Cancer-Associated Venous Thromboembolism: A Practical Review Beyond Low-Molecular-Weight Heparins

You

et al. 2019

Korean J Urol Oncol

Purpose: Although direct oral anticoagulants (DOACs) are recommended as an alternative to low-molecular weighted heparin for cancer-associated venous thromboembolism (VTE), there is no firm evidence on the efficacy and safety of DOACs in patients with urologic cancer. Therefore, we compared the efficacy and safety of rivaroxaban and dalteparin for treating cancer-associated VTE in urologic cancer. Materials and Methods: We reviewed the medical records of 124 eligible VTE patients with urologic cancers who were treated with dalteparin or rivaroxaban. The primary outcome was the composite event of clinically relevant bleeding or VTE recurrence. The secondary outcomes were VTE recurrence, clinically relevant bleeding events, and all-cause mortality. Results: During anticoagulation period, there was no significant difference in primary and secondary outcomes between the groups. In Cox proportional hazards model for composite events, although there was no statistical significance, rivaroxaban presented lower hazard ratio (HR) than dalteparin (HR, 0.472; 95% confidence interval [CI], 0.210-1.060; p=0.069 in univariate analysis; HR, 0.505; 95% CI, 0.206-1.234; p=0.134 in multivariate analysis). In clinically relevant bleeding events, there was no significance difference between rivaroxaban and dalteparin (HR, 0.568; 95% CI, 0.238-1.358; p=0.203 in univariate analysis; HR, 0.617; 95% CI, 0.232-1.636; p=0.331 in multivariate analysis). Conclusions: Rivaroxaban can be regarded as a valuable option for VTE in urologic cancer. Further prospective studies are warranted to prove the safety or efficacy of rivaroxaban for treating VTE in patients with urologic cancer.

Section: Introductionmentioning

confidence: 99%

A Study on the Efficacy and Safety of Rivaroxaban in Urologic Cancer-Associated Venous Thromboembolism

You

et al. 2019

Korean J Urol Oncol

“…In a 2017 prospective cohort study of 200 patients by Mantha et al, rivaroxaban was identified as safe and effective for cancer‐associated thrombosis, with 4.4% VTE recurrence and 2.2% major bleeding . These findings are lower than the reported values of 7% to 9% and 6% to 7%, respectively, for LMWH . Equivalent findings were seen in subsequent prospective randomized trials comparing DOACs with enoxaparin and warfarin .…”

Section: Pancreatic Cancer Disease‐related Complications and Managementmentioning

confidence: 90%

“…96 These findings are lower than the reported values of 7% to 9% and 6% to Cancer November 15, 2019 7%, respectively, for LMWH. 97,98 Equivalent findings were seen in subsequent prospective randomized trials comparing DOACs with enoxaparin 99,100 and warfarin. 101 However, in similar studies between DOACs and dalteparin, DOACs were noninferior but had an increased risk of bleeding.…”

Section: Pancreatic Cancer-related Symptom Managementmentioning

confidence: 96%

Pancreatic cancer—A disease in need: Optimizing and integrating supportive care

Moffat

Epstein

O’Reilly

2019

Cancer

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that continues to be challenging to treat. PDAC has the lowest 5‐year relative survival rate compared with all other solid tumor malignancies and is expected to become the second‐leading cause of cancer‐related death in the United States by 2030. Given the high mortality, there is an increasing role for concurrent anticancer and supportive care in the management of patients with PDAC with the aims of maximizing length of life, quality of life, and symptom control. Emerging trends in supportive care that can be integrated into the clinical management of patients with PDAC include standardized supportive care screening, early integration of supportive care into routine cancer care, early implementation of outpatient‐based advance care planning, and utilization of electronic patient‐reported outcomes for improved symptom management and quality of life. The most common symptoms experienced are nausea, constipation, weight loss, diarrhea, anorexia, and abdominal and back pain. This review article includes current supportive management strategies for these and others. Common disease‐related complications include biliary and duodenal obstruction requiring endoscopic procedures and venous thromboembolic events. Patients with PDAC continue to have a poor prognosis. Systemic therapy options are able to palliate the high symptom burden but have a modest impact on overall survival. Early integration of supportive care can lead to improved outcomes.

“…Treatment of choice is the group of Low Molecular Weight Heparins (LMWH) undoubtfully [22]. Long-term treatment with LMWH is considered safer and more efficacious than standard Vitamin K Antagonists (VKA) therapy, based on the results from the CLOT and CATCH [23,24].…”

Section: Which Treatment and In What Dosing?mentioning

confidence: 99%

“…Rivaroxaban, apixaban and edoxaban as well as the direct thrombin inhibitor dabigatran, (NOACs) may offer a precious therapeutic alternative to LMWH in special subgroups of cancer patients, albeit until now no clinical trial has presented a head-to-head comparison of NOACs vs LMWH in cancer patients with acute VTE [21,22].…”

Section: Which Treatment and In What Dosing?mentioning

confidence: 99%

Venous Thromboembolic Disease and Cardio Oncology

Panagiotopoulos¹

2018

OAJC

Venous thromboembolism along with peripheral arterial thrombosis and cardio toxicity are some terms from the vocabulary of Oncologists that have been used increasingly in recent years. Several mechanisms have been related to the increased thrombotic complications observed in patients with cancer: 1) the expression of tissue factor by circulating tumor cells, 2) the shedding of pro coagulant micro particles by malignant cells, 3) the interaction of cancer cells with blood platelets, 4) the generation of neutrophil extracellular traps and 5) the secondary deleterious effects of anti-cancer therapies. Cancer patients with venous thrombosis experience 3fold higher rates of recurrences and 2fold major anticoagulation-associated bleeding complications than do patients without cancer. Anticoagulation treatment for venous thromboembolism differs in various groups of patients suffering from malignancies and demands a detailed knowledge of advantages and side effects of available medications. Low Molecular Weight Heparins are the first line choice, followed by vitamin K antagonists, which are widely used when treatment has to be prolonged. The new oral anticoagulants have been proven effective for venous thromboembolism (in general) and for atrial fibrillation embolic disease and thus are promising, though more studies are needed in order to investigate their detailed behavior in cancer populations. The emerging interplay between Oncologist and Cardiologists is a new provocation for the two specialties, which will probably impel them to specify a new subspecialty, the Cardio Oncology.