ABSTRACT

OBJECTIVE: Fondaparinux is a synthetic anticoagulant for the prevention of venous thromboembolism (VTE), and its administration in Chinese cancer patients is rarely reported. This study aimed to assess the efficacy and safety of fondaparinux in preventing VTE in Chinese cancer patients.

METHODS: A total of 224 cancer patients who received fondaparinux treatment were reviewed in this single-arm, multicenter, retrospective study. Meanwhile, VTE, bleeding, death, and adverse events of those patients in the hospital and at 1 month after treatment (M1) were retrieved, respectively.

RESULTS: The in-hospital VTE rate was 0.45% and there was no (0.00%) VTE occurrence at M1. The in-hospital bleeding rate was 2.68%, among which the major bleeding rate was 2.23% and the minor bleeding rate was 0.45%. Moreover, the bleeding rate at M1 was 0.90%, among which both the major and minor bleeding rates were 0.45%. The in-hospital death rate was 0.45% and the death rate at M1 was 0.90%. Furthermore, the total rate of adverse events was 14.73%, including nausea and vomiting (3.13%), gastrointestinal reactions (2.23%), and reduced white blood cells (1.34%).

CONCLUSION: Fondaparinux could effectively prevent VTE with low bleeding risk and acceptable tolerance in cancer patients.

PMID:37313468 | PMC:PMC10258345 | DOI:10.3389/fonc.2023.1165437

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PubMed articles on: Cancer & VTE/PE

Comparison of the Efficacy and Safety of Rivaroxaban and Low Molecular Heparin in Preventing Venous Thromboembolism in Inpatient Cancer Patients

Ann Pharmacother. 2023 Jun 13:10600280231178335. doi: 10.1177/10600280231178335. Online ahead of print.

ABSTRACT

BACKGROUND: There are few studies on using rivaroxaban and low molecular heparin (LMWH) to prevent venous thromboembolism (VTE) in hospitalized cancer patients.

OBJECTIVE: We conducted a retrospective study to evaluate the efficacy and safety of rivaroxaban versus LMWH for the primary prevention of VTE in inpatient cancer patients.

METHODS: Information on patients was collected through 6-month follow-up and medical record inquiries. Clinical outcomes included VTE, total bleeding, thrombosis, major bleeding, minor bleeding, all-cause death, and a composite endpoint of bleeding, thrombosis, and death.

RESULTS: A total of 602 hospitalized cancer patients were included in this study. During 6 months of follow-up, there were 26 VTE events (8.6%), 42 total bleeding events (7.0%), 62 all-cause deaths (10.3%), and 140 composite endpoints (23.3%). After adjusting for various confounding factors, there were no significant differences between the rivaroxaban and LMWH for VTE events (OR = 0.851, 95% CI [0.387-1.872], P=0.688), total bleeding (OR = 1.690, 95% CI [0.768-3.719], P= 0.192], thrombosis events (OR = 0.919, 95% CI [0.520-1.624], P= 0.772], major bleeding (OR = 0.276, 95% CI [0.037-2.059], P= 0.209), all-cause death (OR = 0.994, 95% CI [0.492-2.009], P= 0.987), and composite endpoints (OR = 0.994, 95% CI [0.492-2.009], P= 0.987), while minor bleeding (OR = 3.661 95% CI [1.000-7.083], P= 0.050) was significantly higher in the rivaroxaban than in the LMWH.

CONCLUSIONS AND RELEVANCE: In thromboprophylaxis in inpatient cancer patients, rivaroxaban has a similar rate of VTE and bleeding events as LMWH. Our results may provide a reference for the clinical use of rivaroxaban to prevent VTE in hospitalized cancer patients.

PMID:37312538 | DOI:10.1177/10600280231178335

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PubMed articles on: Cancer & VTE/PE

Endovascular Management of Life-Threatening Hemoptysis in Primary Lung Cancer: A Retrospective Study

Cardiovasc Intervent Radiol. 2023 Jun 13. doi: 10.1007/s00270-023-03488-w. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of endovascular treatment of hemoptysis caused by primary lung cancer.

