High Rates of Thromboembolic Events in Patients with Germ Cell Cancer Undergoing Cisplatin-Based Polychemotherapy

Abstract

Background: We examined whether or not extended prophylaxis with low molecular weight heparin (LMWH) would significantly reduce thromboembolic event (TEE) rates in germ cell cancer patients undergoing cisplatin-based chemotherapy. Patients and Methods: LMWH prophylaxis was given from the first day of chemotherapy until 21 days after completing the last chemotherapy cycle to 45 out of 93 (48.4%) patients (extended), and to 48 out of 93 (51.6%) patients during their hospitalization only (limited) between January 2008 and December 2013. Patients were analyzed retrospectively for TEEs such as deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI) or peripheral arterial thrombosis. Results: A total of 22/93 (23.7%) patients experienced 30 TEE during chemotherapy: 12 out of 30 (40%) deep vein thrombosis, 4 out of 30 (13.3%) MI, 10 out of 30 (33.3%) PE and 4 out of 30 peripheral arterial thrombosis (13.3%). TEE rates in both groups did not differ significantly (extended: 26.7 vs. limited: 20.8%). Conclusions: The introduction of extended LMWH prophylaxis did not significantly reduce TEE rates in our patient cohort.

Platinum exposure and cause‐specific mortality among patients with testicular cancer

“…Some case reports have described severe acute myocardial infarction or stroke shortly after chemotherapy in TC survivors, although these events are rare and usually not fatal. Differences in the underlying CVD risk factors, lifestyles, and prophylactic use of low‐molecular‐weight heparin to prevent platinum‐associated thromboembolic events may underlie these heterogeneous findings with respect to CVD mortality …”

Pure Testicular Seminoma Relapsing Late with Somatic Type Malignancy

“…One feature is the excessive thrombosis of the vena cava extending into both iliac veins. As documented in the present patient, such events are pathogenetically associated with abdominal metastases compressing the vena cava, reducing blood flow velocity, and thus precipitating intravascular clotting [19–21]. Another peculiarity is the relapse of disease occurring as late as nine years after primary treatment.…”

Effect of prophylactic anticoagulation on the incidence of venous thromboembolism in patients with testicular germ cell tumor.

“…The observed incidence of VTE events is in line with the incidences reported in the literature. [6,8,10,[18][19][20] However, there is a wide variation in the reported incidences. [21] While the lowest reported incidence is 2%, in a different study, there was an incidence of thromboembolic events of 23.7%.…”

“…[21] While the lowest reported incidence is 2%, in a different study, there was an incidence of thromboembolic events of 23.7%. [8,20] A signi cant part of this variation is probably caused by different inclusion criteria, such as including arterial events, including patients with VTE events before the start of chemotherapy, and events occurring several months after chemotherapy. The small number of patients in some studies may also contribute to this variability.…”