topics / مواضيع: October 2023

Upper-extremity deep vein thrombosis (UEDVT) accounts for about 5-10% of all cases of deep vein thrombosis (DVT). It is often associated with

Abstract

Upper-extremity deep vein thrombosis (UEDVT) accounts for about 5-10% of all cases of deep vein thrombosis (DVT). It is often associated with cancer and/or presence of a central venous catheter (CVC), but it may also occur in the absence of these favoring conditions. The safety and efficacy of using direct oral anticoagulants (DOACs) in subjects with UEDVT has not been systematically evaluated and the only data available in the literature derive from anecdotal evidence, analysis of registries, and small single-centre studies. In addition, a specific analysis of UEDVT not associated with cancer and/or CVC has never been made. In this study, we specifically focused on patients with no cancer and without a CVC who were diagnosed with a first episode of UEDVT and were treated with a DOAC. We studied 61 patients, treated in six Italian centres between January 2014 and December 2018. Treatment lasted at least 3 months in all patients. In terms of efficacy, no recurrence of thrombosis or pulmonary embolism were recorded, while Doppler ultrasonography, performed after at least three months of treatment, documented in all cases either partial or complete recanalization of obstructed veins. In terms of safety, no cases of major bleedings were recorded. This is the only series available in the literature of patients treated with DOACs for UEDVT not associated with cancer and/or CVC. This small multicenter real world experience supports the concept that DOACs might be safe and effective for treating UEDTV. Further studies are required to better understand the role of DOACs in these patients.

PMID: 32008208 [PubMed - as supplied by publisher]

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Risk for Venous Thromboembolic Events in Patients With Advanced Urinary Tract Cancer Treated With First-Line Chemotherapy.

Clin Genitourin Cancer. 2020 Jan 08;:

Authors: Bamias A, Tzannis K, Dimitriadis I, Tsironis G, Papatheorodidi AM, Tsiara A, Fragkoulis C, Xirokosta A, Barbarousi D, Papadopoulos G, Zakopoulou R, Varkarakis I, Mitsogiannis I, Adamakis I, Alamanis C, Stravodimos K, Papatsoris AG, Dellis AE, Drivalos A, Ntoumas K, Matsouka H, Halvatsiotis P, Raptis A, Gerotziafas GT, Dimopoulos MA

BACKGROUND: Anthracycline anticancer drugs such as epirubicin and doxorubicin may induce myocardial dysfunction, leading to

Abstract

BACKGROUND: Anthracycline anticancer drugs such as epirubicin and doxorubicin may induce myocardial dysfunction, leading to poor prognosis. Early detection of minor left ventricular (LV) myocardial dysfunction is important for the prevention of anthracylcine-induced cardiotoxicity. Using layer-specific speckle tracking echocardiography (STE), we investigated the progressive distribution of myocardial dysfunction in both breast cancer patients and an animal toxicity model.

METHODS: Patients with preserved LV ejection fraction (LVEF) preparing for epirubicin chemotherapy (N = 125) were prospectively enrolled. Layer-specific STE, including LV longitudinal and circumferential strains on subepicardium and subendocardium, were evaluated at baseline and after the first cycle, third cycle and six months of epirubicin therapy. A decline of LVEF above 10% to <55%

RESULTS: In patients developing cardiotoxicity, LV longitudinal strain on subendocardium (LVLSendo) was significantly reduced after three cycles of therapy despite no significant changes in conventional LV systolic, diastolic parameters as well as LV circumferential strains at that moment. Compared to conventional echocardiographic parameters, LVLSendo was significantly predictive of cardiotoxicity. Declines in LVLSendo were also observed in doxorubicin-treated rats at an early stage. These reductions also predicted significant fibrosis in the subendocardial layer.

CONCLUSION: LVLSendo is useful for the early detection of minor cardiac dysfunction during chemotherapy, thereby implicating endocardial involvement in the development of cardiotoxicity.

PMID: 32005451 [PubMed - as supplied by publisher]

3 February 2020

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Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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Upper extremity deep vein thrombosis treated with direct oral anticoagulants: a multi-center real world experience.

J Thromb Thrombolysis. 2020 Feb 01;:

Authors: Porfidia A, Agostini F, Giarretta I, Tonello D, Pastori D, Pignatelli P, Santoliquido A, Sartori M, Lessiani G, Visonà A, Donadini MP, Pola R

According to international clinical practice guidelines, low-molecular-weight heparins are advocate for the treatment and the prevention of cancer

Abstract

According to international clinical practice guidelines, low-molecular-weight heparins are advocate for the treatment and the prevention of cancer associated thrombosis. Direct oral anticoagulants recently introduced represent an alternative to vitamin K antagonists and low-molecular-weight heparins since their use doesn't require coagulation monitoring or daily subcutaneous injections. Recent studies comparing direct oral anticoagulants and low-molecular-weight heparins have shown a trend towards a reduction of venous thromboembolism events of direct oral anticoagulants but an increased risk of major bleeding. Recent French inter-group recommendations on the treatment of venous thromboembolism in cancer patients, favor low molecular weight heparins over direct oral anticoagulants as curative agents. In the light of recent studies, the objective of this review is to re-evaluate the place of low-molecular-weight heparins in the management of patents with cancer-associated thrombosis and to focus on the recent updates of international guidelines.

