Cancer and Thrombosis: New Treatments, New Challenges

Dahm, Anders Erik Astrup

doi:10.3390/medsci9020041

Cited by 6 publications

(7 citation statements)

References 47 publications

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“…These findings differ from prior literature stating DOACs to be noninferior to LMWH, 17 which has been the gold standard for VTE prophylaxis in cancer patients since the CLOT in 2003 6 . However, none of these prior randomized control trials were specific to orthopedic oncology patients.…”

Section: Discussioncontrasting

confidence: 90%

The efficacy and safety of direct oral anticoagulants compared with low‐molecular‐weight heparin for venous thromboembolism prophylaxis after surgical resection of primary lower extremity bone or soft‐tissue sarcoma

LiBrizzi,

Agarwal,

Chiu

et al. 2023

Journal of Surgical Oncology

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IntroductionThe incidence of postoperative venous thromboembolism (VTE) and wound complications is greater after sarcoma resection. We sought to identify differences in postoperative VTE and bleeding complications with direct oral anticoagulants (DOACs) versus low‐molecular‐weight heparin (LMWH) following resection of lower extremity primary bone or soft tissue sarcoma.MethodsWe retrospectively identified 2083 patients from the PearlDiver database who underwent resection of primary bone or soft tissue sarcoma of the lower extremity from January 2010 to October 2021 and prescribed LMWH or DOAC within 90‐days postoperatively. The primary outcomes were comparison of postoperative incidence and odds of deep venous thrombosis (DVT), pulmonary embolism (PE), and bleeding complications within 90‐days following resection.ResultsPatients prescribed DOACs had a greater odds of DVT (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.06–2.41; p = 0.024) and PE (OR: 3.38; 95% CI: 1.96–5.86; p < 0.001) within 90‐days following resection of bone sarcoma when compared with the LMWH cohort. Patients undergoing resection of soft tissue sarcomas also had greater odds DVT (OR: 1.65; 95% CI: 1.09–2.49; p = 0.016) and PE (OR: 2.62; 95% CI: 1.52–4.54; p < 0.001) in the DOAC cohort. There was no difference in the odds of bleeding complications.ConclusionThis study demonstrated an increased incidence and odds of VTE, but not bleeding complications, when using DOACs versus LMWH after primary bone or soft tissue sarcoma resection.Level of EvidenceLevel III.

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Section: Discussioncontrasting

confidence: 90%

The efficacy and safety of direct oral anticoagulants compared with low‐molecular‐weight heparin for venous thromboembolism prophylaxis after surgical resection of primary lower extremity bone or soft‐tissue sarcoma

LiBrizzi,

Agarwal,

Chiu

et al. 2023

Journal of Surgical Oncology

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“…This wide range signifies the presence of great heterogeneity as some cancers, such as stomach, pancreatic, and brain cancers, are associated with a higher risk of VTE compared to other low‐risk cancers. To further clarify, the annual incidence of first VTE ranges from 10% to 15% in lung, brain, ovarian, pancreatic, and stomach cancers but 3%–5% in other types of cancer 31 . Because of that, our results are highly heterogeneous, which is a major limitation in our study.…”

Section: Discussionmentioning

confidence: 86%

“…To further clarify, the annual incidence of first VTE ranges from 10% to 15% in lung, brain, ovarian, pancreatic, and stomach cancers but 3%–5% in other types of cancer. 31 Because of that, our results are highly heterogeneous, which is a major limitation in our study. In our inclusion criteria, we included patients who had at least 3 months of follow‐up after MPM diagnosis, which is a great limitation in our study.…”

Section: Discussionmentioning

confidence: 87%

The burden and predictors of venous thromboembolic diseases in patients with multiple primary malignancies

et al. 2022

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Background: Venous thromboembolism (VTE) represents a considerable burden on cancer patients' survival and quality of life, but this burden varies based on the patient's baseline characteristics and cancer-related factors. Although solid evidence on the predictors and effect of VTE in cancer patients exists.Aim: To evaluate VTE rate, morbidity, and mortality to develop parameters that could predict VTEs and their associated mortality in patients with multiple primary malignancies (MPMs). Method and Results:This was a retrospective cohort study that took place at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Two hundred and forty-two patients with at least two biopsy-proven malignancies and had at least 3 months of follow-up after MPMs diagnosis were included. VTE was diagnosed in 14.5% of the cases, two-thirds of which were deep vein thrombosis. VTE was significantly associated with a higher mortality and worse survival. Predictors of VTE after MPMs diagnosis were a high ECOG performance status at MPMs diagnosis, a metastatic first primary malignancy, and ICU admission after MPMs diagnosis. Having a GI or hematological malignancy as the second primary malignancy, a high D-dimer at ICU admission, and palliative care referral were significantly associated with a higher mortality in patients who had VTE.Conclusion: VTE was diagnosed in 14.5% of patients with MPMs and it significantly compromises their survival. We believe that these results might be of particular benefit since the phenomenon of MPMs is becoming more frequently encountered.

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“…3 In the last 2 decades, substantial progress has been made in comprehending the process of therapy and prevention of thrombosis associated with cancer. 4 Cancer-associated thrombosis (CAT) refers to VTE (comprised of DVT and PE), arterial thrombosis, and disseminated intravascular coagulation that manifests in individuals diagnosed with cancer. This category of VTE primarily encompasses DVT affecting the upper or lower extremities, as well as PE.…”

Section: Introductionmentioning

confidence: 99%

Cancer-Associated Thrombosis: Epidemiology, Pathophysiological Mechanisms, Treatment, and Risk Assessment

Pavlovic,

Niciforovic,

Markovic

et al. 2023

Clin Med Insights Oncol

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Cancer patients represent a growing population with drastically difficult care and a lowered quality of life, especially due to the heightened risk of vast complications. Thus, it is well established so far that one of the most prominent complications in individuals with cancer is venous thromboembolism. Since there are various improved methods for screening and diagnosing cancer and its complications, the incidence of cancer-associated thrombosis has been on the rise in recent years. Therefore, the high mortality and morbidity rates among these patients are not a surprise. Consequently, there is an excruciating need for understanding the mechanisms behind this complex process, as well as the imperative for adequate analysis and application of the most suitable steps for cancer-associated thrombosis prevention. There are various and numerous mechanisms offering potential answers to cancer-associated thrombosis, some of which have already been elucidated in various preclinical and clinical scenarios, yet further and more elaborate studies are crucial to understanding and preventing this complex and harsh clinical entity. This article elaborates on the growing incidence, mortality, morbidity, and risk factors of cancer-associated thrombosis while emphasizing the pathophysiological mechanisms in the light of various types of cancer in patients and summarizes the most novel therapy and prevention guidelines recommendations.

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Cancer and Thrombosis: New Treatments, New Challenges

Cited by 6 publications

References 47 publications

The efficacy and safety of direct oral anticoagulants compared with low‐molecular‐weight heparin for venous thromboembolism prophylaxis after surgical resection of primary lower extremity bone or soft‐tissue sarcoma

The efficacy and safety of direct oral anticoagulants compared with low‐molecular‐weight heparin for venous thromboembolism prophylaxis after surgical resection of primary lower extremity bone or soft‐tissue sarcoma

The burden and predictors of venous thromboembolic diseases in patients with multiple primary malignancies

Cancer-Associated Thrombosis: Epidemiology, Pathophysiological Mechanisms, Treatment, and Risk Assessment

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