Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Patients with Lung Adenocarcinoma at Risk for Cancer-Associated Thrombosis: The Observational ROADMAP-CAT Study

Syrigos, Konstantinos; Grapsa, Dimitra; Sangare, Rabiatou; Evmorfiadis, Ilias; Larsen, Annette K.; Dreden, Patrick Van; Boura, Paraskevi; Charpidou, Andriani; Κοττέας, Ηλίας; Sergentanis, Theodoros N.; Elalamy, Ismaı̈l; Falanga, Anna; Gerotziafas, Grigoris T.

doi:10.1634/theoncologist.2017-0530

Cited by 41 publications

(56 citation statements)

References 36 publications

(49 reference statements)

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“…A RAM specific for MM that includes treatment-related parameters to adequate reflect thrombotic risk is required. The value of incorporating biomarkers into clinical RAMs has been shown previously as the incorporation of P-selectin and D-dimers into the Vienna prediction score improved the sensitivity and specificity of the original Khorana score for chemotherapy-related VTE risk in patients with solid tumors [87].…”

Section: Risk Assessment Modelsmentioning

confidence: 93%

Multiple Myeloma and Thrombosis: Prophylaxis and Risk Prediction Tools

Fotiou

Gavriatopoulou

Terpos

2020

Cancers

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Thromboembolism in multiple myeloma (MM) patients remains a common complication that renders the optimization of our thromboprophylaxis practice necessary. This review aims to make clear the need for the development of more accurate risk assessment tools and means of thrombosis prevention. Current clinical practice is guided by available guidelines published by the IMWG in 2014, but the extent to which these are implemented is unclear. Recently, several groups developed clinical scores for thrombosis risk in MM in an attempt to improve risk stratification, but these have not been validated or used in clinical practice so far. Research in this field is increasingly focusing on understanding the unique coagulation profile of the MM patient, and data on potential biomarkers that accurately reflect hypercoagulability is emerging. Finally, promising evidence on the effectiveness of direct oral anticoagulants (DOACs) in the context of thrombosis prevention in MM patients is increasingly becoming available. The critical appraisal of the above research areas will establish the necessity of combining disease-specific clinical risk factors with coagulation biomarkers to allow more effective risk stratification that will eventually lead to the reduction of this significant complication. Results from ongoing clinical trials on the role of DOACs are much anticipated.

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Section: Risk Assessment Modelsmentioning

confidence: 93%

Multiple Myeloma and Thrombosis: Prophylaxis and Risk Prediction Tools

Fotiou

Gavriatopoulou

Terpos

2020

Cancers

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“…In contrast to felines, human beings with pulmonary carcinomas more frequently acquire venous thromboembolism (VTE) than ATE [ 19 ]. Only a few instances of ATE as a result of spontaneous tumor embolization or tumor embolization at the time of surgery for pulmonary carcinoma have been reported [ 20 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…In human beings with neoplasia, underlying causes of a hypercoagulable state include direct coagulation pathway activation, induction of inflammatory responses, inhibition of fibrinolytic activity, venous stasis, and vessel wall injury [ 23 ]. It has been estimated that VTE occurs in about 10% of ambulatory patients with lung neoplasia and the risk of VTE is twice as high for patients with pulmonary carcinoma than for patients with other pulmonary neoplasms [ 19 ]. Risk factors for VTE in human beings with pulmonary carcinoma include a cancer diagnosis of less than 6 months, hospitalization within 3 months prior to assessment, presence of cardiovascular risk factors, obesity, procoagulant phospholipid-dependent clotting time (Procoag-PPL) shorter than 44 seconds, and mean rate index of thrombin generation (MRI) lower than 125 nM/min [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…It has been estimated that VTE occurs in about 10% of ambulatory patients with lung neoplasia and the risk of VTE is twice as high for patients with pulmonary carcinoma than for patients with other pulmonary neoplasms [ 19 ]. Risk factors for VTE in human beings with pulmonary carcinoma include a cancer diagnosis of less than 6 months, hospitalization within 3 months prior to assessment, presence of cardiovascular risk factors, obesity, procoagulant phospholipid-dependent clotting time (Procoag-PPL) shorter than 44 seconds, and mean rate index of thrombin generation (MRI) lower than 125 nM/min [ 19 ]. We are unaware of any studies that have measured these coagulation parameters in cats.…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary Sarcomatoid Carcinoma Associated with Arterial Thromboembolism in a Cat

