ABSTRACT

BACKGROUND: Data on complications following upper extremity vein thrombosis (UEVT) are limited and heterogeneous.

METHODS: The aim of the study was to evaluate the pooled proportions of venous thromboembolic disease (VTE) recurrence, bleeding, and post-thrombotic syndrome (PTS) in patients with UEVT. A systematic literature review was conducted on PubMed, Embase, and the Cochrane Library databases from January 2000 to April 2023 according to Prisma guidelines. All studies included patients with UEVT and were published in English. Meta-analyses of VTE recurrence, occurrence of bleeding and of PTS after UEVT were performed to compute pooled estimates and associated 95% confidence interval (CI) levels. Subgroup analyses according to cancer-associated UEVT and catheter-associated venous thrombosis were conducted. Patients with Paget-Schroetter syndrome or effort thrombosis were excluded.

RESULTS: A total of 55 studies comprising 15,694 patients were included. The pooled proportions for VTE recurrence, major bleeding and PTS were 4.8% [95%CI 3.8;6.2], 3.0% [95%CI 2.2;4.0] and 23.8% [95%CI 17.0;32.3] respectively. The pooled proportions of VTE recurrence were 2.7% [95%CI 1.6;4.6] for patients treated with direct oral anticoagulants (DOACs), 1.7% [95%CI 0.8;3.7] for patients treated with low molecular weight heparin (LMWH) and 4.4% [95%CI 1.5;11.8] for vitamin K antagonist (VKA) (p=0.36); 6.3% [95%CI 4.3;9.1] in cancer patients compared to 3.1% [95%CI 2.1;4.6] in patients without cancer (p=0.01). The pooled proportion of major bleeding under DOACs was 2.1% (95%CI 0.9;5.1), 3.2% (95%CI 1.4;7.2) for patients treated with LMWH and 3.4% (95%CI 1.4;8.4) for patients treated with VKA (p=0.72). The pooled proportion of PTS for patients treated with DOACs was 11.8% [95%CI 6.5; 20.6], 27.9% [95%CI 20.9; 36.2] for patients treated with LMWH and 24.5% [95%CI 17.6; 33.1] for patients treated with VKA (p=0.02).

CONCLUSION: This study suggests that UEVT is associated with significant rates of PTS and recurrence. Treatment with DOACs may be associated with a lower PTS rates than with other anticoagulants.

PMID:37717788 | DOI:10.1016/j.jvsv.2023.09.002

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PubMed articles on: Cancer & VTE/PE

In-Hospital Venous Thromboembolism and Pulmonary Embolism After Major Urologic Cancer Surgery

Ann Surg Oncol. 2023 Sep 18. doi: 10.1245/s10434-023-14246-0. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to test for temporal trends of in-hospital venous thromboembolism (VTE) and pulmonary embolism (PE) after major urologic cancer surgery (MUCS).

METHODS: In the Nationwide Inpatient Sample (NIS) database (2010-2019), this study identified non-metastatic radical cystectomy (RC), radical prostatectomy (RP), radical nephrectomy (RN), and partial nephrectomy (PN) patients. Temporal trends of VTE and PE and multivariable logistic regression analyses (MLR) addressing VTE or PE, and mortality with VTE or PE were performed.

RESULTS: Of 196,915 patients, 1180 (1.0%) exhibited VTE and 583 (0.3%) exhibited PE. The VTE rates increased from 0.6 to 0.7% (estimated annual percentage change [EAPC] + 4.0%; p = 0.01). Conversely, the PE rates decreased from 0.4 to 0.2% (EAPC - 4.5%; p = 0.01). No difference was observed in mortality with VTE (EAPC - 2.1%; p = 0.7) or with PE (EAPC - 1.2%; p = 0.8). In MLR relative to RP, RC (odds ratio [OR] 5.1), RN (OR 4.5), and PN (OR 3.6) were associated with higher VTE risk (all p < 0.001). Similarly in MLR relative to RP, RC (OR 4.6), RN (OR 3.3), and PN (OR 3.9) were associated with higher PE risk (all p < 0.001). In MLR, the risk of mortality was higher when VTE or PE was present in RC (VTE: OR 3.7, PE: OR 4.8; both p < 0.001) and RN (VTE: OR 5.2, PE: OR 8.3; both p < 0.001).

CONCLUSIONS: RC, RN, and PN predisposes to a higher VTE and PE rates than RP. Moreover, among RC and RN patients with either VTE or PE, mortality is substantially higher than among their VTE or PE-free counterparts.

PMID:37721691 | DOI:10.1245/s10434-023-14246-0

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PubMed articles on: Cancer & VTE/PE

Hemostatic considerations for gender affirming care

Thromb Res. 2023 Oct;230:126-132. doi: 10.1016/j.thromres.2023.09.002. Epub 2023 Sep 14.

ABSTRACT

Gender dysphoria or gender incongruence is defined as "persons that are not satisfied with their designated gender" [1]. The awareness and evidence-based treatment options available to this population have grown immensely over the last two decades. Protocols now include an Endocrine Society Clinical Practice Guideline [1] as well as the World Professional Association of Transgender Health Standards of Care (WPATH SOC) [2]. Hematologic manifestations, most notably thrombosis, are one of the most recognized adverse reactions to the hormones used for gender-affirming care. Therefore, hematologists are frequently consulted prior to initiation of hormonal therapy to help guide safe treatment. This review will focus on the scientific evidence related to hemostatic considerations for various gender-affirming therapies and serve as a resource to assist in medical decision-making among providers and patients.

