Thromboembolism in Patients with Bladder Cancer: Incidence, Risk Factors and Prevention

Zareba, Piotr; Duivenvoorden, Wilhelmina; Pinthus, Jehonathan H.

doi:10.3233/blc-170146

Cited by 15 publications

(17 citation statements)

References 59 publications

(57 reference statements)

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“…The results in the present and other series indicate that neoadjuvant or adjuvant chemotherapy might have a further prolonged effect on the occurrence of VTE [20][21][22][23][29][30][31], possibly due to cisplatin-induced apoptosis and vascular necrosis mediated by the cytotoxic effect of caspases and calpain or vascular damage from central venous catheters or other mechanisms of hypercoagulability [17,18]. Similar results have been found with carboplatin and gemcitabine [19].…”

Section: Results Of the Study In Relation To Previous Findingssupporting

confidence: 84%

Thromboembolism in Muscle-Invasive Bladder Cancer. A Population-based Nationwide Study

Jahnson

Gårdmark

Hosseini

et al. 2021

BLC

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BACKGROUND: Routine VTE prophylaxis within 30 days of radical cystectomy (RC) for urinary bladder cancer (UBC) is used to protect from venous thromboembolism (VTE). However, randomized studies and nationwide population-based studies are lacking. OBJECTIVE: To study VTE and risk factors for VTE in muscle-invasive UBC in a nationwide population-based series, with a focus on the association with RC with and without chemotherapy. MATERIALS AND METHODS: We studied all patients with clinical stage T2-T4 UBC diagnosed 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe). Previous VTE events and risk factors for VTE were registered from 1987. Cox regression analyses and Kaplan-Meier curves were performed to study risk factors for VTE and cumulative incidence of VTE. RESULTS: In 9720 patients (71%males) with a median age of 74 years 546 (5.6%) had VTE after diagnosis. In Cox analyses controlling for patient’s and tumour characteristics, and risk factors for VTE, VTE after diagnosis and first treatment date were associated with chemotherapy with or without RC. Cumulative incidence of VTE increased during 24 months after diagnosis and first treatment date. VTE were less common in patients with previous cardiovascular disease. CONCLUSIONS: VTE was commonly observed after 30 days from diagnosis and from first treatment date in patients with T2-T4 UBC, particularly after chemotherapy. The findings suggest that long-term intervention studies of benefit and possible harms of VTE prophylaxis after UBC should be undertaken.

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Section: Results Of the Study In Relation To Previous Findingssupporting

confidence: 84%

Thromboembolism in Muscle-Invasive Bladder Cancer. A Population-based Nationwide Study

Jahnson

Gårdmark

Hosseini

et al. 2021

BLC

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“…A biomarker, therefore, would be helpful for a personalized risk assessment and individually tailored decision-making regarding risk of VTE and duration of prophylaxis. The VTE rate in our cohort (3.2%) is in congruence with the incidence after RC depending on preexisting risk factors in the literature (2.6-11.6%) [20]. Our findings are in contrast to a study in metastatic breast cancer patients, in which CTC detected by the CellSearch ® system were significantly associated with an increased risk of VTE [10].…”

Section: Discussionsupporting

confidence: 87%

The Impact of Circulating Tumor Cells on Venous Thromboembolism and Cardiovascular Events in Bladder Cancer Patients Treated with Radical Cystectomy

Rink

Kölker

et al. 2020

JCM

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Background: Cancer is a relevant risk factor for venous thromboembolism (VTE). Circulating tumor cells (CTC) are associated with an increased risk of VTE in breast cancer. In addition, circulating cell-free nucleic acids have been associated with cardiovascular events (CVE). Objective: To investigate the association of CTC status and the risk of VTE as well as CVE in urothelial carcinoma of the bladder (UCB) patients treated with radical cystectomy (RC). Methods: We collected data of 189 UCB patients treated with RC at our institution. Blood samples were acquired preoperatively and analyzed for CTC using the CellSearch® system. Thirty-day postoperative complications were extracted from digital charts and graded according to the Clavien–Dindo classification (CDC). Moreover, each patient’s individual Comprehensive Complication Index® (CCI®) was calculated. Results: CTC were present in 43 patients (22.8%). Overall, six patients experienced VTE (3.2%) and eight patients (4.2%) experienced CVE. There was no association of VTE or CVE according to CTC status. In total, 168 patients (89%) experienced a total of 801 complications, of which the majority was classified as “minor” (CDC grade ≤ IIIa; 79%). There was no association between CTC status and any grade of a complication or CCI®. Presence of CTC was associated with more aggressive clinicopathological UCB features. Conclusions: The overall rate of VTE and CVE was low in our study. Presence of CTC was neither associated with an increased risk of VTE nor CVE in UCB patients treated with RC. According to this study, CTC are not a qualified biomarker for individualized thromboprophylaxis management in these patients.

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“…1,2 The incidence of VTE is relatively low in urologic cancer compared with other cancer types. [3][4][5] However, the adequate management of cancer-associated VTE is important to prevent patient mortality. Anticoagulation is the mainstay of VTE treatment in which anticoagulants are ap-propriately decided by the clinicians to prevent bleeding events in patients.…”

Section: Introductionmentioning

confidence: 99%

A Study on the Efficacy and Safety of Rivaroxaban in Urologic Cancer-Associated Venous Thromboembolism

Lee

You

Lee

et al. 2019

Korean J Urol Oncol

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Purpose: Although direct oral anticoagulants (DOACs) are recommended as an alternative to low-molecular weighted heparin for cancer-associated venous thromboembolism (VTE), there is no firm evidence on the efficacy and safety of DOACs in patients with urologic cancer. Therefore, we compared the efficacy and safety of rivaroxaban and dalteparin for treating cancer-associated VTE in urologic cancer. Materials and Methods: We reviewed the medical records of 124 eligible VTE patients with urologic cancers who were treated with dalteparin or rivaroxaban. The primary outcome was the composite event of clinically relevant bleeding or VTE recurrence. The secondary outcomes were VTE recurrence, clinically relevant bleeding events, and all-cause mortality. Results: During anticoagulation period, there was no significant difference in primary and secondary outcomes between the groups. In Cox proportional hazards model for composite events, although there was no statistical significance, rivaroxaban presented lower hazard ratio (HR) than dalteparin (HR, 0.472; 95% confidence interval [CI], 0.210-1.060; p=0.069 in univariate analysis; HR, 0.505; 95% CI, 0.206-1.234; p=0.134 in multivariate analysis). In clinically relevant bleeding events, there was no significance difference between rivaroxaban and dalteparin (HR, 0.568; 95% CI, 0.238-1.358; p=0.203 in univariate analysis; HR, 0.617; 95% CI, 0.232-1.636; p=0.331 in multivariate analysis). Conclusions: Rivaroxaban can be regarded as a valuable option for VTE in urologic cancer. Further prospective studies are warranted to prove the safety or efficacy of rivaroxaban for treating VTE in patients with urologic cancer.

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Thromboembolism in Patients with Bladder Cancer: Incidence, Risk Factors and Prevention

Cited by 15 publications

References 59 publications

Thromboembolism in Muscle-Invasive Bladder Cancer. A Population-based Nationwide Study

Thromboembolism in Muscle-Invasive Bladder Cancer. A Population-based Nationwide Study

The Impact of Circulating Tumor Cells on Venous Thromboembolism and Cardiovascular Events in Bladder Cancer Patients Treated with Radical Cystectomy

A Study on the Efficacy and Safety of Rivaroxaban in Urologic Cancer-Associated Venous Thromboembolism

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