METHODS: We conducted a single-center retrospective study (2005-2021), including patients who underwent thoracic embolization for life-threatening hemoptysis complication of lung cancer. Exclusion criteria were hemoptysis caused by a benign lung tumor or by a lung metastasis of a primary non-lung tumor. Depending on the origin of the bleeding, determined by CT-angiography, systemic arteries were treated with microspheres or coils, and pulmonary arteries with coils, plugs or covered stents. Outcomes were assessed from patients' medical records in April 2022. Primary endpoints were clinical success at one month and at one year. Secondary endpoints were incidence of complications, 1 year overall survival, and relative risk of recurrence of hemoptysis. Survival was compared with a log-rank test.

RESULTS: Sixty-two patients underwent 68 systemic artery embolizations and 14 pulmonary artery procedures. Clinical success defined as cessation of hemoptysis without any recurrence was 81% at one month and 74% at one year. Three major complications occurred: spinal cord ischemia, stroke, and acute pancreatitis. 5% of patient died from hemoptysis. One-year overall survival was 29% and was significantly higher in patients without hemoptysis recurrence when compared to patients with recurring hemoptysis (p = 0.021). In univariate analysis, recurrence of hemoptysis at one year was associated with massive hemoptysis (RR = 2.50; p = 0.044) and with tumor cavitation (RR = 2.51; p = 0.033).

CONCLUSION: Endovascular treatment for primary lung cancer-related hemoptysis is effective but not uneventful.

PMID:37311841 | DOI:10.1007/s00270-023-03488-w

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PubMed articles on: Cardio-Oncology

Mind the Gap: Differences in Acute Myocardial Infarction Care Due to a Cancer Diagnosis in England

Circ Cardiovasc Qual Outcomes. 2023 Jun;16(6):e010080. doi: 10.1161/CIRCOUTCOMES.123.010080. Epub 2023 Jun 20.

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PMID:37339192 | DOI:10.1161/CIRCOUTCOMES.123.010080

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PubMed articles on: Cardio-Oncology

Impact of a Prior Cancer Diagnosis on Quality of Care and Survival Following Acute Myocardial Infarction: Retrospective Population-Based Cohort Study in England

Circ Cardiovasc Qual Outcomes. 2023 Jun;16(6):e009236. doi: 10.1161/CIRCOUTCOMES.122.009236. Epub 2023 Jun 20.

ABSTRACT

BACKGROUND: An increasing proportion of patients with cancer experience acute myocardial infarction (AMI). We investigated differences in quality of AMI care and survival between patients with and without previous cancer diagnoses.

METHODS: A retrospective cohort study using Virtual Cardio-Oncology Research Initiative data. Patients aged 40+ years hospitalized in England with AMI between January 2010 and March 2018 were assessed, ascertaining previous cancers diagnosed within 15 years. Multivariable regression was used to assess effects of cancer diagnosis, time, stage, and site on international quality indicators and mortality.

RESULTS: Of 512 388 patients with AMI (mean age, 69.3 years; 33.5% women), 42 187 (8.2%) had previous cancers. Patients with cancer had significantly lower use of ACE (angiotensin-converting enzyme) inhibitors/angiotensin receptor blockers (mean percentage point decrease [mppd], 2.6% [95% CI, 1.8-3.4]) and lower overall composite care (mppd, 1.2% [95% CI, 0.9-1.6]). Poorer quality indicator attainment was observed in patients with cancer diagnosed in the last year (mppd, 1.4% [95% CI, 1.8-1.0]), with later stage disease (mppd, 2.5% [95% CI, 3.3-1.4]), and with lung cancer (mppd, 2.2% [95% CI, 3.0-1.3]). Twelve-month all-cause survival was 90.5% in noncancer controls and 86.3% in adjusted counterfactual controls. Differences in post-AMI survival were driven by cancer-related deaths. Modeling improving quality indicator attainment to noncancer patient levels showed modest 12-month survival benefits (lung cancer, 0.6%; other cancers, 0.3%).

CONCLUSIONS: Measures of quality of AMI care are poorer in patients with cancer, with lower use of secondary prevention medications. Findings are primarily driven by differences in age and comorbidities between cancer and noncancer populations and attenuated after adjustment. The largest impact was observed in recent cancer diagnoses (<1

PMID:37339190 | DOI:10.1161/CIRCOUTCOMES.122.009236

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PubMed articles on: Cardio-Oncology

Statins for attenuating cardiotoxicity in patients receiving anthracyclines: a systematic review and meta-analysis

Curr Probl Cardiol. 2023 Jun 17:101885. doi: 10.1016/j.cpcardiol.2023.101885. Online ahead of print.