ardiotoxicity News

Previous messages

29 August 2023

C

17:35

Cardiotoxicity News

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:35

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:35

In reply to this message

PubMed articles on: Cancer & VTE/PE

Hormone Therapy: Menopausal Hormone Therapy

FP Essent. 2023 Aug;531:15-21.

ABSTRACT

The marked decrease in estrogen levels in menopausal women can cause bothersome symptoms that affect daily life. More than 75% of women experience menopausal symptoms, which can include vaginal dryness, itching, discharge, dyspareunia, mood changes, hot flushes, and night sweats. Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms. Benefits include decreased risk of osteoporotic fractures and vaginal atrophy, improved glycemic control, and decreased vasomotor symptoms. However, recent research on risks associated with MHT has shown increased risk of venous thromboembolism and breast cancer. MHT typically is an option for patients younger than 60 years or within 10 years of menopause onset with bothersome vasomotor symptoms. The decision to start MHT should be made on an individual basis after a thorough evaluation and counseling. Oral, intramuscular, transdermal, and intravaginal formulations are available. The goal of therapy is use of the lowest dose for the shortest time that effectively manages symptoms. The patient and physician should regularly assess the risks and benefits associated with MHT and ensure that the benefits of its use continue to outweigh the risks.

PMID:37603881

17:35

In reply to this message

PubMed articles on: Cancer & VTE/PE

Cost-effectiveness of apixaban and rivaroxaban in thromboprophylaxis of cancer patients treated with chemotherapy in Spain

J Med Econ. 2023 Aug 21:1-28. doi: 10.1080/13696998.2023.2248839. Online ahead of print.

ABSTRACT

BACKGROUND: Apixaban and rivaroxaban are two direct-acting oral anticoagulants (DOACs) recommended for thromboprophylaxis in cancer patients treated with chemotherapy in an ambulatory setting. We aimed to assess the cost-utility of thromboprophylaxis with apixaban and rivaroxaban vs no thromboprophylaxis in ambulatory cancer patients starting chemotherapy with an intermediate-to-high risk of venous thromboembolism (VTE), Khorana score ≥ 2 points.

METHODS: A cost-effectiveness analysis was performed from the perspective of Spain´s National Health System (NHS) using an analytical decision model in the short term (180 days) and a Markov model in the long term (5 years). Transition probabilities were obtained from randomized, double-blind, placebo-controlled clinical trials of apixaban and rivaroxaban in adult ambulatory patients with cancer at risk for VTE, treated with chemotherapy (AVERT and CASSINI trials). The costs (€2021) were taken from Spanish sources. The utilities of the model were obtained through the EQ-5D questionnaire. Deterministic (base case) and probabilistic (second-order Monte Carlo simulation) analyses were conducted.

RESULTS: In the probabilistic sensitivity analysis, apixaban generated a cost per patient of €1,082 ± 187 with a 95% confidence intervals (CI) of €713;1,442, while no prophylaxis produced a cost per patient of €1,146 ± 218 with a 95% CI of €700; 1491, with a saving of €64 per patient and a gain of 0.008 QALYs. Likewise, rivaroxaban provided a cost per patient of €993 ± 133 with a 95% CI of €748; 1,310, while no prophylaxis produced a cost per patient of €872 ± 152 with a 95% CI of €602; 1,250, with an additional expense of €121 per patient and a gain of 0.008 QALYs.

CONCLUSIONS: In thromboprophylaxis of cancer patients, the use of apixaban and rivaroxaban generated similar cost compared to non-prophylaxis, without the difference found being statistically significant, with a clinically insignificant QALY gain.

PMID:37602646 | DOI:10.1080/13696998.2023.2248839

17:35

In reply to this message

PubMed articles on: Cancer & VTE/PE

Reply to "Is venous thromboembolism a time-dependent event in breast cancer patients taking tamoxifen?"

Breast Cancer. 2023 Aug 21. doi: 10.1007/s12282-023-01495-w. Online ahead of print.