Guarino

Jeon

Abbott

et al. 2021

Case Reports in Veterinary Medicine

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A 14-year-old, neutered male domestic shorthair cat presented for acute monoparesis with physical exam findings and biochemical data supportive of a distal arterial thromboembolism. Thoracic radiographs revealed an alveolar pattern in the right middle lung lobe and multifocal nodules in other lung lobes. A pulmonary mass was found on necropsy, which was composed of both carcinomatous and sarcomatous components, confirmed with cytokeratin and vimentin immunohistochemistry. Using the World Health Organization classification scheme for mixed pulmonary tumors, this tumor would be characterized as a pleomorphic squamous cell carcinoma under the umbrella term of pulmonary sarcomatoid carcinoma. The World Health Organization classification of mixed pulmonary tumors and its application to previously reported mixed pulmonary tumors in companion animals is discussed. This is the first reported case of this tumor type in a cat, as well as the first report of this tumor type associated with an arterial thromboembolism in any veterinary species.

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“…21 Similar risk models using a combination of clinical risk factors and biomarkers have been published, although few have been validated. [22][23][24][25] The major determinant of the Khorana score, and the most recent score from the Vienna Cancer Associated Thrombosis cohort, 26 is cancer site, which places all patients with gynecologic cancer in an intermediate-risk category prior to the addition of other risk determinants. Hence, this approach lacks stratification power among cohorts of a single cancer type, as has been shown in studies of patients with lung cancer.…”

Section: Introductionmentioning

confidence: 99%

A risk score for prediction of venous thromboembolism in gynecologic cancer: The Thrombogyn score

Norris

Ward

O’Toole

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Gynecologic cancers are associated with high rates of venous thromboembolism (VTE), which is exacerbated by pelvic surgery and chemotherapy. Objectives The aim of this study was to develop and validate a risk score for VTE in patients with gynecologic cancer and to test the predictive ability of the score following addition of procoagulant biomarker data. Patients and methods Clinical and laboratory variables were used to develop a risk score for the prediction of VTE in patients with gynecological cancer (n = 616), which was validated in a separate cohort of patients (n = 406). Endogenous thrombin potential and D‐dimer levels were determined in a subset (n = 290) of patients and used to produce an extended score in the validation cohort. Results Multivariable regression analysis identified BMI >30, hemoglobin <11.5 g/dL and chemotherapy as independent predictors of VTE, which formed the Thrombogyn score. Following competing risk regression analysis, subdistribution hazard ratios (SHRs), adjusted for cancer stage, were 8.16 (95% confidence interval [CI], 1.69‐43.77) in the high‐risk group (score = 2‐3) and 4.12 (95% CI, 0.85‐20.15) in the intermediate‐risk group (score = 1) compared with the low‐risk group (score = 0). SHRs for the validation cohort were 6.26 (95% CI, 1.24‐31.39) and 3.00 (95% CI, 0.67‐13.32), respectively. Cumulative incidence of VTE in the validation cohort high‐risk group was 10.34% (95% CI, 6.51‐16.41) per women‐years compared with 1.06% (95% CI, 0.26‐4.26) in the low‐risk group. Using the extended Thrombogyn score, adjusted SHRs were 16.83 (95% CI, 4.20‐67.37) in the high‐risk group with a cumulative incidence of 21.15% (95% CI, 10.32‐45.24). External validation of the score is required. Conclusions The Thrombogyn score identifies patients with gynecologic cancer at high and low risk of VTE. Addition of biomarker data improves the predictive power of the score.

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Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Patients with Lung Adenocarcinoma at Risk for Cancer-Associated Thrombosis: The Observational ROADMAP-CAT Study

Cited by 41 publications

References 36 publications

Multiple Myeloma and Thrombosis: Prophylaxis and Risk Prediction Tools

Multiple Myeloma and Thrombosis: Prophylaxis and Risk Prediction Tools

Pulmonary Sarcomatoid Carcinoma Associated with Arterial Thromboembolism in a Cat

A risk score for prediction of venous thromboembolism in gynecologic cancer: The Thrombogyn score

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