Perioperative safety analysis of transcatheter arterial chemoembolization for hepatocellular carcinoma patients with preprocedural leukopenia or thrombocytopenia

Zhou, Lin; Zhang, Lin‐Zhi; Wang, Jingyan; Li, Yongwu; Hu, Haidong; Peng, Xiaoming; Zhao, Yun; Wang, Xi‐Ming; Xie, Hui; Liu, Chunzi; Wang, Huaming

doi:10.3892/mco.2017.1345

Cited by 11 publications

(14 citation statements)

References 31 publications

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“…In a retrospective study of more than 2,000 TACEs, the highest reported bleeding rate, which occurred in 2.2% of the procedures, involved the vascular access site and was due to inappropriate local hemostasis. 85…”

Section: Transarterial Chemoembolizationmentioning

confidence: 99%

Prevention and Management of Bleeding Risk Related to Invasive Procedures in Cirrhosis

Schepis¹,

Turco²,

Bianchini³

et al. 2018

Semin Liver Dis

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Cirrhosis represents the end stage of chronic liver disease and its transition from a compensated to a decompensated status is mainly driven by portal hypertension and systemic inflammation. Although relevant modifications in the evaluation of the coagulative balance in cirrhosis across its natural history have occurred and alterations in routine indices of hemostasis have lost their role as indicators of the hemorrhagic risk of patients with liver cirrhosis, these are still perceived as prone to bleed when admitted to invasive procedures. This view, which is still present in guidelines addressing the management of bleeding risk, makes preprocedural transfusion of plasma and platelets still an ongoing clinical practice. In this review, we describe the limitations of both bleeding risk assessment in cirrhotic patients admitted to radiologic and endoscopic invasive procedures and evaluate whether preventive strategies indicated by current guidelines can affect the procedure-related hemorrhagic events.

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Section: Transarterial Chemoembolizationmentioning

confidence: 99%

Prevention and Management of Bleeding Risk Related to Invasive Procedures in Cirrhosis

Schepis¹,

Turco²,

Bianchini³

et al. 2018

Semin Liver Dis

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“…Three studies found that platelet counts < 10 Â 10 9 /L were associated with an increased risk of bleeding, 124,127,130 whereas the remaining eight studies demonstrated no association between platelet counts and bleeding. This could be explained by higher cutoffs for thrombocytopenia (50 Â 10 9 /L) 132,134 as well as higher median platelet counts 128,131 in the latter studies. Furthermore, a large proportion of studies on solid tumors focused on bleeding related to invasive procedures.…”

Section: Discussionmentioning

confidence: 73%

“…Thus, 52 studies were included for quality assessment and data extraction. 2, Studies included patients with hematological malignancy (n ¼ 31), 2,94-123 solid tumors (n ¼ 11), [124][125][126][127][128][129][130][131][132][133][134] or both (n ¼ 10). [135][136][137][138][139][140][141][142][143][144] There were 3 posthoc studies on data from randomized controlled trials, 104,117,120 2 case series 111,112 and 47 cohort studies, among which data were collected prospectively in 24 96,97,99,105-110,113,115,116,118,123,126,127 129-131,135,136,140,142,144 and obtained from medical records in 23.…”

Section: Resultsmentioning

confidence: 99%

“…[135][136][137][138][139][140][141][142][143][144] There were 3 posthoc studies on data from randomized controlled trials, 104,117,120 2 case series 111,112 and 47 cohort studies, among which data were collected prospectively in 24 96,97,99,105-110,113,115,116,118,123,126,127 129-131,135,136,140,142,144 and obtained from medical records in 23. 2, 94,95,98,100-103,114,119,121,122,124,125,128,132-134,137-139 141,143 Platelet count only was reported in 40 studies, 2, 94,95,97,98,[100][101][102][103][104][105]107,114,[116][117][118][119][120][121][122][124][125][126][127][128][129][130][131][132][133][134]…”