NO ABSTRACT

PMID:37603254 | DOI:10.1007/s12282-023-01495-w

17:35

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:35

In reply to this message

PubMed articles on: Cancer & VTE/PE

Evaluation of anti-Xa levels in patients with venous thromboembolism within the first 48 h of anticoagulation with unfractionated heparin

SAGE Open Med. 2023 Aug 17;11:20503121231190963. doi: 10.1177/20503121231190963. eCollection 2023.

ABSTRACT

Background:A 2019 study by Prucnal and colleagues found that the majority of patients treated with unfractionated heparin for pulmonary embolism did not maintain therapeutic activated partial thromboplastin time levels during the first 48 h of therapy. Objective:The purpose of this study was to evaluate the ability of an institution's unfractionated heparin dosing protocol to achieve and maintain therapeutic anti-Xa levels within the first 48 h of therapy in patients with venous thromboembolism. Methods: This retrospective study included 205 patients from May 2016 through September 2020. Patients were divided into two cohorts: bolus plus infusion (N = 89) and infusion only (N = 116). The primary objective was to determine the number of patients who achieved at least one therapeutic level. Results:Overall, 200 patients (97.6%) had at least one therapeutic level with no statistically significant difference between cohorts (p = 0.65). No more than 60% of patients achieved a therapeutic level at any of the 6-h intervals throughout the timeframe. The median time to the first therapeutic level in the overall group was 12.8 h with no statistically significant difference between the bolus plus infusion and infusion-only cohorts (13.3 h versus 12.7 h, respectively, p= 0.48). Conclusions:Most patients were able to achieve at least one therapeutic level within the first 48 h, but fewer were able to maintain therapeutic levels. Further studies are warranted to determine whether alternative dosing strategies would yield consistent achievement of therapeutic levels and affect patient-oriented outcomes.

PMID:37602272 | PMC:PMC10438427 | DOI:10.1177/20503121231190963

17:35

In reply to this message

PubMed articles on: Cancer & VTE/PE

Non-bacterial Thrombotic Endocarditis Related to Squamous Cell Carcinoma of the Cervix

Cureus. 2023 Jul 19;15(7):e42128. doi: 10.7759/cureus.42128. eCollection 2023 Jul.

ABSTRACT

We report the case of a 51-year-old woman who presented with multiple thrombotic events, including deep vein thrombosis, extensive pulmonary embolisms, myocardial infarction, and multiple ischemic strokes suggesting cardiogenic embolization. Recent history was significant for locally advanced squamous cell carcinoma of the cervix. Echocardiogram revealed large aortic valve vegetations in the absence of evidence of infectious endocarditis consistent with the diagnosis of non-bacterial thrombotic endocarditis (NBTE). This case is a rare presentation of NBTE associated with squamous cell carcinoma of the cervix.

PMID:37602093 | PMC:PMC10437085 | DOI:10.7759/cureus.42128

17:35

In reply to this message

PubMed articles on: Cancer & VTE/PE

Venous Thromboembolism in Hospitalized Patients With Surgical Breast Cancer: Risks and Outcomes

Cureus. 2023 Jul 18;15(7):e42096. doi: 10.7759/cureus.42096. eCollection 2023 Jul.

ABSTRACT

Background The Caprini risk assessment model has been validated in breast cancer surgery patients. However, its utility in our population has not been described. This study evaluated the benefits and risks of the Caprini risk stratification tool and the incidence of venous thromboembolism (VTE) in the 30-day postoperative period among surgical female patients with breast cancer who were hospitalized during their treatment. Methodology This is a retrospective review of prospectively collected data of all surgical patients with histologically confirmed breast cancer who were hospitalized between January and December 2018. Caprini score, treatment information, and 30-day outcome of prophylaxis were collated and analyzed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Results A total of 167 female patients with breast cancer aged 19 to 75 years were hospitalized during the study period. All patients had invasive ductal carcinoma, and the majority (76.6%) were premenopausal. Two fatal VTE events occurred during hospitalization, giving a 30-day incidence of 1.2%. There was no adverse event from chemoprophylaxis. Conclusions VTE is rare in hospitalized surgical patients with breast cancer undergoing routine pharmacologic and mechanical prophylaxis. The Caprini tool can identify extremely low-risk patients who require no prophylaxis.

