Role of Factor Xa Inhibitors in Cancer-Associated Thrombosis: Any New Data?

Zalpour, Ali; Kroll, Michael H.; Afshar-Kharghan, Vahid; Yusuf, Salim; Escalante, Carmen P.

doi:10.1155/2011/196135

Cited by 10 publications

(22 citation statements)

References 71 publications

(78 reference statements)

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“…Large retrospective analyses [4] and a recently published prospective trial [5] indicate that low molecular weight and unfractionated heparin are equally effective for the prevention of DVT in ICU patients, although LMWH may be better at preventing pulmonary embolism. Emerging data also supports the use of factor Xa inhibitors, such as fondaparinux, in selected ICU patients [6].…”

Section: Introductionmentioning

confidence: 88%

Standard subcutaneous dosing of unfractionated heparin for venous thromboembolism prophylaxis in surgical ICU patients leads to subtherapeutic factor Xa inhibition

et al. 2012

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Section: Introductionmentioning

confidence: 88%

Standard subcutaneous dosing of unfractionated heparin for venous thromboembolism prophylaxis in surgical ICU patients leads to subtherapeutic factor Xa inhibition

et al. 2012

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“…Active factor X (FXa) inhibitors have recently emerged as alternatives to heparins in cancer patients [4] and, in particular, Apixaban has been suggested to be a possible option for cancer patients with venous thromboembolism [5]. …”

Section: Introductionmentioning

confidence: 99%

In vitro effects of Apixaban on 5 different cancer cell lines

et al. 2017

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BackgroundCancer is associated with hypercoagulability. However, several data suggest that anticoagulant drugs may have an effect on tumor development and progression mediated by both coagulation dependent processes and non-coagulation dependent processes. Therefore, we investigated the in vitro effects of Apixaban on cell proliferation, mortality, cell migration, gene expression and matrix metalloproteinase in 5 different cancer cell lines.MethodsThe following cancer cell lines, and 2 normal fibroblast cultures (lung and dermal fibroblasts), were studied: OVCAR3 (ovarian cancer), MDA MB 231 (breast cancer), CaCO-2 (colon cancer), LNCaP (prostate cancer) and U937 (histiocytic lymphoma). Proliferation and cell mortality were assessed in control cells and Apixaban treated cultures (dose from 0.1 to 5 μg/ml, 0 to 96-h). Necrosis/Apoptosis (fluorescence microscopy), cell migration (24-h after scratch test), matrix metalloproteinase (MMP) activity and mRNA expression (RT PCR) of p16, p21, p53 and HAS were also assessed.ResultsHigh-dose (5 μg/ml) Apixaban incubation was associated with a significantly reduced proliferation in 3 cancer cell lines (OVCAR3, CaCO-2 and LNCaP) and with increased cancer cell mortality in all, except LNCaP, cancer lines. Apoptosis seems to account for the increased mortality. The migration capacity seems to be impaired after high-dose Apixaban incubation in OVCAR3 and CaCO-2 cells. Data on mRNA expression suggest a consistent increase in tumor suppression gene p16 in all cell lines.ConclusionsOur data suggest that high-dose Apixaban may be able to interfere with cancer cell in vitro, reducing proliferation and increasing cancer cell mortality through apoptosis in several cancer cell lines.

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“…It was demonstrated to be an option for VTE prevention in cancer patients hospitalized for acute medical illness or surgery. 29 On account of the lack of a reversal agent and significant dependence on renal clearance, its employment in the palliative care setting might be limited, although there are reports on the successful use of fondaparinux in both primary and secondary VTE prevention in oncological patients. 30 Novel oral anticoagulants (NOA) are specific inhibitors of activated factor X (apixaban, rivaroxaban and edoxaban) or thrombin (dabigatran).…”

Section: Selection Of Thromboprophylaxis Methods With Reference To Hosmentioning

confidence: 99%

Thromboprophylaxis in cancer patients in hospice

Zabrocka¹,

Wojtukiewicz²,

Sierko³

2018

Adv Clin Exp Med

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Advanced cancer patients in hospice are at notably increased risk of venous thromboembolism (VTE) due to age, local and distal advancement of the malignancy and bed confinement, among other factors. Asymptomatic VTE prevalence among palliative care patients has been found to reach 50%, whereas the clinically overt form occurs in 10%. Hospice patients are frequently given medications increasing VTE risk, for instance megestrol which is a drug commonly used in cancer cachexia. Many of the available guidelines encourage the implementation of thromboprophylaxis (TPX) in cancer patients, e.g., in the perioperative period or over the course of chemotherapy. However, concerning patients remaining under hospice care where the priority goal is not life extension but assurance of the best possible quality of life (QoL), the main benefit from the TPX would be a decrease in the risk of symptom burden associated with VTE, i.e., pain, edema or dyspnea. Nevertheless, studies performed on a sufficiently large study group, which could unequivocally determine the influence of anticoagulation on VTE symptom burden in hospice patients, are still lacking. VTE prophylaxis is challenging for many reasons: its unknown effect on QoL, vague risk of its discontinuation, and risk of bleeding complications which is additionally increased in conditions prevalent in hospice population, i.e., malnutrition, renal or liver insufficiency. So far, most of the guidelines issued by oncological societies do not precisely refer to the problem of TPX in hospice patients. Therefore, the decisions on the implementation of anticoagulation should be taken individually, with previous assessment of VTE risk, comorbidities and possible hemorrhagic complications.

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Role of Factor Xa Inhibitors in Cancer-Associated Thrombosis: Any New Data?

Cited by 10 publications

References 71 publications

Standard subcutaneous dosing of unfractionated heparin for venous thromboembolism prophylaxis in surgical ICU patients leads to subtherapeutic factor Xa inhibition

Standard subcutaneous dosing of unfractionated heparin for venous thromboembolism prophylaxis in surgical ICU patients leads to subtherapeutic factor Xa inhibition

In vitro effects of Apixaban on 5 different cancer cell lines

Thromboprophylaxis in cancer patients in hospice

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