PMID: 32005356 [PubMed - as supplied by publisher]

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Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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Layer-specific distribution of myocardial deformation from anthracycline-induced cardiotoxicity in patients with breast cancer-From bedside to bench.

Int J Cardiol. 2020 Jan 16;:

Authors: Chang WT, Feng YH, Kuo YH, Chen WY, Wu HC, Huang CT, Huang TL, Chen ZC

Importance: It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE).

Abstract

Importance: It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE).

Objective: To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism.

Design, Setting, and Participants: This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731 728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421 537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February 2016). Participants without cardiovascular disease at baseline were included. Data were analyzed from June 2017 to September 2018.

Exposures: A panel of several established cardiovascular risk factors.

Main Outcomes and Measures: Hazard ratios (HRs) per 1-SD higher usual risk factor levels (or presence/absence). Incident fatal outcomes in ERFC (VTE, 1041; coronary heart disease [CHD], 25 131) and incident fatal/nonfatal outcomes in UK Biobank (VTE, 2321; CHD, 3385). Hazard ratios were adjusted for age, sex, smoking status, diabetes, and body mass index (BMI).

Results: Of the 731 728 participants from the ERFC, 403 396 (55.1%) were female, and the mean (SD) age at the time of the survey was 51.9 (9.0) years; of the 421 537 participants from the UK Biobank, 233 699 (55.4%) were female, and the mean (SD) age at the time of the survey was 56.4 (8.1) years. Risk factors for VTE included older age (ERFC: HR per decade, 2.67; 95% CI, 2.45-2.91; UK Biobank: HR, 1.81; 95% CI, 1.71-1.92), current smoking (ERFC: HR, 1.38; 95% CI, 1.20-1.58; UK Biobank: HR, 1.23; 95% CI, 1.08-1.40), and BMI (ERFC: HR per 1-SD higher BMI, 1.43; 95% CI, 1.35-1.50; UK Biobank: HR, 1.37; 95% CI, 1.32-1.41). For these factors, there were similar HRs for pulmonary embolism and deep vein thrombosis in UK Biobank (except adiposity was more strongly associated with pulmonary embolism) and similar HRs for unprovoked vs provoked VTE. Apart from adiposity, these risk factors were less strongly associated with VTE than CHD. There were inconsistent associations of VTEs with diabetes and blood pressure across ERFC and UK Biobank, and there was limited ability to study lipid and inflammation markers.

Conclusions and Relevance: Older age, smoking, and adiposity were consistently associated [...]

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with higher VTE risk.

PMID: 30649175 [PubMed - indexed for MEDLINE]

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Venous thromboembolism prevention in lower limb trauma - Can we do better?

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Venous thromboembolism prevention in lower limb trauma - Can we do better?

Phlebology. 2019 06;34(5):291-293

Authors: Langridge BJ, Goodall RJ, Onida S, Shalhoub J, Davies AH

PMID: 30354874 [PubMed - indexed for MEDLINE]

2 February 2020

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Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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[Low-molecular-weight heparins for cancer-associated thromboembolism: What place in 2019?]

Bull Cancer. 2020 Jan 28;:

Authors: Debourdeau P, Cossou-Gbeto C, Takam-Sohwe T, Laroche JP

BACKGROUND: Patients with cancer are of a high level risk of venous thromboembolism (VTE). Low molecular weight heparin (LMWH)

Abstract

BACKGROUND: Patients with cancer are of a high level risk of venous thromboembolism (VTE). Low molecular weight heparin (LMWH) is recommended as the normal treatment for cancer-associated venous thrombosis. Recently, some studies suggest that patients with cancer-associated venous thrombosis can get a good efficacy and safety profile from treating with direct oral anticoagulants (DOACs) compared with other anticoagulants. However, when it comes to the efficacy of DAOCs in preventing VTE in patient with cancer, the data are limited. Thus, we performed such a meta-analysis to determine the efficacy and safety of DOACs in preventing VTE in patient with cancer compared with LMWHs.

METHODS: Medline/PubMed and CENTRAL (The Cochrane Central Register of Controlled Trials) were systematically searched for relevant studies. For each trial, data on VTE, major bleeding, or bleeding were extracted by 2 reviewers independently. Pooled risk ratios (RRs) were calculated by using Review Manager 5.3 software and the significance was determined by the Z test.

RESULTS: A total of 6 studies with 7185 patients were included in our meta-analysis. DOACs (RR = 0.55, 95% confidence interval [95%CI]: 0.34-0.90, I = 31%) had a similar prevention effect of VTE to LMWH (RR = 0.59, 95% CI: 0.37-0.95, I = 59%). DOACs (RR = 1.52, 95% CI: 0.99-2.33, I = 0%) yielded a similar bleeding occurrence rate compared with LMWH (RR = 1.35, 95% CI: 1.07-1.70, I = 35%). DOACs (RR = 1.95, 95% CI: 0.88-4.30, I = 0%) showed a sight higher major bleeding occurrence rate than LMWH (RR = 1.38, 95% CI: 0.88-2.14, I = 0%).

