High rates of venous thromboembolic events in patients undergoing systemic therapy for urothelial carcinoma: A systematic review and meta-analysis

Gopalakrishna, Ajay; Longo, Thomas A.; Fantony, Joseph J.; Doshi, Uma; Harrison, Michael R.; Noord, Megan Van; Inman, Brant A.

doi:10.1016/j.urolonc.2016.05.009

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…Important limitations of this review were the heterogeneity in the study population, and incomplete information on several variables of interest and timing of systemic therapy and VTE in the included studies. Finally, rates of VTE did not significantly change over time, which the authors suggest may be related to poor development of guidelines and adherence for prophylaxis treatment [17]. …”

Section: Discussionmentioning

confidence: 99%

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Venous Thromboembolism and Peri-Operative Chemotherapy for Muscle-Invasive Bladder Cancer: A Population-based Study

Brennan

Karim

d’Oiron

et al. 2018

BLC

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Background:Chemotherapy and major pelvic surgery are established risk factors for venous thromboembolism (VTE). We evaluate the incidence rate, timing, and factors associated with VTE in patients with bladder cancer who underwent radical cystectomy and peri-operative chemotherapy in routine clinical practice.Methods:Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients who underwent cystectomy for bladder cancer in Ontario 1994–2013. VTE events within 6 months of before or after cystectomy were identified using diagnostic codes recorded on hospital admissions and emergency department visits. Multivariable logistic regression was used to analyze factors associated with VTE prior to surgery, within 90-days of cystectomy, and 120-days after the start of adjuvant chemotherapy.Results:4205 patients had cystectomy and 26% (1084/4205) received peri-operative chemotherapy. The overall incidence rate of VTE within 6 months of cystectomy was 9% (363/4205). VTE rate was highest among those patients treated with neoadjuvant chemotherapy (NACT) compared to patients treated with no chemotherapy or only adjuvant chemotherapy (ACT) (12% vs 8% vs 9%, p = 0.002). Among all VTE events, 10%, 28%, and 61% occurred before, during, and after hospitalization for cystectomy. Pre-operative VTE rate was highest among cases treated with NACT (4%) compared to patients with no chemotherapy (<1%) or ACT (<1%) (p < 0.001). VTE within 90 days of surgery was associated with greater length of hospital admission (p < 0.001) across all treatment groups.Conclusions:A substantial proportion of patients treated with peri-operative chemotherapy will develop VTE. The majority of these occur after discharge from hospital following cystectomy. Extended thromboprophylaxis treatment in high-risk patients including those who receive peri-operative chemotherapy should be considered.

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Section: Discussionmentioning

confidence: 99%

“…Our previous work did not identify an association between delivery of adjuvant chemotherapy (ACT) and VTE [13]. A systematic review and meta-analysis of 5082 of patients with bladder cancer treated with chemotherapy for any stage of disease describe an overall VTE rate of 7% [17]. …”

Section: Introductionmentioning

confidence: 99%

Venous Thromboembolism and Peri-Operative Chemotherapy for Muscle-Invasive Bladder Cancer: A Population-based Study

Brennan

Karim

d’Oiron

et al. 2018

BLC

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“…A recent meta-analysis of 62 studies that included a total of 5,082 patients with bladder cancer receiving systemic therapy (with 47 of the 62 studies employing a platinum-based regimen) reported a pooled VTE rate of 5.4%. The reported incidences of DVT and PE, which were derived from different sets of studies than that for VTE, were 2.9% and 2.9%, respectively, with the reported risk of fatal PE being 0.5% [ 45 ]. The lower VTE risk reported by this meta-analysis compared to the studies referenced above can likely be attributed to the fact that the majority of the studies included in the meta-analysis were clinical trials, which tend to enroll relatively young and healthy patients with a relatively low baseline risk of VTE.…”

Section: Incidence Of and Risk Factors For Thromboembolism In Patientmentioning

confidence: 99%

“…In principle, one can assume that in this typically elderly patient population with multiple comorbidities that is treated with a combination of chemotherapy and radiation, TE events are not an infrequent complication. Interestingly, one of the previously referenced meta-analyses raised the possibility of an association between receipt of radiation therapy and risk of VTE in patients with bladder cancer treated with chemotherapy [ 45 ].…”