PMID:37717369 | DOI:10.1016/j.thromres.2023.09.002

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PubMed articles on: Cancer & VTE/PE

Intravenous tranexamic acid decreases intraoperative transfusion requirements and does not increase incidence of symptomatic venous thromboembolic events in musculoskeletal sarcoma surgery

Surg Oncol. 2023 Oct;50:101989. doi: 10.1016/j.suronc.2023.101989. Epub 2023 Sep 9.

ABSTRACT

BACKGROUND AND OBJECTIVES: Tranexamic acid (TXA) is poorly studied in patients with bone and musculoskeletal sarcoma due to perceived increased risk of venous thromboembolism (VTE). This study aims to assess the safety and efficacy of intravenous (IV) TXA for patients undergoing surgical resection of primary bone or soft-tissue sarcoma.

METHODS: A retrospective, single center review of adult patients with pelvic or extremity sarcoma who underwent surgical resections between January 2005 and March 2020 was performed. Patients between 2005 and 2012 were included as a historical comparison prior to the routine use of IV TXA for all sarcoma resections at our institution.

RESULTS: Thirty-nine non-TXA and 59 TXA resections were identified. Two non-TXA patients experienced symptomatic pulmonary embolism compared to zero VTEs amongst TXA patients. IV TXA administered at any dose significantly reduced the probability of intraoperative transfusion (p = 0.003) and the median units of blood transfused at the time of any perioperative transfusion (p = 0.007). Intraoperative times were significantly shorter for TXA patients (128 vs 190 min; p = 0.004). A subset of patients who underwent wide resection with endoprosthetic reconstruction and received TXA similarly showed decreased requirement for intraoperative transfusion (p = 0.014) and decreased procedure times (p = 0.009).

CONCLUSIONS: During sarcoma resection, at least 1 g of IV TXA can safely decrease the need for any intraoperative transfusion and the median number of PRBCs transfused by 2 units when any perioperative transfusion is given.

PMID:37717375 | DOI:10.1016/j.suronc.2023.101989

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PubMed articles on: Cancer & VTE/PE

Comparative Efficacy of Oral Apixaban and Subcutaneous Low Molecular Weight Heparins in the Treatment of Cancer-Associated Thromboembolism: A Meta-Analysis

Cureus. 2023 Aug 14;15(8):e43447. doi: 10.7759/cureus.43447. eCollection 2023 Aug.

ABSTRACT

Cancer patients' risk of developing venous thromboembolism (VTE) is four to seven times higher than the general population. Cancer-associated VTE (CA-VTE), is a leading cause of morbidity and mortality in cancer patients. Low Molecular Weight Heparin (LMWH) has historically been the mainstay treatment of CA-VTE; however, complications such as bleeding and recurrent VTE make it challenging to manage these patients. Recent randomized controlled trials (RCTs) have proven that direct oral anticoagulants (DOACs) are as efficacious as LMWHs in treating CA-VTE. We conducted a systematic review and meta-analysis to ascertain the efficacy and safety of LMWH and Apixaban for the treatment of CA-VTE. A systematic review was conducted using Medline, Embase, and Scopus, databases for all cohort studies, case-control studies, and RCTs in English comparing cancer patients undergoing treatment with Apixaban or LMWH to treat CA-VTE from inception-May 2023. The Review Manager program, version 5.4.1, was used for statistical analysis and the Mantel-Haenszel fixed-effects models to calculate the risk ratio (RR) and 95% confidence intervals (CIs) and the inverse variance approach to get the weighted mean difference for the continuous outcomes. Q-test for heterogeneity was used to examine statistical heterogeneity and an I2 statistics value >50% was defined as significant heterogeneity. A total of four studies were included, and the total number of patients was 1,632 across all studies. The Apixaban group was associated with a statistically significant increase in minor bleeding (RR 1.57; 95% CI (1.12, 2.21); p=0.009; I2=0%), but not for major and total bleeding. The Apixaban group showed a statistically significant lower risk of recurrent VTE when compared to the LMWH group (RR: 0.61; 95% CI (0.41, 0.92); p=0.02; I2 = 7%), and there was no statistically significant difference in terms of mortality between the two groups (RR: 0.89; 95% CI (0.73, 1.09); I2=0). Our findings suggest that Apixaban may be a favorable anticoagulant option for managing cancer-associated thromboembolism, as it demonstrated a lower risk of recurrent VTE. The risk of bleeding with DOAC in gastrointestinal cancers warrants further investigation.

PMID:37711939 | PMC:PMC10498340 | DOI:10.7759/cureus.43447

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PubMed articles on: Cancer & VTE/PE

Drug-eluting beads bronchial arterial chemoembolization/bronchial arterial infusion chemotherapy with and without PD-1 blockade for advanced non-small cell lung cancer: a comparative single-center cohort study

Quant Imaging Med Surg. 2023 Sep 1;13(9):6241-6256. doi: 10.21037/qims-23-287. Epub 2023 Aug 10.