CONCLUSION: DOACs show comparable efficacy to LMWH in cancer patients without VTE with a slightly higher major bleeding occurrence rate. DOACs are inclined to be an alternative thromboprophylaxis strategy in cancer patients as they have superiorities compared to traditional anticoagulation agents. Further studies are still demanded as exiting relevant researches are limited.

PMID: 32000440 [PubMed - in process]

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Cardiovascular Risk Factors Associated With Venous Thromboembolism.

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Cardiovascular Risk Factors Associated With Venous Thromboembolism.

JAMA Cardiol. 2019 02 01;4(2):163-173

Authors: Gregson J, Kaptoge S, Bolton T, Pennells L, Willeit P, Burgess S, Bell S, Sweeting M, Rimm EB, Kabrhel C, Zöller B, Assmann G, Gudnason V, Folsom AR, Arndt V, Fletcher A, Norman PE, Nordestgaard BG, Kitamura A, Mahmoodi BK, Whincup PH, Knuiman M, Salomaa V, Meisinger C, Koenig W, Kavousi M, Völzke H, Cooper JA, Ninomiya T, Casiglia E, Rodriguez B, Ben-Shlomo Y, Després JP, Simons L, Barrett-Connor E, Björkelund C, Notdurfter M, Kromhout D, Price J, Sutherland SE, Sundström J, Kauhanen J, Gallacher J, Beulens JWJ, Dankner R, Cooper C, Giampaoli S, Deen JF, Gómez de la Cámara A, Kuller LH, Rosengren A, Svensson PJ, Nagel D, Crespo CJ, Brenner H, Albertorio-Diaz JR, Atkins R, Brunner EJ, Shipley M, Njølstad I, Lawlor DA, van der Schouw YT, Selmer RM, Trevisan M, Verschuren WMM, Greenland P, Wassertheil-Smoller S, Lowe GDO, Wood AM, Butterworth AS, Thompson SG, Danesh J, Di Angelantonio E, Meade T, Emerging Risk Factors Collaboration

Gastric cancer is the fifth most common malignancy worldwide. Venous thromboembolism is an independent predictor of death among

Abstract

Gastric cancer is the fifth most common malignancy worldwide. Venous thromboembolism is an independent predictor of death among patients with gastric cancer. We aimed to describe the factors associated with mortality, thrombosis recurrence, and bleeding complications in patients with gastric cancer who develop venous thromboembolism. We included 612 patients with gastric cancer and venous thromboembolism in the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry from 2001 to 2018. We used Cox proportional hazard ratios and a Fine-Gray model to define factors associated with outcomes. The overall mortality at 6 months was 44.4%. Factors associated with increased 6-month mortality included immobility (HR 1.8, 95% CI 1.3-2.4; p < 0.001), anemia (HR 1.4, 95% CI 1.1-1.8; p < 0.02), and leukocytosis (HR 1.8, 95% CI 1.4-2.3; p < 0.001). Recurrent thrombosis occurred in 6.5% of patients and major bleeding complications in 8.5% of the cohort. Male sex was the main factor associated with thrombosis recurrence (HR 2.1, 95% CI 1.1-4.0; p < 0.02) and hemoglobin below 10 g/dL (HR 1.6, 95% CI 1.05-2.50; p = 0.03) the main factor associated with bleeding. In conclusion, patients with gastric cancer who develop venous thrombosis have a very high likelihood of death. Low hemoglobin in this population is associated with poor outcomes.

PMID: 32000631 [PubMed - as supplied by publisher]

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Prevention of venous thromboembolism in patients with cancer with direct oral anticoagulants: A systematic review and meta-analysis.

Medicine (Baltimore). 2020 Jan;99(5):e19000

Authors: Chen H, Tao R, Zhao H, Jiang J, Yang J

OBJECTIVE: To assess the incidence and the risk factors of venous thromboembolism (VTE) in patients with epithelial ovarian carcinoma (EOC)

Abstract

OBJECTIVE: To assess the incidence and the risk factors of venous thromboembolism (VTE) in patients with epithelial ovarian carcinoma (EOC) during the perioperative period.

METHODS: A retrospective analysis was conducted on the patients with epithelial ovarian cancer treated in our hospital, between January 2017 and July 2019, and a comprehensive review of the medical documentation was performed to collect relevant data. We then analyzed the related factors of the thrombosis in the EOC patients, using univariate and multivariate analysis to identify significant risk factors for VTE, and bootstrap resampling method was used to verify the multivariate analysis results. The ROC curve methods were conducted to evaluate the diagnostic value for the prediction of VTE.

RESULTS: We analyzed 233 cases of patients with EOC, of whom the incidence of VTE was 11.16%. According to multivariate and 5000 bootstrap samples analysis, preoperative D-dimer levels (>4.215 μg/ml, p = 0.041 and p = 0.032) and comorbid of cerebral infarction (p < 0.001< 0.001)50.5 years old, p = 0.019 and p = 0.002) and nonoptimal debulking surgery (p = 0.007 and p = 0.002) showed significance in predicting VTE after surgery; bootstrap analysis also found the D-dimer levels (>4.215 μg/ml) and tuberculosis had statistical significance.