Section: Incidence Of and Risk Factors For Thromboembolism In Patientmentioning

confidence: 99%

Thromboembolism in Patients with Bladder Cancer: Incidence, Risk Factors and Prevention

Zareba

Duivenvoorden

Pinthus

2018

BLC

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Patients with bladder cancer are at high risk of developing both venous and arterial thromboembolic events. Factors that contribute to this phenomenon include the hypercoagulable state induced by the malignancy itself, medical comorbidities that are common in this predominantly elderly patient population as well as treatments such as prolonged pelvic surgery and cisplatin-based chemotherapy. While formal guidelines address prevention of venous thromboembolism in patients undergoing radical cystectomy, consensus regarding the role of pharmacologic prophylaxis in patients with bladder cancer being treated with chemotherapy, either with neoadjuvant or adjuvant intent in conjunction with radical cystectomy, as part of bladder preservation protocols or for metastatic disease, has proved elusive. The present narrative review was undertaken to define the incidence of and identify risk factors for thromboembolism among patients with bladder cancer, as well as to assess the efficacy of pharmacologic prophylaxis in reducing the risk of thromboembolism in this patient population.

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“…There are many possible explanations for the large variations in the rates of VTE observed within this group: for example, the heterogeneity of risk factors in this population that could affect the rate of VTE such as minimal invasive (robotic) cystectomy or open radical cystectomy [10]. Additionally, 33 of the included studies did not state, discuss or categorise BC patients according to confounding factors that alter the rate of VTE such as receiving surgical thromboprophylaxis for 14 or 28 days, which then makes it difficult to compare rates between studies [13,[15][16][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. All included studies, with the exception of two [19][20], did not clearly discuss or state the thromboprophylaxis measures employed.…”

Section: Discussion Of the Systematic Reviewmentioning

confidence: 99%

Venous Thromboembolism Rate in Patients With Bladder Cancer According to the Type of Treatment: A Systematic Review

Abdullah¹,

Parashar²,

Mustafa³

et al. 2022

Cureus

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Bladder cancer (BC) is classified as a high-risk tumour type for venous thromboembolism (VTE). VTE presents an extra challenge in the management of patients with cancer, given the increase in morbidity and mortality on having both conditions.To summarise the contemporary evidence on the VTE rate in patients with BC according to the stage, type of anti-cancer treatment and highlight VTE rate in the UK and other countries. A systematic review was carried out, and an electronic search for publications between January 2000 and November 2021 was done. Studies recording VTE in BC patients were included, whilst paediatric patients, case reports, studies reporting on a mix of arterial and venous thrombosis, studies reporting DVT or PE only and recorded hospitalised VTE only were excluded. The rate of VTE, country of origin, risk factors and thromboprophylaxis duration for VTE in BC patients were identified.A total of 38 papers met the search criteria. All publications were original research papers (cohort studies). The overall VTE rate in patients with BC was estimated at 1.9% to 4.7%. For those patients undergoing cystectomy, the VTE rate ranged from 3% to 17.6%; however, the VTE rate in the metastatic stage of BC patients ranged from 3.1% to 5.1%.The rates of VTE in BC patients are high, further increased by interventions such as surgery and chemotherapy. Thromboprophylaxis measures should be optimised. This review highlighted the fact that the VTE rate in BC varies between studies due to the heterogeneity of risk factors reported.

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High rates of venous thromboembolic events in patients undergoing systemic therapy for urothelial carcinoma: A systematic review and meta-analysis

Cited by 5 publications

References 27 publications

Venous Thromboembolism and Peri-Operative Chemotherapy for Muscle-Invasive Bladder Cancer: A Population-based Study

Venous Thromboembolism and Peri-Operative Chemotherapy for Muscle-Invasive Bladder Cancer: A Population-based Study

Thromboembolism in Patients with Bladder Cancer: Incidence, Risk Factors and Prevention

Venous Thromboembolism Rate in Patients With Bladder Cancer According to the Type of Treatment: A Systematic Review

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