ABSTRACT

Long-term indwelling central venous catheters (CVC) are frequently used to secure vascular access to deliver injectable treatment. Catheter-related thrombosis (CRT) occurs in approximately 2-6% of cancer patients. We conducted a single-center retrospective study to assess the rate of venous thromboembolism (VTE) recurrence in cancer patients; 200 patients were included. Mean age was 56 ± 15.15 years, median follow-up duration was 16.5 [range: 10-36] months. The incidence of recurrence was estimated using Gray's method for competing risk with death as the competing event of VTE. Recurrent VTE occurred in 25.5% of patients with a median occurrence time of 6.5 [range: 5-11.25] months. In case of recurrence, 94.6% of patients were treated for cancer and 80.4% of them received anticoagulants; 4 major bleeds and 17 non-major bleeds occurred during follow-up. In multivariate analysis, previous VTE (Hazard Ratio (HR) 2.48 (95% CI 1.42-4.32) and presence of CVC (HR 5.56 (95% CI 1.96-15.75) were significant recurrence risk factors. After a first episode of CRT, 25.5% of patients experienced VTE recurrence as UEDVT in 30 cases (55.5%), PE in 17 cases (31.5%), and DVT in 7 cases (13%), mostly during anticoagulation therapy. Anticoagulation therapy does not avoid CRT in case of cancer and must be balanced with hemorrhagic risk.

PMID:37195809 | DOI:10.1177/00033197231176985

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PubMed articles on: Cancer & VTE/PE

Overexpression of miR-483-5p predicts venous thrombo-embolism onset in patients with lung cancer especially in high BMI cases

Acta Biochim Pol. 2023 May 16. doi: 10.18388/abp.2020_6214. Online ahead of print.

ABSTRACT

BACKGROUND: Venous thromboembolism (VTE) is a common complication in patients with lung cancer. The important roles of microRNAs (miRNAs) in VTE have emerged, however, studies about the roles of miRNAs in VTE remain scarce. This study aimed to measure the expression of miR-483-5p in lung cancer patients with VTE, evaluate whether miR-483-5p could predict VTE onset in patients, and further evaluate its predictive value in patients with different BMI values.

METHODS: A total of 170 patients with lung cancer were recruited in this study, including 70 patients with VTE, and 110 patients with non-VTE. The expression of miR-483-5p was detected by quantitative real time PCR. Receiver operating characteristic analysis was used to screen VTE patients from non-VTE patients. Whether miR-483-5p was independently associated with VTE onset in lung cancer patients was evaluated by univariate and multivariate logistic regression analyses.

RESULTS: miR-483-5p was higher in VTE patients than that in non-VTE patients. miR-483-5p was correlated with body mass index (BMI), hypertension, C-reactive protein (CRP), and platelet count in VTE patients. In addition, miR-483-5p had high diagnostic value to differentiate between VTE patients and non-VTE patients and served as an independent biomarker in predicting the VTE onset in lung cancer patients. Moreover, miR-483-5p had the highest diagnostic accuracy to screen VTE patients from non-VTE patients in patients with high BMI values.

CONCLUSION: miR-483-5p, increased in VTE patients, can independently predict VTE onset in lung cancer patients especially in patients with high BMI values.

PMID:37192419 | DOI:10.18388/abp.2020_6214

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PubMed articles on: Cancer & VTE/PE

Anticoagulation management and related outcomes in patients with cancer-associated thrombosis and thrombocytopenia: A systematic review and meta-analysis

Thromb Res. 2023 May 11;227:8-16. doi: 10.1016/j.thromres.2023.05.012. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with cancer have an increased risk of both venous thromboembolism (VTE) requiring anticoagulation and thrombocytopenia. The optimal management is unclear. We performed a systematic review and meta-analysis to evaluate the outcomes in these patients.

METHODS: We searched MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials from inception to February 5, 2022. Studies assessing adult patients with cancer-associated thrombosis and platelet count <1009/L were included. Three anticoagulation management strategies were reported: full dose, modified dose, or no anticoagulation. The primary efficacy outcome was recurrent VTE, and the primary safety outcome was major bleeding. The incidence rates of thrombotic and bleeding outcomes by anticoagulation management strategies were descriptive, and were pooled using random effects model and expressed as events per 100 patient-months with associated 95 % confidence intervals (CI).

RESULTS: We included 19 observational cohort studies (N = 1728 patients) in the systematic review, with 10 included in the meta-analysis (N = 707 patients). Approximately 90 % of patients had hematological malignancies, with low-molecular-weight heparin being the main anticoagulant. The rates of recurrent VTE and bleeding complications were high regardless of management strategies - recurrent VTE on full dose: 2.65/100 patient-months (95 % CI 1.62-4.32), modified dose: 3.51/100 patient-months (95 % CI 1.00-12.39); major bleeding on full dose: 4.45/100 patient-months (95 % CI 2.80-7.06), modified dose: 4.16/100 patient-months (95 % CI 2.24-7.74). There was serious risk of bias in all studies.

CONCLUSIONS: Patients with cancer-associated thrombosis and thrombocytopenia have high risks of both recurrent VTE and major bleeding, but current literature is significantly limited to guide the best management.

PMID:37196605 | DOI:10.1016/j.thromres.2023.05.012

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PubMed articles on: Cancer & VTE/PE

Outcomes From a Prospectively Implemented Protocol Using Apixaban After Robotic Radical Cystectomy

BJU Int. 2023 Apr 25. doi: 10.1111/bju.16036. Online ahead of print.