Section: Resultsmentioning

confidence: 99%

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The Role of Platelets in Cancer-Related Bleeding Risk: A Systematic Review

Larsen

Højbjerg

Hvas

2019

Semin Thromb Hemost

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Cancer patients face an elevated risk of bleeding, and here platelets play a pivotal role. The association between platelet count and bleeding, as well as safe thresholds for prophylactic platelet transfusion, is described mainly in hematological malignancies, and knowledge is sparse for patients with solid tumors. Platelet function tests may further improve bleeding risk assessment in cancer patients. This study provides a systematic review of the available literature on associations between platelet count and/or function and bleeding in adult cancer patients. The review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, and Web of Science were searched up to August 2019. The National Heart, Lung, and Blood Institute's tools were used for quality assessment. In total, 52 studies investigated associations between bleeding and platelet count (n = 40) or function (n = 12) in patients with hematological malignancy (n = 31), solid tumors (n = 11), or both (n = 10). The majority of included studies rated good (n = 23) or fair (n = 25). The association between platelet count and bleeding was most pronounced at platelet counts ≤ 10 × 109/L but was less evident for solid tumors. Overall, reduced platelet function was significantly associated with bleeding risk. Thus, the available evidence supports current guidelines for prophylactic platelet transfusions at platelet count ≤ 10 × 109/L in hematological cancer patients, whereas more evidence is needed in patients with solid tumors. Platelet function analysis may be valuable in assisting bleeding risk assessment in cancer patients but is sparsely investigated so far.

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“…Several studies report a decrease in platelet count after TACE 48 , 49 . In contrast, we observed no significant decrease in the platelet count in our patients.…”

Section: Discussionmentioning

confidence: 99%

The short-term safety and efficacy of TANDEM microspheres of various sizes and doxorubicin loading concentrations for hepatocellular carcinoma treatment

Lin

Liu

Pan

et al. 2021

Sci Rep

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Drug-eluting bead transarterial chemoembolization (DEB-TACE) is the most common treatment for unresectable hepatocellular carcinoma (HCC). However, the effect of drug loading concentration and microsphere size on treatment outcomes remains unclear. This retrospective study compares the outcomes of 87 HCC patients who underwent DEB-TACE with half-loaded or full-loaded doxorubicin (maximum capacity 50 mg/mL) in 75-µm or 100-µm microspheres. Treatment with 100-μm microspheres resulted in significantly lower rates of procedure-related complications (6.6% vs. 26.9%; P < 0.05), post-embolization syndrome (32.8% vs. 61.5%, P < 0.05), SIR complications (32.8% vs. 61.5%; P < 0.01) and adverse events involving abdominal pain (19.7% vs. 42.3%; P < 0.05). Half-load doxorubicin microspheres resulted in greater treatment response (OR, 4.00; 95% CI 1.06–15.13; P, 0.041) and shorter hospital stays (OR, − 1.72; 95% CI − 2.77–0.68; P, 0.001) than did microspheres loaded to full capacity. Stratified analysis further showed that patients treated with 100-μm half-load doxorubicin microspheres had a higher CR (63.6% vs 18.0%) and ORR (90.9 vs 54.0%) and a shorter hospital stay (1.6 ± 1.3 vs 4.2 ± 2.3 days) than did those treated with full-load microspheres (P < 0.05). Thus, the drug-loading concentration of microspheres in DEB-TACE should be carefully considered.

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Perioperative safety analysis of transcatheter arterial chemoembolization for hepatocellular carcinoma patients with preprocedural leukopenia or thrombocytopenia

Cited by 11 publications

References 31 publications

Prevention and Management of Bleeding Risk Related to Invasive Procedures in Cirrhosis

Prevention and Management of Bleeding Risk Related to Invasive Procedures in Cirrhosis

The Role of Platelets in Cancer-Related Bleeding Risk: A Systematic Review

The short-term safety and efficacy of TANDEM microspheres of various sizes and doxorubicin loading concentrations for hepatocellular carcinoma treatment

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