Evaluation of direct oral anticoagulants for the treatment of cancer-associated thrombosis: an update

Franco-Moreno, Ana Isabel; Cabezón-Gutiérrez, Luis; Palka-Kotlowsa, M.; Villamayor-Delgado, Maria Luisa; García-Navarro, María José

doi:10.1007/s11239-018-1783-2

Cited by 16 publications

(11 citation statements)

References 35 publications

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“…Low molecular weight heparins (LMWHs) are the traditionally recommended therapy for the VTE treatment, and have been shown to significantly decrease the recurrence of VTE (6). Nevertheless, direct oral anticoagulants (DOACs), which include rivaroxaban, edoxaban, apixaban, and others, are being increasingly recognized as a promising strategy for decreasing VTE events in cancer patients, with many recent studies demonstrating that DOACs are comparable with LMWHs in the efficacy of VTE treatment in cancer patients (7)(8)(9). However, there is a lack of systematic reviews and meta-analyses investigating the relative efficacy and adverse events of different DOACs for the treatment of VTE in patients with cancer.…”

Section: Introductionmentioning

confidence: 99%

Treatment of venous thromboembolism in cancer patients: a systematic review and meta-analysis on the efficacy and safety of different direct oral anticoagulants (DOACs)

Song¹,

Liu²,

Zeng³

et al. 2021

Ann Transl Med

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Background: To evaluate the efficacy and safety of different direct oral anticoagulants (DOACs) compared with low molecular weight heparins (LMWHs) in the treatment of venous thromboembolism (VTE) in cancer patients. Methods: Literature was searched in databases including Cochrane Library, EMBASE (Ovid), and MEDLINE (PubMed). Eligible studies were included, and data were collected independently by 2 reviewers. We conducted a systematic review of the efficacy and safety of DOACs in the treatment of VTE in cancer patients. The odds ratios (ORs) of different DOACs compared with LMWHs for VTE, deep vein thrombosis (DVT), pulmonary embolism (PE) recurrence, major bleeding, and clinically relevant non-major bleeding (CRNMB), were calculated in meta-analyses and subgroup analyses. Results: A total of 18 articles were eligible for analyses, including 4 randomized controlled trials (RCTs) and 14 retrospective studies. Both RCTs and retrospective studies confirmed that DOACs decreased the risk of VTE recurrence

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Section: Introductionmentioning

confidence: 99%

Treatment of venous thromboembolism in cancer patients: a systematic review and meta-analysis on the efficacy and safety of different direct oral anticoagulants (DOACs)

Song¹,

Liu²,

Zeng³

et al. 2021

Ann Transl Med

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“…There is no definite evidence demonstrating the efficacy of fondaparinux, a synthetic pentassaccharide like heparin, for the treatment of NBTE. Instead, direct oral anticoagulants, such as rivaroxaban and edoxaban, are acceptable alternatives to LMWH but should be used carefully, due to the considerable risk of bleeding events (30). However, recently a case of metastatic pancreatic cancer underlying a NBTE was reported, highlighting the clinical improvement and tumor control obtained with LMWH and chemotherapy administration (31).…”

Section: Discussionmentioning

confidence: 99%

Systemic thromboembolism from a misdiagnosed non‑bacterial thrombotic endocarditis in a patient with lung cancer: A case report

