Extended treatment of cancer-associated thrombosis

Marín-Romero, Samira; Jara‐Palomares, Luis

doi:10.1016/j.thromres.2019.07.003

Cited by 4 publications

(8 citation statements)

References 37 publications

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“…If the cancer recurs, the risk of VTE recurrence also increases, in which case prophylactic anticoagulants might be necessary during further cancer treatment. 5 Another observation of this study is that DOACs reduced the risk of bleeding in the VTE subgroup of the "continued I t has been more than 150 years since the association between cancer and thrombosis was reported by Bouillaud and Trousseau. 1 Cancer cells activate the coagulation-fibrinolysis and platelet systems through various pathways during their growth and invasion.…”

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confidence: 53%

“…The primary endpoint, a composite of all-cause death, VTE recurrence and bleeding complications, was significantly more common in the continued cancer compared with the other groups at up to 3 years of follow-up, although the "cancer remission group" had a very good prognosis. 10 Most of the previous clinical studies of VTE in CAT have examined prognosis within 1 year, 5 and very few studies have compared prognosis for more than 3 years. 8 In addition, this cohort study compared the efficacy of VTE treatment with DOACs and VKA.…”

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confidence: 99%

“…3 Although treatment guidelines recommend long-term anticoagulation for cancer-related VTE, cancer patients are also at a high risk for bleeding, making continued anticoagulation a major dilemma. 4, 5 Worldwide, low-molecular-weight (LMW) heparin has been used for the treatment of VTE in CAT, 4 but based on the results of recent large-scale clinical studies, direct oral anticoagulants (DOACs) are now being used in cancer cases as well, 6,7 On the other hand, in Japan, the use of LMW heparin is not approved by national insurance as a treatment for VTE, and DOACs or vitamin K antagonists (VKA; warfarin) are mainly used for cancer-related VTE. 8 Although a number of clinical studies have been reported worldwide on long-term anticoagulation in cancer patients and the pros and cons of discontinuing LMW heparin, 9 providing a rationale for the current treatment strategy, there is little evidence on the use of DOACs for very longterm treatment of VTE in cancer patients.…”

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confidence: 99%

“…8 Although a number of clinical studies have been reported worldwide on long-term anticoagulation in cancer patients and the pros and cons of discontinuing LMW heparin, 9 providing a rationale for the current treatment strategy, there is little evidence on the use of DOACs for very longterm treatment of VTE in cancer patients. 5,6 In this issue of the Journal, Hara et al 10 report a singlecenter retrospective analysis for a composite outcome of all-cause death, VTE recurrence, bleeding and a composite outcome of VTE-related death, recurrence and bleeding using clinical data from patients with VTE. A total of 893 patients treated for acute VTE between 2011 and 2019 cancer treatment group" compared with VKA.…”

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confidence: 99%

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Can I Stop Anticoagulation When Cancer Is in Remission?

Koitabashi

2022

Circ J

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Can I Stop Anticoagulation When Cancer Is in Remission?

Koitabashi

2022

Circ J

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“…Patients with cancer-associated VTE and indication for anticoagulation should preferably be treated for 6 months 22. Duration of anticoagulation should be extended in patients with ongoing active malignancy, for example in metastatic disease, and/or ongoing antineoplastic therapy and should be reassessed periodically for its risk–benefit ratio 21–23 34…”

Section: Duration Of Anticoagulationmentioning

confidence: 99%

How I treat cancer-associated thrombosis

Moik

Pabinger

2019

ESMO Open

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Patients with cancer are at an increased risk of symptomatic venous thromboembolism (VTE). In addition, an increasing number of patients with incidental thromboembolic events have been recorded in clinical practice. Therapeutic anticoagulation is crucial to prevent thrombus progression and reduce risk of recurrence; however, this comes at the price of an increased bleeding risk, which necessitates a personalised approach to choose the most appropriate type of therapy. Over the last decade, low-molecular-weight heparin has been the preferred anticoagulant agent for patients with cancer-associated thrombosis due to better efficacy and similar safety profile compared with vitamin K antagonists. While direct oral anticoagulants (DOAC) have emerged as new option for treatment of VTE in a general population, only limited data have been available specifically for patients with cancer until recently. Randomised, controlled trials have now been published, establishing DOAC as an alternative for the treatment of cancer-associated thrombosis. However, the improvement in the therapeutic armamentarium is accompanied by a number of special considerations. For instance, risk of bleeding is elevated in patients with cancer-associated VTE receiving DOAC, especially in certain tumour types (eg, gastrointestinal), and no guidance exists regarding their use in patients with severe thrombocytopaenia. Furthermore, DOAC are prone to certain drug–drug interactions and their effect might be altered due to nausea and vomiting in patients receiving chemotherapy. Here, we provide guidance on how to treat cancer-associated VTE and how new evidence from randomised controlled trials can be implemented in clinical practice. There are still clinical scenarios where robust evidence is lacking and treatment recommendations are based on extrapolations from other populations or expert opinion only. Therefore, additional research in special subpopulations is needed to optimise management of patients in challenging clinical scenarios.

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Cancer‐associated venous thromboembolism in Israel: Incidence, risk factors, treatment, and health care utilization in a population based cohort study

Moser

Spectre

Raanani

et al. 2022

Research and Practice in Thrombosis and Haemostasis

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Background Recent international guidelines recommend thromboprophylaxis in patients with cancer at intermediate‐high venous thromboembolism (VTE) risk. Objectives We aimed to assess the current incidence, risk factors and management of cancer‐associated VTE and associated health care resource utilization in a 2.5‐million‐member state‐mandated health service in Israel. Methods Patients aged ≥18 years with newly diagnosed cancer, initiating systemic anticancer treatment from 2010 through 2018 were identified from the Israel National Cancer Registry. The index date was fixed as the first day of systemic anticancer treatment. The cumulative VTE incidence from the first day of systemic anticancer treatment and the respective hazard ratios for VTE risk factors were calculated at 12 months of follow‐up. Health care resource utilization (primary care physician, emergency room, and hospital visits) during the study period was compared between patients with and without VTE. Results A total of 15 388 patients were included, and 338 had VTE with a 12‐month cumulative incidence of 2.2% (95% confidence interval, 1.96%‐2.43%). In a multivariable model, older age, higher comorbidity index, intermediate‐high‐risk Khorana score, certain malignancy types, and chemotherapy were significantly associated with an increased VTE risk in the year after initiating anticancer treatment. Compared with matched controls, the VTE subcohort were more likely to be hospitalized (81.4% vs 35.2%), have longer hospital stays (20.1 days vs 13.1 days), have an emergency room visit (41.5% vs 19.3%), and have a larger number of primary care physician visits (17.6 vs 12.5). Conclusion Several risk factors, including the Khorana score, were associated with VTE incidence. VTE was associated with long‐term use of anticoagulation. Health care utilization was higher in patients with VTE.

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Extended treatment of cancer-associated thrombosis

Cited by 4 publications

References 37 publications

Can I Stop Anticoagulation When Cancer Is in Remission?

Can I Stop Anticoagulation When Cancer Is in Remission?

How I treat cancer-associated thrombosis

Cancer‐associated venous thromboembolism in Israel: Incidence, risk factors, treatment, and health care utilization in a population based cohort study

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