ABSTRACT

OBJECTIVES: To compare safety and efficacy of oral Apixaban with injectable Enoxaparin after robotic-assisted radical cystectomy (RARC) for venous thromboembolism (VTE) thromboprophylaxis. Traditionally, injectable low molecular weight heparin is used as VTE prophylaxis after RARC, but direct oral anticoagulants have been recently trialed.

MATERIALS AND METHODS: Retrospective review of prospectively collected data for all RARC patients treated at our tertiary care center between 2018-2022. Two groups in the study were: patients after prospectively implemented protocol from October 2021 to present utilizing a 21-day postoperative course of Apixaban 2.5mg twice daily after discharge, or patients prior to October 2021 receiving Enoxaparin 40mg daily. Baseline demographics and clinical characteristics such as VTE (defined as DVT or PE) were analyzed. Primary outcome was incidence of symptomatic VTE confirmed with definitive imaging within 90 days of RARC. Secondary outcomes included major bleeding, complications, readmission, and mortality within 30 days postoperatively. Descriptive statistics depicted baseline patient characteristics, operative information, complications. Differences in baseline characteristics and post-operative data were compared between groups. Multivariate logistic regression was used to determine associations between variables and primary outcome.

RESULTS: 124 patients received Apixaban prophylaxis, and 250 patients received Enoxaparin prophylaxis. Ten (2.7%) patients experienced a VTE within 90 days post-operatively (2 (1.6%) Apixaban group vs. 8 (3.2%) Enoxaparin group, p = 0.5). Upon patient stratification into EAU risk groups, no statistically significant difference in VTE rates was seen between groups in the Apixaban (2.7% "high + intermediate" vs. 1.1% "low", p = 0.5) and Enoxaparin cohorts (4.3% "high + intermediate" vs. 2.5% "low", p = 0.5). On multivariate logistic regression, no variables were associated with the development of the primary outcome.

CONCLUSION: Prophylaxis with Apixaban and Enoxaparin showed no statistically significant differences in VTE rates among RARC patients. Apixaban appears safe and effective for VTE prophylaxis after RARC.

PMID:37186173 | DOI:10.1111/bju.16036

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PubMed articles on: Cardio-Oncology

Quantitative cardiovascular magnetic resonance findings and clinical risk factors predict cardiovascular outcomes in breast cancer patients

PLoS One. 2023 May 30;18(5):e0286364. doi: 10.1371/journal.pone.0286364. eCollection 2023.

ABSTRACT

BACKGROUND: Cardiac magnetic resonance (CMR) global longitudinal strain and circumferential strain abnormalities have been associated with left ventricular ejection fraction (LVEF) reduction and cardiotoxicity from oncologic therapy. However, few studies have evaluated the associations of strain and cardiovascular outcomes.

OBJECTIVES: To assess CMR circumferential and global longitudinal strain (GLS) correlations with cardiovascular outcomes including myocardial infarction, systolic dysfunction, diastolic dysfunction, arrhythmias and valvular disease in breast cancer patients treated with and without anthracyclines and/or trastuzumab therapy.

METHODS: Breast cancer patients with a CMR from 2013-2017 at Yale New Haven Hospital were included. Patient co-morbidities, medications, and cardiovascular outcomes were obtained from chart review. Biostatistical analyses, including Pearson correlations, competing risk regression model, and competing risk survival curves comparing the two groups were analyzed.

RESULTS: 116 breast cancer with CMRs were included in our analysis to assess differences between Anthracycline/Trastuzumab (AT) (62) treated versus non anthracycline/trastuzumab (NAT) (54) treated patients in terms of imaging characteristics and outcomes. More AT patients 17 (27.4%) developed systolic heart failure compared to the NAT group 6 (10.9%), p = 0.025. Statin use was associated with a significant reduction in future arrhythmias (HR 0.416; 95% CI 0.229-0.755, p = 0.004). In a sub-group of 13 patients that underwent stress CMR, we did not find evidence of microvascular dysfunction by sub-endocardial/sub-epicardial myocardial perfusion index ratio after adjusting for ischemic heart disease.

CONCLUSIONS: In our study, CMR detected signs of subclinical cardiotoxicity such as strain abnormalities despite normal LV function and abnormal circumferential strain was associated with adverse cardiovascular outcomes such as valvular disease and systolic heart failure. Thus, CMR is an important tool during and after cancer treatment to identity and prognosticate cancer treatment-related cardiotoxicity.

PMID:37252927 | DOI:10.1371/journal.pone.0286364

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PubMed articles on: Cardio-Oncology

Cardiotoxicities of Non-Chemotherapeutic Metastatic Breast Cancer Treatments

Curr Oncol Rep. 2023 May 30. doi: 10.1007/s11912-023-01427-z. Online ahead of print.