Thrombosis and kidney disease in cancer: comorbidities defining a very high risk patient: A position paper from the Cancer &amp; the Kidney International Network

Launay‐Vacher, Vincent; Scotté, Florian; Riess, Hanno; Ashman, Neil; McFarlane, Philip A.; C, Christine Maria Ribic; Elalamy, Ismaı̈l

doi:10.1177/2399369318809102

Cited by 4 publications

(3 citation statements)

References 109 publications

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“…The Cancer and the Kidney International Network (C-KIN) states that, "Among LMWHs, tinzaparin presents with the clearest data on its use in CKD patients, demonstrating no accumulation at the usual dosage, and thus there is no need for dosage adjustment." The same network recommended that among LMWHs, tinzaparin should be the treatment of choice in cancer patients with CKD [31]. This is consistent with the absence of significant impact of CKD on the bleeding risk in cancer patients treated with tinzaparin based on the clinical experience from randomized controlled trials.…”

Section: Clinical Practice Implicationsmentioning

confidence: 59%

Tinzaparin Sodium Pharmacokinetics in Patients with Chronic Kidney Disease: Practical Implications

Helfer

Siguret

Mahé

2019

Am J Cardiovasc Drugs

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Low-molecular-weight heparins (LMWHs) are the mainstay of the prophylaxis and treatment of venous thromboembolism (VTE). Due to their renal elimination, the risk of accumulation with the related bleeding risk may represent a limitation for the use of LMWHs in patients with chronic kidney disease (CKD) as the risk of major bleeding is increased in patients with creatinine clearance (CrCl) < 30 mL/min, especially in patients with cancer. LMWH structure and molecular weight (MW) are heterogeneous among available agents. The elimination of tinzaparin, which has the highest mean MW among LMWHs, is less dependent on renal function as it is also metabolized through the reticuloendothelial system. A subcutaneous therapeutic dose of tinzaparin (175 IU/kg) once daily has been shown to cause no accumulation of anti-factor Xa activity in patients with CrCl ≥ 20 mL/min. Clinical experience from randomized controlled studies has shown no significant impact of CKD on bleeding risk in cancer patients receiving treatment doses of tinzaparin. This suggests that in these patients the use of treatment doses of tinzaparin does not require anticoagulation monitoring or dose adjustment.

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Section: Clinical Practice Implicationsmentioning

confidence: 59%

Tinzaparin Sodium Pharmacokinetics in Patients with Chronic Kidney Disease: Practical Implications

Helfer

Siguret

Mahé

2019

Am J Cardiovasc Drugs

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“…Older age is a controversial risk factor for CAT in LC patients, and further investigation is needed [13,17,26,147]. Major comorbidities, including chronic obstructive pulmonary disease (COPD), chronic kidney disease and cardiovascular disease, as well as smoking and obesity, may also increase the risk of CAT [16,38,[148][149][150][151][152][153]. In a recent meta-analysis of 16 studies, the prevalence of PE was significantly higher among LC patients with COPD history (OR =2.59; 95% CI, 1.09-6.15; p = 0.03) [149].…”

Section: Special Populationsmentioning

confidence: 99%

Lung Cancer Related Thrombosis (LCART): Focus on Immune Checkpoint Blockade

Charpidou,

Gerotziafas,

Popat

et al. 2024

Cancers

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Cancer-associated thrombosis (CAT) is a common complication in lung cancer patients. Lung cancer confers an increased risk of thrombosis compared to other solid malignancies across all stages of the disease. Newer treatment agents, including checkpoint immunotherapy and targeted agents, may further increase the risk of CAT. Different risk-assessment models, such as the Khorana Risk Score, and newer approaches that incorporate genetic risk factors have been used in lung cancer patients to evaluate the risk of thrombosis. The management of CAT is based on the results of large prospective trials, which show similar benefits to low-molecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs) in ambulatory patients. The anticoagulation agent and duration of therapy should be personalized according to lung cancer stage and histology, the presence of driver mutations and use of antineoplastic therapy, including recent curative lung surgery, chemotherapy or immunotherapy. Treatment options should be evaluated in the context of the COVID-19 pandemic, which has been shown to impact the thrombotic risk in cancer patients. This review focuses on the epidemiology, pathophysiology, risk factors, novel predictive scores and management of CAT in patients with active lung cancer, with a focus on immune checkpoint inhibitors.

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“…Accordingly, treatment doses do not require monitoring or adjustment in patients with CrCl ≥ 20 ml/min. Cancer and the Kidney International Network recommended tinzaparin as the treatment of choice in cancer patients with chronic RI [ 58 ]. A systematic review regarding tinzaparin safety, including a total of 1588 cancer patients with RI, stated that MB were between 0.8% and 7% and CRNM were significantly lower compared to VKA.…”

Section: Renal Insufficiencymentioning

confidence: 99%

Cancer-Associated Thrombosis: Not All Low-Molecular-Weight Heparins Are the Same, Focus on Tinzaparin, A Narrative Review

Fioretti

Leopizzi

Puzzovivo

et al. 2022

International Journal of Clinical Practice

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Cancer-associated thrombosis (CAT) is the second main cause of cancer death with high related mortality and morbidity, leading to anticancer agent delays and interruptions. The recommended therapy, low-molecular-weight heparin (LMWH), however, is burdensome for patients and costly for society, as treatment should last until cancer is no longer active, even indefinitely. Tinzaparin is a manageable, efficient, safe, and cost-effective option. Compared to the other LMWHs, advantages are single-daily dose and safety in the elderly and those with renal impairment (RI). The purpose of this review is to critically discuss recent data on its efficacy and safety in CAT.

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Thrombosis and kidney disease in cancer: comorbidities defining a very high risk patient: A position paper from the Cancer & the Kidney International Network

Cited by 4 publications

References 109 publications

Tinzaparin Sodium Pharmacokinetics in Patients with Chronic Kidney Disease: Practical Implications

Tinzaparin Sodium Pharmacokinetics in Patients with Chronic Kidney Disease: Practical Implications

Lung Cancer Related Thrombosis (LCART): Focus on Immune Checkpoint Blockade

Cancer-Associated Thrombosis: Not All Low-Molecular-Weight Heparins Are the Same, Focus on Tinzaparin, A Narrative Review

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