et al. 2020

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Thromboembolic events are frequent in patients with cancer, commonly involving the venous and pulmonary circulation. The arterial system is rarely implicated in embolism and, when involved, a cardiogenic origin should always be excluded. In the present study, a case of a patient who developed multiple embolic events concomitantly with the diagnosis of locally-advanced non-small cell lung cancer with high expression levels of programmed death-ligand 1 (PD-L1) in >50% of tumor cells is reported. A cardiac defect interpreted as a patent foramen ovale required low molecular weight heparin administration. Despite the anti-coagulant therapy, before first-line anticancer treatment with pembrolizumab immunotherapy could be administered due to high PD-L1 expression levels, a new hospitalization was required due to the onset of novel ischemic manifestation. New transthoracic and transesophageal echocardiography revealed a previously misdiagnosed vegetation of the mitral valve that caused systemic embolization. The lack of any sign of infection led to the diagnosis of a non-bacterial thrombotic endocarditis (NBTE), whose embolic sprouting gave rise to the widespread ischemic events. No active anticancer treatment was feasible due to the rapid progression of the disease. NBTE can evolve quickly, eventually preventing any chance of treatment targeting the primary cause, which in the present study was lung cancer. If NBTE can be correctly diagnosed sooner then there may be the potential for anticancer therapy that does not worsen the hypercoagulability state, thus improving cancer-associated survival.

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“…In addition to chemotherapy, CVCs also constitute a very important clinical risk factor for VTE [22]. According to a study reported by the MD, CVC-PE events were responsible for 9.4% and 4.7% of cases in the ALL and AML groups, respectively [22]. In our center, a PICC line was usually placed once a patient was diagnosed with HM.…”

Section: Impact Of Pe On Survivalmentioning

confidence: 93%

“…This study showed that ongoing chemotherapy in HM patients was associated with a greater risk of PE than tumor patients. In addition to chemotherapy, CVCs also constitute a very important clinical risk factor for VTE [22]. According to a study reported by the MD, CVC-PE events were responsible for 9.4% and 4.7% of cases in the ALL and AML groups, respectively [22].…”

Section: Impact Of Pe On Survivalmentioning

confidence: 99%

Comparison of Clinical Features in Hematologic-Malignancy Patients and Tumor Patients Developing Pulmonary Embolism

Liu

Zhang

et al. 2021

Preprint

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Background: venous thromboembolism (VTE) is a common complication in patients with cancer. Pulmonary embolism (PE) is a form of VTE that is common and a major cause of morbidity and mortality in cancer patients. Patients with hematological malignancies (HM) constitute a particular subset of patients with significant differences that may require specific evidence for the management of pulmonary embolism (PE) prophylaxis and treatment. Methods: a single-center retrospective analysis was conducted on HM and tumor patients developing PE from January 2015 to September 2020. Results: in this study, 56% of the HM patients had malignancies derived from B-cells. Non-Hodgkin's lymphoma(NHL), especially diffuse large B-cell lymphoma, had the highest incidence rates. Seventy-six percent of HM patients occurred PE within 50 days from the date of diagnosis. But the onset time of PE in tumor patients had two peaks. Several factors, including developing pneumonia especially in male patient with a smoking history, catheter history and ongoing chemotherapy were more valuable in predicting PE occurrence in HM patients compared with caner patients. The D-dimer level was elevated in 84% of HM cases and 97.5% in tumor patients.The D-Dimer values in HM patients were significantly lower than those in tumor patients. There was no significant difference in embolus location between two groups. Patients with acute leukemia had a higher incidence of peripheral PE, whereas patients with NHL had a higher incidence of central PE. No treatment-related modality and major bleeding were observed in HM patients. PE-related mortality rate was similar to that in tumor patients. Conclusions: this study identified several clinical differences between HM and tumor patients when PE occurred, which may be helpful for PE diagnosis, prevention and treatment of HM patients in the future.

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Evaluation of direct oral anticoagulants for the treatment of cancer-associated thrombosis: an update

Cited by 16 publications

References 35 publications

Treatment of venous thromboembolism in cancer patients: a systematic review and meta-analysis on the efficacy and safety of different direct oral anticoagulants (DOACs)

Treatment of venous thromboembolism in cancer patients: a systematic review and meta-analysis on the efficacy and safety of different direct oral anticoagulants (DOACs)

Systemic thromboembolism from a misdiagnosed non‑bacterial thrombotic endocarditis in a patient with lung cancer: A case report

Comparison of Clinical Features in Hematologic-Malignancy Patients and Tumor Patients Developing Pulmonary Embolism

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