CONCLUSION: More effective thromboprophylaxis and pre-test assessment is necessary for EOC patients. For prediction VTE events, D-dimer levels (>4.215 μg/ml) were the independent predictors before operation. Age and debulking surgery were the independent predictors post operation.

PMID: 32001042 [PubMed - as supplied by publisher]

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Outcomes after venous thromboembolism in patients with gastric cancer: Analysis of the RIETE Registry.

Vasc Med. 2020 Jan 30;:1358863X19893432

Authors: Majmudar K, Golemi I, Tafur AJ, Toro JD, Visonà A, Falgá C, Sahuquillo JC, Lorente MA, Tufano A, Weinberg I, Monreal M, RIETE Investigators

BACKGROUND: The influence of morbid obesity on mortality in patients receiving anticoagulant therapy for venous thromboembolism (VTE)

Abstract

BACKGROUND: The influence of morbid obesity on mortality in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated.

METHODS: We used the data from RIETE registry to compare the mortality risk during anticoagulation in VTE patients with morbid obesity (body mass index [BMI] ≥40) versus those with normal weight (BMI: 18.5-24.9). Patients with or without active cancer were analyzed separately.

RESULTS: By September 2018, there were 4,443 VTE patients with morbid obesity and 12,047 with normal weight in RIETE. Of these, 245 (5.5%) and 1,397 (11.6%) respectively had cancer. Median duration of anticoagulant therapy was longer in the morbidly obese, with- (185 vs. 114 days) or without cancer (203 vs. 177 days). Among cancer patients, 44 (18.0%) morbidly obese and 1,377 (32.8%) patients with normal weight died during anticoagulation. Among those without cancer, 44 (3.1%) and 601 (5.6%) respectively died. On bivariate analysis, morbid obesity was associated with a lower mortality rate, both in patients with cancer (hazard ratio [HR]: 0.34; 95%CI: 0.25-0.45) and in those without cancer (HR: 0.43; 95%CI: 0.32-0.58). Multivariable analysis confirmed a lower hazard of death in morbidly obese patients with- (HR: 0.68; 95%CI: 0.50-0.94) or without cancer (HR: 0.67; 95%CI: 0.49-0.96). The risk for VTE recurrences or major bleeding did not differ in patients with or without morbid obesity.

CONCLUSIONS: In patients with VTE, the risk for death during anticoagulation was about one third lower in morbidly obese patients than in those with normal weight, independently of the presence of cancer.

PMID: 32004553 [PubMed - as supplied by publisher]

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Incidence and potential predictors of thromboembolic events in epithelial ovarian carcinoma patients during perioperative period.

Eur J Surg Oncol. 2020 Jan 20;:

Authors: Zhou Q, Zhu C, Shen Z, Zhang T, Li M, Zhu J, Qin J, Xie Y, Zhang W, Chen R, Wang G, Qian L, Wu D, Nashan B, Zhou Y

BACKGROUND: Use of anti-programmed cell death-1 (anti-PD-1) has been successful in treating many types of cancers. Despite its promising efficacy

Abstract

BACKGROUND: Use of anti-programmed cell death-1 (anti-PD-1) has been successful in treating many types of cancers. Despite its promising efficacy, immune-related adverse events are still a major concern. Immune-related cardiotoxicity, which is rare but fatal, has recently become a focus of attention. Cardiotoxicities including myocarditis, cardiomyopathy, cardiac fibrosis, heart block and cardiac arrest have been reported. Of these toxicities, myocarditis is often accompanied by dysrhythmia. The presentation of sick sinus syndrome as an immune-related adverse event has not yet been reported. Here, we reported the first case of sick sinus syndrome, a rare toxicity induced by anti-PD-1.

CASE PRESENTATION: A 42-year-old male patient who had metastatic hepatocellular carcinoma failed treatment with sorafenib. Pembrolizumab at a fixed dose of 100 mg every three weeks was given. His heart rate gradually slowed down and he presented sick sinus syndrome with a lowest heart rate of 38 bpm after six cycles of pembrolizumab. He denied chest tightness, cold sweating, palpitation and dyspnea. Lab data including cardiac enzyme, electrolytes and thyroid function were all within a normal range. Simultaneously, he complained of fatigue, dizziness and anorexia with hypotension. Lab data revealed low cortisol and ACTH levels. Anti-PD-1 induced adrenal insufficiency was suspected. Low-dose cortisone (12.5 mg) was prescribed, and the patient's symptoms, hypotension and sick sinus syndrome showed rapid improvement. Cortisone was gradually titrated and discontinued three weeks later. His sick sinus syndrome did not relapse and the cortisol and ACTH level returned to normal.

CONCLUSIONS: Sick sinus syndrome caused by anti-PD-1 treatment is a rare adverse event. With the development of sick sinus syndrome, myocarditis should be the first differential diagnosis because of its lethality. From this case, we learned that sick sinus syndrome may be a presentation of immune- or adrenal insufficiency-mediated sinus node dysfunction, both could be reversed with a glucocorticoid supplement.

