Management and prevention of thromboembolic events in patients with cancer-related hypercoagulable states

Sarasin, François; Eckman, Mark H.

doi:10.1007/bf02600108

Cited by 53 publications

(19 citation statements)

References 52 publications

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“…The published literature was used to identify utilities for PHN pain, relief from PHN pain, and the decrement in utilities from adverse effects [50][51][52][53][54][55] . Several studies were identified that measured health state utilities with neuropathic pain 9,14,51 .…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of a new 8% capsaicin patch compared to existing therapies for postherpetic neuralgia

Armstrong

Malone

McCarberg

et al. 2011

Current Medical Research and Opinion

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Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of a new 8% capsaicin patch compared to existing therapies for postherpetic neuralgia

Armstrong

Malone

McCarberg

et al. 2011

Current Medical Research and Opinion

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“…The hypercoagulability of malignancy, the presence of underlying inherited or acquired (e.g., antiphospholipid antibodies) hypercoagulable states, and exposure to situational risk factors (such as prolonged immobilization, surgery, central venous access devices, and chemotherapy itself) all can promote or trigger pathologic thrombosis. The impact of these risk factors on the overall risk of VTE can be illustrated by the fact that patients with breast carcinoma have an increased risk of VTE relative to patients of the same age but without cancer and have an even greater, exponentially increased VTE risk during chemotherapy (e.g., cyclophosphamide, methotrexate, and 5‐fluorouracil) 8, 9. The risks with newer chemotherapy regimens (e.g., doxorubicin and cyclophosphamide) and with sequential instead of concomitant chemotherapy plus hormone therapy may be different.…”

Section: Hormonal Agents Available or Under Study For The Prevention mentioning

confidence: 99%

The risk of venous thromboembolic disease associated with adjuvant hormone therapy for breast carcinoma

Deitcher

Gomes

2004

Cancer

161

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BACKGROUNDTamoxifen therapy for patients with breast carcinoma is perceived as an independent risk factor for venous thromboembolic events (VTE), but the risk associated with other adjuvant therapies is less well recognized.METHODSThe authors conducted a computerized PubMed literature search for English‐language articles published between January 1966 and December 2003. Studies were analyzed with regard to trial design, breast carcinoma staging, adjuvant agent, definition of VTE outcomes, method of VTE case ascertainment, and the presence of concomitant VTE risk factors.RESULTSAccurate determination of VTE rates was impaired by the universal lack of routine assessments for asymptomatic VTE. Therefore, only the risk of symptomatic VTE could be derived. The risk of VTE was increased twofold to threefold during tamoxifen or raloxifene use for breast carcinoma chemoprevention. It remains unknown whether the risk is increased further in women with inherited hypercoagulable states. In the setting of early‐stage breast carcinoma, the risk of VTE is increased both with tamoxifen use and anastrozole use. Such risk appeared to be lower, albeit not negligible, with anastrozole. Significant methodologic limitations of all available studies in women with advanced‐stage breast carcinoma precluded determination of the true VTE risk associated with different adjuvant hormonal agents and made it nearly impossible to compare the risk between different drugs.CONCLUSIONSAll agents used for breast carcinoma chemoprevention and adjuvant therapy appear to increase the risk of VTE. Available data were insufficient to support any assumptions that newer hormonal forms of hormone manipulation are safer than tamoxifen in women with advanced breast carcinoma. Cancer 2004. © 2004 American Cancer Society.

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“…We obtained utility values (Table 2) from previous publications and the Cost-Effectiveness Analysis Registry from the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center [26-35]. We considered the baseline utility for our study (0.96) to be less than a perfect state of health (1.00) because all patients in our model would have already suffered a major trauma with associated head injury [36].…”

Section: Methodsmentioning

confidence: 99%

Prophylactic anticoagulation to prevent venous thromboembolism in traumatic intracranial hemorrhage: a decision analysis

et al. 2010

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IntroductionPatients with intracranial hemorrhage due to traumatic brain injury are at high risk of developing venous thromboembolism including deep vein thrombosis (DVT) and pulmonary embolism (PE). Thus, there is a trade-off between the risks of progression of intracranial hemorrhage (ICH) versus reduction of DVT/PE with the use of prophylactic anticoagulation. Using decision analysis modeling techniques, we developed a model for examining this trade-off for trauma patients with documented ICH.MethodsThe decision node involved the choice to administer or to withhold low molecular weight heparin (LMWH) anticoagulation prophylaxis at 24 hours. Advantages of withholding therapy were decreased risk of ICH progression (death, disabling neurologic deficit, non-disabling neurologic deficit), and decreased risk of systemic bleeding complications (death, massive bleed). The associated disadvantage was greater risk of developing DVT/PE or death. Probabilities for each outcome were derived from natural history studies and randomized controlled trials when available. Utilities were obtained from accepted databases and previous studies.ResultsThe expected value associated with withholding anticoagulation prophylaxis was similar (0.90) to that associated with the LMWH strategy (0.89). Only two threshold values were encountered in one-way sensitivity analyses. If the effectiveness of LMWH at preventing DVT exceeded 80% (range from literature 33% to 82%) our model favoured this therapy. Similarly, our model favoured use of LMWH if this therapy increased the risk of ICH progression by no more than 5% above the baseline risk.ConclusionsOur model showed no clear advantage to providing or withholding anticoagulant prophylaxis for DVT/PE prevention at 24 hours after traumatic brain injury associated with ICH. Therefore randomized controlled trials are justifiable and needed to guide clinicians.

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Management and prevention of thromboembolic events in patients with cancer-related hypercoagulable states

Cited by 53 publications

References 52 publications

Cost-effectiveness analysis of a new 8% capsaicin patch compared to existing therapies for postherpetic neuralgia

Cost-effectiveness analysis of a new 8% capsaicin patch compared to existing therapies for postherpetic neuralgia

The risk of venous thromboembolic disease associated with adjuvant hormone therapy for breast carcinoma

Prophylactic anticoagulation to prevent venous thromboembolism in traumatic intracranial hemorrhage: a decision analysis

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