the hypertension and the urgency of blood pressure control should also be taken into consideration. As there are no specific guidelines on the hypertension treatment in cancer patients we should follow the available guidelines to obtain the best possible outcomes and pay the attention to the individualization of the therapy according to the actual situation.

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“…A combination of antiplatelet agents and anticoagulation therapy multiplies the risk of bleeding both in the general population and in the oncological population as well. On the basis of the CHA 2 DS 2 -VASc score and HAS-BLED score, low-molecular-weight heparin or direct oral anticoagulants such as NOACs are recommended by both cardiologist and oncologist to prevent complications mentioned before in neoplastic patients [ 106 , 107 , 108 , 109 ].…”

Section: Arrhythmias Related To Neoplastic Treatmentmentioning

confidence: 99%

Cardiomyopathies and Arrhythmias Induced by Cancer Therapies

et al. 2020

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Cardiology and oncology are two fields dedicated to the study of various types of oncological and cardiac diseases, but when they collide, a new specialty is born, i.e., cardio-oncology. Continuous research on cancer therapy has brought into the clinic novel therapeutics that have significantly improved patient survival. However, these therapies have also been associated with adverse effects that can impede the proper management of oncological patients through the necessity of drug discontinuation due to life-threatening or long-term morbidity risks. Cardiovascular toxicity from oncological therapies is the main issue that needs to be solved. Proper knowledge, interpretation, and management of new drugs are key elements for developing the best therapeutic strategies for oncological patients. Upon continuous investigations, the profile of cardiotoxicity events has been enlarged with the inclusion of myocarditis upon administration of immune checkpoint inhibitors and cardiac dysfunction in the context of cytokine release syndrome with chimeric antigen receptor T cell therapy. Affinity enhanced and chimeric antigen receptor T cells have both been associated with hypotension, arrhythmia, and left ventricular dysfunction, typically in the setting of cytokine release syndrome. Therefore, the cardiologist must adhere to the progressing field of cancer therapy and become familiar with the adverse effects of novel drugs, and not only the ones of standard care, such as anthracycline, trastuzumab, and radiation therapy. The present review provides essential information summarized from the latest studies from cardiology, oncology, and hematology to bring together the three specialties and offers proper management options for oncological patients.

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Anticoagulation prescribing patterns in patients with cancer

Cited by 26 publications

References 31 publications

Inpatient and outpatient treatment patterns of cancer-associated thrombosis in the United States

Inpatient and outpatient treatment patterns of cancer-associated thrombosis in the United States

Hypertension in malignancy-an underappreciated problem

Cardiomyopathies and Arrhythmias Induced by Cancer Therapies

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