PMID: 30012209 [PubMed - indexed for MEDLINE]

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Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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Morbid obesity and mortality in patients with venous thromboembolism. Findings from real life clinical practice.

Chest. 2020 Jan 28;:

Authors: Giorgi-Pierfranceschi M, Núñez JJL, Monreal M, Cattabiani C, Lodigiani C, Di Micco P, Bikdeli B, Braester A, Soler S, Dentali F

RATIONALE: Pyothorax-associated lymphoma (PAL) is a rare type of malignant pleural lymphoma. Most lymphomas are normally

Abstract

RATIONALE: Pyothorax-associated lymphoma (PAL) is a rare type of malignant pleural lymphoma. Most lymphomas are normally discovered around 20 to 50 years after tuberculosis infection. In China, there have been few reports about PAL cases so far. We report a case of a patient, whose tuberculosis and lymphoma were diagnosed concurrently.

PATIENT CONCERNS: The patient, a 76-year-old male, was reported to our hospital on March 13, 2015. He had recurrent shortness of breath during the previous 2 years of routine activities solely. His symptoms became more serious which was manifested by edema of lower limbs 1 day before his admission to our hospital.

DIAGNOSES: Doctors reached the diagnosis of PAL based on the patient's pathologic cell morphology and immunohistochemistry. The chest computed tomography examination revealed that there were pleural effusions on both sides, and some extent of compressive atelectasis in the lower parts of the inflamed lungs yet without space-occupying lesions. There were multiple small nodules which may be benign in the right upper lung.

INTERVENTIONS: The current first-line treatment for diffuse large B-cell lymphoma is the cyclophosphamide, adriamycin, vincristine, prednisone (CHOP) protocol. Given that the patient had cardiac diseases and cardiotoxicity of anthracyclines, doctors decided to adopt rituximab with cyclophosphamide, vincristine, and prednisone chemotherapy without anthracyclines.

OUTCOMES: The treatment effect was obvious after one cycle of chemotherapy. The patient's pleural and pericardial effusions were significantly reduced. With the chemotherapy protocol above continuously adopted, pleural and pericardial effusions did not increase in multiple reexaminations on October 25, 2015, February 15, 2016, and August 10, 2016.

LESSONS: Analytical research revealed that chemotherapy with rituximab can increase the complete remission rate of non-Hodgkin lymphoma, reduce the possibility of failure and relapse, and prolong disease-free and overall survival. Moreover, there is no significant increase in adverse drug reactions compared with the effect of chemotherapy with CHOP alone. In the case of this patient, chemotherapy with rituximab was safe and efficacious.

PMID: 31852157 [PubMed - indexed for MEDLINE]

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Sick sinus syndrome associated with anti-programmed cell death-1.

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Sick sinus syndrome associated with anti-programmed cell death-1.

J Immunother Cancer. 2018 07 16;6(1):72

Authors: Hsu CY, Su YW, Chen SC

Bleeding is the most concerning complication associated with anticoagulant therapy but poorly characterized and important for risk

Abstract

Bleeding is the most concerning complication associated with anticoagulant therapy but poorly characterized and important for risk/benefit assessment. We developed a risk stratification score to predict vitamin K antagonist (VKA)-associated bleeding in venous thromboembolism (VTE) using the UK Clinical Practice Research Datalink. Significant bleeding events in outpatients consisted of major bleeding and clinically relevant non-major bleeding requiring hospitalisation (CRNMB-H) within 90 days of VKA initiation. A scoring scheme for predicting bleeding was developed from subhazard ratios, validated using cross-validation and expressed by the C-statistic. The study cohort consisted of 10,010 patients with first VTE receiving initial VKA treatment, mean age 62·2 years. Between 2008 and 2016, 167 significant bleeding events were recorded (1·7%), i.e. incidence rate was 7·4/100 person-years. Independent predictors for community-acquired significant bleeding included active cancer, trauma/surgical procedure, male gender, dementia, liver disease, anaemia, history of bleeding, cerebrovascular, renal and chronic pulmonary disease, VTE presenting as pulmonary embolism and age over 75. The overall C-statistic was 0·68 (95% CI, 0·60-0·76), 0·75 (0·60-0·88) for major bleeding and 0·65 (0·55-0·75) for CRNMB-H, and higher than in other risk schemes applied to our study population. The developed risk score may identify patients having a significant bleeding risk, in particular major bleeding events, in outpatients.

PMID: 31997309 [PubMed - as supplied by publisher]

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Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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Preventive Cardio-Oncology: The Time Has Come.

Front Cardiovasc Med. 2019;6:187

Authors: Brown SA

PMID: 31998754 [PubMed]

1 February 2020

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Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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Cardiac PET/CT-Determined Amyloid Light Chain Depositions: A New Risk Biomarker?

J Am Coll Cardiol. 2020 Feb 04;75(4):391-394

Authors: Schindler TH, Gropler RJ, Lenihan DJ

PMID: 32000950 [PubMed - in process]

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A case report on the effect of rituximab on pyothorax-associated lymphoma.

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A case report on the effect of rituximab on pyothorax-associated lymphoma.

