Hematological Malignancies and Arterial Thromboembolism

Visweshwar, Nathan; Jaglal, Michael; Sokol, Lubomir; Djulbegoviĉ, Benjamin

doi:10.1007/s12288-019-01085-x

Cited by 8 publications

(11 citation statements)

References 132 publications

(154 reference statements)

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“…Moreover, the KRS system does not include other clinical parameters-such as female sex, older age, number of chronic comorbidities, and presence of a central venous catheter-that were previously shown to be associated with an increased risk of thrombosis among AML patients [22]. Hematopoietic growth factors (erythropoietin, granulocyte colony-stimulating factor, and granulocytemacrophage colony-stimulating factor) play a role in activating coagulation factors and cytokines that alter coagulation, modulate hemostasis, and cause platelet aggregationall of which contribute to thrombotic events [23][24][25][26][27]. In addition, the KRS does not stratify by type of thrombosis, and arterial thromboembolism may be associated with greater morbidity and mortality than venous thromboembolism [27,28].…”

Section: Discussionmentioning

confidence: 99%

“…The pathophysiology of arterial and venous thrombosis both follow the principles of Virchow's Triad: alterations in flow, abnormal cell and molecular properties, and altered blood vessel walls [27]. The multifactorial pathogenesis of thrombosis in leukemia involves blast cells secreting prothrombotic tissue factor, cancer procoagulants, and cytokines.…”

Section: Discussionmentioning

confidence: 99%

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Validation of the Khorana Score in Acute Myeloid Leukemia Patients: A Single Institution Experience

Mirza

Yun

Ali

et al. 2018

Blood

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Background: Although patients with acute myeloid leukemia (AML) were shown to have an increased risk of thrombosis, no thrombosis risk assessment scoring system has been developed for AML patients. The Khorana Risk Score (KRS), which has been widely used for thrombosis risk assessment in the clinical setting, was developed on the basis of solid tumor data and has not been validated among AML patients. This study aims to validate the use of the KRS as a thrombosis risk-scoring system among patients with AML. Methods: Using data from H. Lee Moffitt Cancer Center and Research Institution's Total Cancer Care Research Study, we retrospectively identified patients who were histologically confirmed with AML from 2000 to 2018. Clinical and laboratory variables at the time of AML diagnosis were characterized and analyzed. The thrombotic event rate was estimated with the Kaplan-Meier method and compared using the log-rank test. Results: A total of 867 AML patients were included in the analysis. The median age at AML diagnosis was 75 years (range, 51-96), and the majority were male (65%, n = 565). A total of 22% (n = 191), 51% (n = 445), 24% (n = 207), and 3% (n = 24) of patients had a KRS of 0, 1, 2, and 3, respectively. A total of 42 thrombotic events (3% [n = 6/191] with a KRS of 1; 5% [n = 23/445] with a KRS of 2; 6.3% [n = 13/207] with a KRS of 3) were observed, with a median follow-up of 3 months (range, 0.1-307). There was no statistical difference in the risk of thrombosis between these groups (P = .1949). Conclusions: Although there was an increased risk of thrombosis associated with a higher KRS among AML patients with a KRS of 1 to 3, the difference was not statistically significant. Furthermore, only a few patients were found to have a KRS > 3, and this was largely due to pancytopenia, which is commonly associated with AML. These results indicate the need for a better thrombotic risk-scoring system for AML patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Validation of the Khorana Score in Acute Myeloid Leukemia Patients: A Single Institution Experience

Mirza

Yun

Ali

et al. 2018

Blood

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“…For the peculiar characteristics of arterial thrombosis related to acute leukemia, including acute promyelocytic leukemia, we refer the readers to other comprehensive recent reviews. 12,15,16…”

