Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis

Sun, Ming-Yee; Bhaskar, Sonu

doi:10.3390/diagnostics12122954

Cited by 7 publications

(15 citation statements)

References 145 publications

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“…Qian et al [ 53 ] analyzed nine studies and showed that brain tumors, especially those diagnosed with HGG and GBM and submitted to neurosurgery, are associated with an increased risk of VTE. However, the authors did not mention the prevalence of VTE among these patients [ 52 ]. Horsted, West and Grainge [ 54 ] pointed out that having brain cancer lead to the second highest risk of VTE inferior only to pancreas cancer.…”

Section: Discussionmentioning

confidence: 99%

Incidence of venous thromboembolism and bleeding in patients with malignant central nervous system neoplasm: Systematic review and meta-analysis

Veiga,

Peres,

Ostolin

et al. 2024

PLoS ONE

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Purpose Central nervous system (CNS) malignant neoplasms may lead to venous thromboembolism (VTE) and bleeding, which result in rehospitalization, morbidity and mortality. We aimed to assess the incidence of VTE and bleeding in this population. Methods: This systematic review and meta-analysis (PROSPERO CRD42023423949) were based on a standardized search of PubMed, Virtual Health Library and Cochrane (n = 1653) in July 2023. After duplicate removal, data screening and collection were conducted by independent reviewers. The combined rates and 95% confidence intervals for the incidence of VTE and bleeding were calculated using the random effects model with double arcsine transformation. Subgroup analyses were performed based on sex, age, income, and type of tumor. Heterogeneity was calculated using Cochran’s Q test and I2 statistics. Egger’s test and funnel graphs were used to assess publication bias. Results: Only 36 studies were included, mainly retrospective cohorts (n = 30, 83.3%) from North America (n = 20). Most studies included were published in high-income countries. The sample size of studies varied between 34 and 21,384 adult patients, mostly based on gliomas (n = 30,045). For overall malignant primary CNS neoplasm, the pooled incidence was 13.68% (95%CI 9.79; 18.79) and 11.60% (95%CI 6.16; 18.41) for VTE and bleeding, respectively. The subgroup with elderly people aged 60 or over had the highest incidence of VTE (32.27% - 95%CI 14.40;53.31). The studies presented few biases, being mostly high quality. Despite some variability among the studies, we observed consistent results by performing sensitivity analysis, which highlight the robustness of our findings. Conclusions: Our study showed variability in the pooled incidence for both overall events and subgroup analyses. It was highlighted that individuals over 60 years old or diagnosed with GBM had a higher pooled incidence of VTE among those with overall CNS malignancies. It is important to note that the results of this meta-analysis refer mainly to studies carried out in high-income countries. This highlights the need for additional research in Latin America, and low- and middle-income countries.

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Section: Discussionmentioning

confidence: 99%

Incidence of venous thromboembolism and bleeding in patients with malignant central nervous system neoplasm: Systematic review and meta-analysis

Veiga,

Peres,

Ostolin

et al. 2024

PLoS ONE

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“…Certain phenotypes of cancer, such as lung, pancreatic, and brain cancer, carry an elevated risk of cancer-related stroke or thromboembolism [3]. Furthermore, cancer therapies, such as chemotherapy, radiation therapy, and surgery, might increase the risk of blood clots and strokes [1,35]. For instance, chemotherapy medications might cause damage to the lining of blood vessels, which can result in inflammation and clotting [60].…”

Section: Discussionmentioning

confidence: 99%

“…Haematologic intracerebral haemorrhages should be distinguished from other aetiologies of haemorrhagic strokes as they may have varying prognoses and require different treatment approaches for optimal secondary prevention for recurrent cerebral vascular disease [62]. Concerning recommendations for future direction, the improvement and standardisation of screening tools are of utmost priority in bridging the gap between low-and middle-income countries (LMICs) around the globe [2,35]. In the therapeutic management of stroke in cancer patients, we provide a stratified toolkit for clinical decision making or management for treating clinicians, to inform their clinical decision making in determining the appropriate preventive therapy.…”

Section: Discussionmentioning

confidence: 99%

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Bridging the Gap in Cancer-Related Stroke Management: Update on Therapeutic and Preventive Approaches

Sun

Bhaskar

2023

IJMS

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The underlying aetiopathophysiology of cancer-related strokes and thromboembolisms differs from that of noncancer-related strokes, which makes treating cancer-related strokes and thromboembolisms a distinct clinical challenge. This necessitates the development of novel, individualised diagnostic and treatment strategies. However, limited guidelines are available for the management of cancer-related strokes and the prevention of acute strokes or other thromboembolic events in this patient population. In this article, we present an updated overview of the therapeutic and preventive strategies for strokes in cancer settings. These strategies include acute reperfusion therapy, anticoagulant therapy, antiplatelet therapy, and lifestyle management options. We also outline comprehensive pathways and highlight gaps in the evidence-based clinical management of cancer-related strokes or thromboembolisms. Additionally, future recommendations for the management of strokes in cancer patients are provided.

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“…Research into a wider variety of chemotherapeutic drugs stratified by cancer phenotype and analysis of ischaemic vs. hemorrhagic stroke incidence is required to best guide clinicians in the administration of prophylactic therapy [ 117 ]. Our recent meta-analysis on VTE in cancer patients receiving chemotherapy revealed a pooled prevalence rate of 6%, ranging from 6% to 7% [ 118 ]. Furthermore, given the relatively increased risks of VTE in certain phenotypes of cancer, such as bladder, gastric, and ovarian, comprehensive cancer care should consider stratified VTE risk assessment based on cancer phenotype.…”

Section: Cancer Treatments and Stroke Riskmentioning

confidence: 99%

When Two Maladies Meet: Disease Burden and Pathophysiology of Stroke in Cancer

Sun

Bhaskar

2022

IJMS

Self Cite

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Stroke and cancer are disabling diseases with an enormous global burden, disproportionately affecting vulnerable populations and low- and middle-income countries. Both these diseases share common risk factors, which warrant concerted attention toward reshaping population health approaches and the conducting of fundamental studies. In this article, an overview of epidemiological trends in the prevalence and burden of cancer and stroke, underlying biological mechanisms and clinical risk factors, and various tools available for risk prediction and prognosis are provided. Finally, future recommendations for research and existing gaps in our understanding of pathophysiology. Further research must investigate the causes that predispose patients to an increased risk of stroke and/or cancer, as well as biomarkers that can be used to predict growing morbidity and mortality.

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Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis

Cited by 7 publications

References 145 publications

Incidence of venous thromboembolism and bleeding in patients with malignant central nervous system neoplasm: Systematic review and meta-analysis

Incidence of venous thromboembolism and bleeding in patients with malignant central nervous system neoplasm: Systematic review and meta-analysis

Bridging the Gap in Cancer-Related Stroke Management: Update on Therapeutic and Preventive Approaches

When Two Maladies Meet: Disease Burden and Pathophysiology of Stroke in Cancer

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