Medicine (Baltimore). 2019 Dec;98(50):e18393

Authors: Wang F, Lan H

Venous thromboembolism is a common complication of asparaginase-based chemotherapy regimens for the treatment of acute lymphoblastic

Abstract

Venous thromboembolism is a common complication of asparaginase-based chemotherapy regimens for the treatment of acute lymphoblastic leukemia. Thrombosis associated with asparaginase administration poses a number of specific and often clinically challenging management decisions. This review provides guidance on the prevention and treatment of thrombosis associated with asparaginase in adults including discussions on antithrombin repletion, pharmacologic thromboprophylaxis, cerebral venous thrombosis, and therapeutic anticoagulation.

PMID: 31999063 [PubMed - in process]

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Prediction of significant bleeding during vitamin K antagonist treatment for venous thromboembolism in outpatients.

Br J Haematol. 2020 Jan 29;:

Authors: Martinez C, Katholing A, Wallenhorst C, Cohen AT

BACKGROUND: Randomized controlled trials (RCTs

Abstract

BACKGROUND: Randomized controlled trials (RCTs) have demonstrated that low-dose direct oral anticoagulants (DOACs), including rivaroxaban and apixaban, may help reduce the incidence of cancer-associated venous thromboembolism (VTE).

METHODS: A cost-utility analysis was performed from the health sector perspective using a Markov state-transition model in patients with cancer who are at intermediate-to-high risk for VTE. Transition probability, relative risk, cost, and utility inputs were obtained from a meta-analysis of the RCTs and relevant epidemiology studies. Differences in cost, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) per patient were calculated over a lifetime horizon. One-way, probabilistic, and scenario sensitivity analyses were conducted.

RESULTS: In patients with cancer at intermediate-to-high risk for VTE, treatment with low-dose DOAC thromboprophylaxis for 6 months, compared with placebo, was associated with 32 per 1000 fewer VTE and 11 per 1000 more major bleeding episodes over a lifetime. The incremental cost and QALY increases were $1445 and 0.12, respectively, with an ICER of $11,947 per QALY gained. Key drivers of ICER variations included the relative risks of VTE and bleeding as well as drug cost. This strategy was 94% cost effective at the threshold of $50,000 per QALY. The selection of patients with Khorana scores ≥3 yielded the greatest value, with an ICER of $5794 per QALY gained.

CONCLUSIONS: Low-dose DOAC thromboprophylaxis for 6 months appears to be cost-effective in patients with cancer who are at intermediate-to-high risk for VTE. The implementation of this strategy in patients with Khorana scores ≥3 may lead to the highest cost-benefit ratio.

PMID: 31999844 [PubMed - as supplied by publisher]

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Prevention of venous thromboembolism in medical cancer patients: Guidance or guideline?

J Thromb Haemost. 2020 Feb;18(2):520-521

Authors: Douketis JD

PMID: 31999064 [PubMed - in process]

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The prevention and management of asparaginase-related venous thromboembolism in adults: Guidance from the SSC on Hemostasis and Malignancy of the ISTH.

J Thromb Haemost. 2020 Feb;18(2):278-284

Authors: Zwicker JI, Wang TF, DeAngelo DJ, Lauw MN, Connors JM, Falanga A, McMasters M, Carrier M

BACKGROUND: The SELECT-D trial demonstrated reduction in recurrent venous thromboembolism (VTE) but increased bleeding with rivaroxaban

Abstract

BACKGROUND: The SELECT-D trial demonstrated reduction in recurrent venous thromboembolism (VTE) but increased bleeding with rivaroxaban compared to dalteparin for treatment of acute VTE in cancer patients, at 6 months. Uncertainty remains around optimal duration of anticoagulation.

OBJECTIVES: To assess VTE recurrence and bleeding, with anticoagulation or not, beyond 6 months PATIENTS/METHODS: In SELECT-D, after 6 months of trial treatment for VTE, patients with active cancer and residual deep vein thrombosis (RDVT) or index pulmonary embolism (PE) were eligible for randomisation to a further 6 months of rivaroxaban or placebo. Patients with no RDVT stopped anticoagulation. Primary outcome was VTE recurrence at 12 months. The second randomisation closed prematurely due to low recruitment when 92 of the planned 300 patients were recruited.

RESULTS: 92 of 136 eligible patients were randomised to rivaroxaban or placebo. The cumulative VTE recurrence after 6 months from the second randomisation, was 14% with placebo and 4% with rivaroxaban (Hazard Ratio 0.32; 95% CI 0.06-1.58). The major and clinically-relevant non-major bleeding rates were 0% and 0% with placebo; and 5% (95% CI 1-18%) and 4% (95% CI 1-17%) with rivaroxaban. In an exploratory analysis, 7 (15.2 %) of 46 placebo patients with RDVT or an index PE experienced recurrent VTE compared to none in the 35 patients in the RDVT-negative cohort (P=0.03).

CONCLUSION: The SELECT-D trial was underpowered to detect a statistically significant reduction in recurrent VTE with extended anticoagulation. The absence of RDVT and/or index PE, defined a population at low risk of recurrence.

PMID: 31995662 [PubMed - as supplied by publisher]

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Enhanced recovery after surgery: implementing a new standard of surgical care.

