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

Impact of pegaspargase dose capping on incidence of pegaspargase-related adverse events in adults

J Oncol Pharm Pract. 2023 Sep 20:10781552231202217. doi: 10.1177/10781552231202217. Online ahead of print.

ABSTRACT

INTRODUCTION: Asparaginase derivatives are essential components of the treatment of acute lymphoblastic leukemia in adolescent and young adult patients. However, their associated toxicities limit wider use in older populations. This study seeks to determine if the practice of capping the pegaspargase dose at 3750 units reduces the risk of related adverse events in adults.

METHODS: Adverse event data were retrospectively collected 28 days following each administration of pegaspargase in a single center. Doses were categorized as either capped (≤3750 units) (n = 57, 47.5%) or non-capped (>3750 units) (n = 63, 52.5%). The primary endpoint of this study was the composite incidence of serious pegaspargase-related adverse events, defined as grade 3 or higher.

RESULTS: Of the 120 doses administered, 47 (39.2%) were administered to patients > 39 years. For the primary endpoint, 26 doses (45.6%) in the dose capped group versus 22 doses (34.9%) in the non-dose capped group were associated with serious pegaspargase-related adverse events (p = 0.23). Isolated laboratory abnormalities accounted for all hepatotoxicity and pancreatic toxicity events, while venous thromboembolism and bleeding occurred after 8.3% and 13.3% of doses, respectively. Multivariate analysis of the primary outcome to adjust for differences in baseline characteristics found no difference between groups (OR 2.56 (0.84, 7.77, p = 0.098)).

CONCLUSIONS: The incidence of serious clinical toxicities was low in this study, particularly pegaspargase-related venous thromboembolism. This suggests that the practice of capping pegaspargase doses at 3750 units, coupled with vigilant monitoring and prophylaxis for pegaspargase-related adverse events, can allow for the inclusion of this drug in the treatment of older individuals.

PMID:37728166 | DOI:10.1177/10781552231202217

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PubMed articles on: Cancer & VTE/PE

Baicalin and lung diseases

Naunyn Schmiedebergs Arch Pharmacol. 2023 Sep 19. doi: 10.1007/s00210-023-02704-1. Online ahead of print.

ABSTRACT

Studies focusing on natural products have been conducted worldwide, and the results suggest that their natural ingredients effectively treat a wide range of illnesses. Baicalin (BIA) is a glycoside derived from the flavonoid baicalein present in Scutellaria baicalensis of the Lamiaceae family. Interestingly, BIA has been shown to protect the lungs in several animal models used in numerous studies. Therefore, we fully analyzed the data of the studies that focused on BIA's lung protective function against various injuries and included them in this review. Interestingly, BIA exhibits promising effects against acute lung injury, lung fibrosis, pulmonary embolism, and lung remodelling associated with COPD, LPS, and paraquat insecticide. BAI exhibits anticancer activity against lung cancer. Additionally, BIA potently attenuates lung damage associated with infections. BIA primarily exerts its therapeutic effects by suppressing inflammation, oxidative stress immune response, and apoptosis pathways. Nrf2/HO-1, PI3K/Akt, NF-κB, STAT3, MAPKs, TLR4, and NLRP3 are important targets in the pulmonary therapeutic effects of BIA on different lung disease models. Consequently, we recommend using it in future potential clinical applications, its contribution to treatment guidelines, and translating its promising effects to clinical practice in lung diseases.

PMID:37725153 | DOI:10.1007/s00210-023-02704-1

08:52

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

Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study

J Yeungnam Med Sci. 2023 Sep 20. doi: 10.12701/jyms.2023.00689. Online ahead of print.

ABSTRACT

BACKGROUND: Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease.

METHODS: We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score.

RESULTS: The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001)

CONCLUSION: Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.

PMID:37726959 | DOI:10.12701/jyms.2023.00689

08:52

PubMed articles on: Cancer & VTE/PE

A systematic review and meta-analysis of incidence of post-thrombotic syndrome, recurrent thromboembolism, and bleeding after upper extremity vein thrombosis

J Vasc Surg Venous Lymphat Disord. 2023 Sep 15:S2213-333X(23)00382-7. doi: 10.1016/j.jvsv.2023.09.002. Online ahead of print.

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

C

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Cardiotoxicity News

PubMed articles on: Cardio-Oncology

Cancer survivorship at heart: a multidisciplinary cardio-oncology roadmap for healthcare professionals

Front Cardiovasc Med. 2023 Sep 15;10:1223660. doi: 10.3389/fcvm.2023.1223660. eCollection 2023.

ABSTRACT

In cancer, a patient is considered a survivor from the time of initial diagnosis until the end of life. With improvements in early diagnosis and treatment, the number of cancer survivors (CS) has grown considerably and includes: (1) Patients cured and free from cancer who may be at risk of late-onset cancer therapy-related cardiovascular toxicity (CTR-CVT); (2) Patients with long-term control of not-curable cancers in whom CTR-CVT may need to be addressed. This paper highlights the importance of the cancer care continuum, of a patient-centered approach and of a prevention-oriented policy. The ultimate goal is a personalized care of CS, achievable only through a multidisciplinary-guided survivorship care plan, one that replaces the fragmented management of current healthcare systems. Collaboration between oncologists and cardiologists is the pillar of a framework in which primary care providers and other specialists must be engaged and in which familial, social and environmental factors are also taken into account.

PMID:37786510 | PMC:PMC10541962 | DOI:10.3389/fcvm.2023.1223660

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PubMed articles on: Cardio-Oncology

Comparison of Plan Quality Metrics after Left Anterior Descending Coronary Artery Sparing in VMAT Esophageal Radiotherapy

Int J Radiat Oncol Biol Phys. 2023 Oct 1;117(2S):e706. doi: 10.1016/j.ijrobp.2023.06.2197.