Section: Search Methods and Inclusion Criteriamentioning

confidence: 99%

Arterial Thrombosis in Cancer Patients: An Update

Franchini

Tufano

Casoria

et al. 2021

Semin Thromb Hemost

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Cancer is associated with an increased incidence of both venous thromboembolism (VTE) and arterial thrombosis (cardiovascular events and ischemic stroke). Cancer-associated arterial thrombotic events are less well studied than VTE, but increasingly recognized, particularly in specific malignancies and in association with specific anticancer therapies. The pathogenesis of arterial thrombotic events in cancer is complex and involves generation of tumor-associated procoagulant factors and a variety of alterations in platelet function as well as in the coagulation and fibrinolytic systems, and endothelial injury and dysfunction, that combine to produce hypercoagulability. The multifactorial interaction between this prothrombotic state, the individual cardiovascular risk, advanced age and presence of comorbidities, and the specific neoplasm characteristics and therapy, may induce the vascular events. Recent studies based on population databases and prospective or retrospective analyses with prolonged follow-up highlight that cancer patients experience an increased (approximately 1.5–2-fold) risk of both cerebrovascular and cardiovascular events compared with noncancer individuals, which peaks in the time period of the diagnosis of cancer but may persist for years. Beyond the type of cancer, the risk reflects the tumor burden, being higher in advanced stages and metastatic cancers. The occurrence of arterial thromboembolic events is also associated with increased overall mortality. We here present an update of the pathophysiology, risk factors, clinical evidence, and treatment considerations on cancer-associated arterial thrombosis, in the light of the need for specific multidisciplinary prevention and surveillance strategies in this setting, in the frame of cardio-oncology approaches.

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“…Malignancies are associated with the development of thromboembolic event, approximately up to six-fold higher than the general population. The pathogenesis of cancer-associated thrombosis (CAT) is multifactorial and complex, mainly related to components of Virchow’s triad [ 1 , 2 ]. Cancer cells may alter hemostasis by secreting procoagulant factors and interacting with endothelial cells to trigger a coagulation cascade [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Soluble P-selectin and correlation with Prothrombin Fragment 1 + 2 in myeloid malignancies in Cipto Mangunkusumo general hospital

Sukrisman

2021

Thrombosis J

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Background Myeloid cells express microparticles that could increase the expression of adhesion molecules including P-selectin. We aimed to evaluate the level of soluble P-selectin (sP-selectin) and prothrombin fragment 1 + 2 (F1 + 2), and to determine correlation of sP-selectin with leukocyte count and F1 + 2 levels in acute myeloid leukemia (AML) and chronic myeloid leukemia (CML) patients. Methods Patients with newly diagnosed AML (n = 25), CML (n = 13), and controls (n = 17) were recruited in this study. The diagnosis of AML and CML is based on 2001 WHO and/or FAB criteria. Levels of sP-selectin and F1 + 2 were determined using enzyme-linked immunosorbent assay kits (Behring ELISA Processor-III® and Behring Enzygnost F1 + 2). Results sP-selectin was significantly elevated in CML patients compared to AML patients (p = 0.001). Levels of F1 + 2 in AML and CML patients were significantly increased in comparison to controls (p < 0.001 and p = 0.043). Levels of sP-selectin were significantly correlated to leukocyte count (r = 0.437; p = 0.029) and F1 + 2 (r = 0.436; p = 0.029) in AML patients. Conclusions AML and CML patients had an increased tendency to thrombosis. While CML patients had higher platelet and/or endothelial activation, hypercoagulable state are more pronounced in AML patients.

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Hematological Malignancies and Arterial Thromboembolism

Cited by 8 publications

References 132 publications

Validation of the Khorana Score in Acute Myeloid Leukemia Patients: A Single Institution Experience

Validation of the Khorana Score in Acute Myeloid Leukemia Patients: A Single Institution Experience

Arterial Thrombosis in Cancer Patients: An Update

Soluble P-selectin and correlation with Prothrombin Fragment 1 + 2 in myeloid malignancies in Cipto Mangunkusumo general hospital

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