//www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--highwire.stanford.edu-icons-externalservices-pubmed-cmaj_full.gif Related Articles

Enhanced recovery after surgery: implementing a new standard of surgical care.

CMAJ. 2019 04 29;191(17):E469-E475

Authors: Altman AD, Helpman L, McGee J, Samouëlian V, Auclair MH, Brar H, Nelson GS, Society of Gynecologic Oncology of Canada’s Communities of Practice in ERAS and Venous Thromboembolism

PMID: 31036609 [PubMed - indexed for MEDLINE]

31 January 2020

13:22

Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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Cost-effectiveness analysis of low-dose direct oral anticoagulant (DOAC) for the prevention of cancer-associated thrombosis in the United States.

Cancer. 2020 Jan 30;:

Authors: Li A, Carlson JJ, Kuderer NM, Schaefer JK, Li S, Garcia DA, Khorana AA, Carrier M, Lyman GH

OBJECTIVE: To investigate the impact of modifications to contemporary cancer protocols, which minimize exposures to cardiotoxic treat

Abstract

OBJECTIVE: To investigate the impact of modifications to contemporary cancer protocols, which minimize exposures to cardiotoxic treatments and preserve long term health, on serious cardiac outcomes among adult survivors of childhood cancer.

DESIGN: Retrospective cohort study.

SETTING: 27 institutions participating in the Childhood Cancer Survivor Study.

PARTICIPANTS: 23 462 five year survivors (6193 (26.4%) treated in the 1970s, 9363 (39.9%) treated in the 1980s, and 7906 (33.6%) treated in the 1990s) of leukemia, brain cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, renal tumors, neuroblastoma, soft tissue sarcomas, and bone sarcomas diagnosed prior to age 21 years between 1 January 1970 and 31 December 1999. Median age at diagnosis was 6.1 years (range 0-20.9) and 27.7 years (8.2-58.3) at last follow-up. A comparison group of 5057 siblings of cancer survivors were also included.

MAIN OUTCOME MEASURES: Cumulative incidence and 95% confidence intervals of reported heart failure, coronary artery disease, valvular heart disease, pericardial disease, and arrhythmias by treatment decade. Events were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. Multivariable subdistribution hazard models were used to estimate hazard ratios by decade, and mediation analysis examined risks with and without exposure to cardiotoxic treatments.

RESULTS: The 20 year cumulative incidence of heart failure (0.69% for those treated in the 1970s, 0.74% for those treated in the 1980s, 0.54% for those treated in the 1990s) and coronary artery disease (0.38%, 0.24%, 0.19%, respectively), decreased in more recent eras (P<0.01),

CONCLUSIONS: Historical reductions in exposure to cardiac radiation have been associated with a reduced risk of coronary artery disease among adult survivors of childhood cancer. Additional follow-up is needed to investigate risk reductions for other cardiac outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov NCT01120353.

PMID: 31941657 [PubMed - indexed for MEDLINE]

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Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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Treatment of Cancer-Associated Venous Thromboembolism: 12-month outcomes of the placebo versus rivaroxaban randomisation of the SELECT-D Trial. (SELECT-D: 12m).

J Thromb Haemost. 2020 Jan 29;:

Authors: Marshall A, Levine M, Hill C, Hale D, Thirlwall J, Wilkie V, French K, Kakkar A, Lokare A, Maraveyas A, Chapman O, Arif A, Petrou S, Maredza M, Hobbs FR, Dunn JA, Young AM

BACKGROUND: Anthracycline-induced cardiotoxicity (AIC) remains the main long-term and irreversible side effect in malignancy

Abstract

BACKGROUND: Anthracycline-induced cardiotoxicity (AIC) remains the main long-term and irreversible side effect in malignancy survivors. Cardiotoxicity prevention is one of most reasonable attitudes.

AIM: To verify whether ramipril is able to protect from early-onset AIC in prospective randomized open-label study.

METHODS: Women with breast cancer (BC) were randomized to ramipril (RA) or control arm (CA). Data from 96 women, median age 47 years, without significant cardiovascular diseases, post-breast surgery and eligible for adjuvant anthracyclines, was analyzed. Cardiotoxicity was estimated with repeated echocardiography, troponin I and NT-proBNP levels over one-year follow-up. AIC was defined as a decrease in left ventricular ejection fraction (LVEF) and/or biomarkers elevation and/or occurrence of heart failure (HF) or cardiac death.

RESULTS: LVEF decrease ˃10 percent points occurred in 6.3% in RA vs 18.5% in controls (P = 0.15). No cases of HF, cardiac death or LVEF decline below ˂50% were reported. Percentage of patients with NT-proBNP elevation increased with time in CA (P = 0.003), whereas it remained unchanged in RA. At the end of observation, more patients in CA showed NTproBNP increase and fewer NT-proBNP decline (P = 0.01). No significant difference in troponin levels was found between the study arms. Ramipril was well tolerated in normotensive women.

CONCLUSIONS: In relatively young BC women without serious co-morbidities, who underwent anthracycline therapy, one year treatment with ramipril exerts potentially protective effect on the cardiotoxicty assessed with NT-proBNP, however its efficacy in long-term follow-up needs further investigations.