PMID:37602036 | PMC:PMC10435390 | DOI:10.7759/cureus.42096

17:35

In reply to this message

PubMed articles on: Cancer & VTE/PE

Long-term mortality in patients with pulmonary embolism: results in a single-center registry

Res Pract Thromb Haemost. 2023 Jun 14;7(5):100280. doi: 10.1016/j.rpth.2023.100280. eCollection 2023 Jul.

ABSTRACT

BACKGROUND: While numerous studies have investigated short-term outcomes after pulmonary embolism (PE), long-term mortality remains insufficiently studied.

OBJECTIVES: To investigate long-term outcomes in an unselected cohort of patients with PE.

METHODS: A total of 896 consecutive patients with PE enrolled in a single-center registry between May 2005 and December 2017 were followed up for up to 14 years. The observed mortality rate was compared with the expected rate in the general population.

RESULTS: The total follow-up time was 3908 patient-years (median, 3.1 years). The 1- and 5-year mortality rates were 19.7% (95% CI, 17.2%-22.4%) and 37.1% (95% CI, 33.6%-40.5%), respectively. The most frequent causes of death were cancer (28.5%), PE (19.4%), infections (13.9%), and cardiovascular events (11.6%). Late mortality (after >30 days) was more frequent than expected in the general population, a finding that was consistent in patients without cancer (the 5-year standardized mortality ratios were 2.77 [95% CI, 2.41-3.16] and 1.80 [95% CI, 1.50-2.14], respectively). Active cancer was the strongest risk factor for death between 30 days and 3 years (hazard ratio [HR], 6.51; 95% CI, 4.67-9.08) but was not associated with later mortality. Death after >3 years was predicted by age (HR, 1.86; 95% CI, 1.51-2.29 per decade), chronic heart failure (HR, 1.66; 95% CI, 1.02-2.70), and anemia (HR, 1.62; 95% CI, 1.09-2.41).

CONCLUSION: The risk of mortality in patients with PE remained elevated compared with that in the general population throughout the follow-up period. The main driver of long-term mortality during the first 3 years was cancer. After that, mortality was predicted by age, chronic heart failure, and anemia.

PMID:37601025 | PMC:PMC10439384 | DOI:10.1016/j.rpth.2023.100280

17:35

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:35

In reply to this message

PubMed articles on: Cancer & VTE/PE

Recurrent venous thromboembolism in hospitalized children with a history of prior venous thromboembolism: a report from the Children's Hospital-Acquired Thrombosis Consortium

Res Pract Thromb Haemost. 2023 Jun 29;7(5):102139. doi: 10.1016/j.rpth.2023.102139. eCollection 2023 Jul.

NO ABSTRACT

PMID:37601027 | PMC:PMC10439380 | DOI:10.1016/j.rpth.2023.102139

17:35

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:35

In reply to this message

PubMed articles on: Cancer & VTE/PE

Comment On: The Duration and Magnitude of Postdischarge Venous Thromboembolism Following Colectomy

Ann Surg Open. 2022 Nov 2;3(4):e220. doi: 10.1097/AS9.0000000000000220. eCollection 2022 Dec.

NO ABSTRACT

PMID:37600281 | PMC:PMC10406020 | DOI:10.1097/AS9.0000000000000220

17:36

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:36

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:36

Photo

Not included, change data exporting settings to download.

1200×1200, 39.0 KB

17:36

In reply to this message

PubMed articles on: Cancer & VTE/PE

Giant breast phyllodes tumor with silent thromboembolism: A case report

Cancer Rep (Hoboken). 2023 Aug 14:e1865. doi: 10.1002/cnr2.1865. Online ahead of print.