Predicting recurrences or major bleeding in women with cancer and venous thromboembolism. Findings from the RIETE Registry

Trujillo‐Santos, Javier; Ruíz-Gamietea, Ángeles; Luque, Juan M.; Sampériz, A.; García‐Bragado, F.; Todolí, José; Monréal, Manuel

doi:10.1016/s0049-3848(09)70003-9

Cited by 87 publications

(109 citation statements)

References 15 publications

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“…Common risk factors for bleeding events while on anticoagulant treatment include older age, female sex, history of bleeding, peptic ulcer, active cancer, hypertension, prior stroke, renal insufficiency, alcohol abuse, liver disease, targeted intensity of anticoagulant therapy and poor anticoagulant control [28][29][30][31][32][33][34][35][36][37][38][39]. The translation of these risk factors to clinical practice remains difficult, and physicians' estimates of the risk for anticoagulant-related bleeding are often inaccurate and poorly reproducible [40].…”

Section: Prediction Of Bleeding Eventsmentioning

confidence: 99%

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

et al. 2014

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Diagnosis of venous thromboembolism (VTE) requires prompt treatment with anticoagulants in therapeutic doses. Since these drugs are associated with the occurrence of haemorrhage, identification of patients at increased risk of major bleeding is of utmost clinical importance for defining the optimal treatment regimen and duration of anticoagulation. Current suggested prediction scores for bleeding risk in VTE patients have been derived from observational studies of moderate quality, or from patients with various indications for therapeutic anticoagulation other than VTE. To date, none of the scores have been adequately validated in cohorts that underwent dedicated monitoring and independent adjudication of bleeding complications. In addition, while the scarce available evidence has focused on patients treated with heparins and/or vitamin K antagonists, risk stratification scores for bleeding complications in VTE patients treated with non-vitamin K dependent anticoagulants have not yet been developed. This clinically oriented review covers the incidence and risk factors of anticoagulation-related bleeding in VTE patients treated with different anticoagulant drugs as well as the available bleedingprediction scores. Further, we attempt to provide guidance for bleeding-prevention in clinical practice and speculate on developments in the near future that may fundamentally change our current thinking on VTE management. @ERSpublications Bleeding in VTE: no validated risk-prediction scores, no effective preventive measures: are NOACs the solution?

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Section: Prediction Of Bleeding Eventsmentioning

confidence: 99%

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

et al. 2014

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“…87 Hutten et al 88 reported that oncology patients on vitamin K antagonists for documented VTE had a 3-to 6-fold higher risk for both recurrence and major bleeding compared with noncancer patients. According to the Computerized Registry of Patients with Venous Thromboembolism (RIETE), 89 patients younger than 65 years (OR, 3.0; 95% CI, 1.9-4.9), those with a PE diagnosis (OR, 1.9; 95% CI, 1.2-3.1), or those who developed VTE within 3 months after cancer diagnosis (OR, 2.0; 95% CI, 1.2-3.2) had an increased incidence of recurrent PE. Those younger than 65 years (OR, 1.6; 95% CI, 1.0-2.4) or less than 3 months from cancer diagnosis (OR, 2.4; 95% CI, 1.5-3.6) had an increased incidence of recurrent DVT.…”

mentioning

confidence: 99%

“…Finally, patients with immobility (OR, 1.8; 95% CI, 1.2-2.7), metastases (OR, 1.6; 95% CI, 1.1-2.3), recent bleeding (OR, 2.4; 95% CI, 1.1-5.1), or creatinine clearance below 0.50 ml/s/m 2 (OR, 2.2; 95% CI, 1.5-3.4; had an increased incidence of major bleeding. 89 Both VTE recurrence and bleeding events are related to cancer severity and are usually observed during the first month of anticoagulant treatment. Interestingly, they cannot be completely explained by either overtreatment or undertreatment, and therefore patients must be closely monitored during this period.…”

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confidence: 99%

Assessing the Risk and Prognosis of Thrombotic Complications in Cancer Patients

Kyriazi

Theodoulou

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Cancer is characterized by the development of a prothrombotic state. Approximately 15% to 20% and 1.5% to 3.1% of cancer patients develop venous and arterial thrombosis, respectively, whereas 18% to 20% of idiopathic venous events are caused by an occult neoplasia. The highest risk is observed in hematologic, gastrointestinal, and lung malignancies, as well as in patients with active disease, especially in the first 3 months after cancer diagnosis. Hospitalization, surgical interventions, and implanted venous devices increase the thrombotic risk. Patients with metastatic disease, febrile neutropenia, infections, and severe comorbidities experience more frequently a thrombotic event. A contemporary prechemotherapy predictive model incorporates both clinical and biologic parameters, such as the primary cancer site, platelet count, white blood cell count, hemoglobin, use of erythropoietic agents, and body mass index. Several studies aim to clarify the prognostic value of tissue factor, P-selectin, thrombin generation, microparticles, and D-dimers. Objectives.—To summarize current views on epidemiology, risk factors, and predictive variables, discussing the future perspectives and existing limitations in clinical practice. Data Sources.—Review of published literature, including review papers, epidemiologic studies, and clinical trials, in online medical databases. Conclusions.—The thrombogenic properties of tumor cells affect the prognosis and quality of life for the cancer population. Despite the improved awareness and prompt use of thromboprophylaxis, recent studies reported increased rates of thrombotic events, whereas the annual risks for thrombosis recurrence and bleeding are 21% and 12%, respectively. The clinical use of risk factors and prognostic parameters could allow for patient risk stratification and individualization of anticoagulant treatment.

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“…Up to nine per cent of patients with cancer treated with LMWH, and 20% of those treated with warfarin, can develop recurrent VTE. 19 Although randomised control trials are lacking, observational data support the use of LMWH in this setting. The recommended practice is to switch patients, who develop a recurrence while on warfarin therapy, to LMWH.…”

Section: How Should a Vte Be Treated In A Patient With A Malignancy?mentioning

confidence: 99%

Venous thrombosis in the patient with cancer

Wessels

2012

Southern African Journal of Gynaecological Oncology

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Predicting recurrences or major bleeding in women with cancer and venous thromboembolism. Findings from the RIETE Registry

Cited by 87 publications

References 15 publications

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

Assessing the Risk and Prognosis of Thrombotic Complications in Cancer Patients

Venous thrombosis in the patient with cancer

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