PMID: 31995035 [PubMed - as supplied by publisher]

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LncRNA OIP5-AS1 promotes the development of esophageal squamous cell carcinoma by binding to miR-1297.

Panminerva Med. 2020 Jan 24;:

Authors: Wang L, Ren X, Ma X, Yin L, Niu X, Xing S

PMID: 31992030 [PubMed - as supplied by publisher]

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Major cardiac events for adult survivors of childhood cancer diagnosed between 1970 and 1999: report from the Childhood Cancer Survivor Study cohort.

//www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--highwire.stanford.edu-icons-externalservices-pubmed-bmj_full.gif //www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--highwire.stanford.edu-icons-externalservices-pubmed-bmjjournals_open_access.gif Related Articles

Major cardiac events for adult survivors of childhood cancer diagnosed between 1970 and 1999: report from the Childhood Cancer Survivor Study cohort.

BMJ. 2020 01 15;368:l6794

Authors: Mulrooney DA, Hyun G, Ness KK, Ehrhardt MJ, Yasui Y, Duprez D, Howell RM, Leisenring WM, Constine LS, Tonorezos E, Gibson TM, Robison LL, Oeffinger KC, Hudson MM, Armstrong GT

AIMS: Heart failure is a major complication in cancer treatment due to the cardiotoxic effects of anticancer drugs, especially from the

Abstract

AIMS: Heart failure is a major complication in cancer treatment due to the cardiotoxic effects of anticancer drugs, especially from the anthracyclines such as doxorubicin. Doxorubicin enhances oxidative stress and stimulates matrix metalloproteinase-2 (MMP-2) in cardiomyocytes. We investigated whether MMP inhibitors protect against doxorubicin cardiotoxicity given the role of MMP-2 in proteolyzing sarcomeric proteins in the heart and remodeling the extracellular matrix.

METHODS AND RESULTS: 8-week old male C57BL/6J mice were treated with doxorubicin weekly with or without MMP inhibitors doxycycline or ONO-4817 by daily oral gavage for 4 weeks. Echocardiography was used to determine cardiac function and left ventricular remodeling before and after treatment. MMP inhibitors ameliorated doxorubicin-induced systolic and diastolic dysfunction by reducing the loss in left ventricular ejection fraction, fractional shortening, and E'/A'. MMP inhibitors attenuated adverse left ventricular remodeling, reduced cardiomyocyte dropout, and prevented myocardial fibrosis. Doxorubicin increased myocardial MMP-2 activity in part also by upregulating N-terminal truncated MMP-2. Immunogold transmission electron microscopy showed that doxorubicin elevated MMP-2 levels within the sarcomere and mitochondria which were associated with myofilament lysis, mitochondrial degeneration, and T-tubule distention. Doxorubicin-induced myofilament lysis was associated with increased titin proteolysis in the heart which was prevented by ONO-4817. Doxorubicin also increased the level and activity of MMP-2 in human embryonic stem cell-derived cardiomyocytes, which was reduced by ONO-4817.

CONCLUSIONS: MMP-2 activation is an early event in doxorubicin cardiotoxicity and contributes to myofilament lysis by proteolyzing cardiac titin. Two orally available MMP inhibitors ameliorated doxorubicin cardiotoxicity by attenuating intracellular and extracellular matrix remodeling, suggesting their use may be a potential prophylactic strategy to prevent heart injury during chemotherapy.

TRANSLATIONAL PERSPECTIVE: Heart failure is the primary chronic toxicity of anthracycline chemotherapy. Anthracyclines such as doxorubicin cause left ventricular remodeling and loss of myofilament proteins. We determined in mice whether matrix metalloproteinase-2, an intracellular and extracellular protease in the heart, contributes to doxorubicin cardiotoxicity. Doxorubicin activated myocardial MMP-2 in mouse hearts and human cardiomyocytes, including de novo expression of an N-terminal truncated MMP-2 isoform which is exclusively expressed by increased oxidative stress. Increased MMP-2 levels and activity in the heart contributed to left ventricular remodeling, interstitial fibrosis, and titin proteolysis in doxorubicin cardiotoxicity. These adverse effects on the heart were prevented by two orally available MMP inhibitors, demonstrating the potential benefits of MMP inhibition in the prophylaxis of doxorubicin cardiotoxicity.

PMID: 31995179 [PubMed - as supplied by publisher]

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Anthracycline-induced cardiotoxicity prevention with angiotensin-converting enzyme inhibitor ramipril in low-risk breast cancer women: results of a prospective randomized study.

Kardiol Pol. 2020 Jan 29;:

Authors: Słowik A, Jagielski P, Potocki P, Streb J, Ochenduszko S, Wysocki P, Gajos G, Konduracka E

Doxorubicin (DOX) is a classic anti-tumor chemotherapeutic used to treat a wide range of tumors. One major downfall of DOX treatment is it can in

Abstract

Doxorubicin (DOX) is a classic anti-tumor chemotherapeutic used to treat a wide range of tumors. One major downfall of DOX treatment is it can induce fatal cardiotoxicity. Astragaloside IV (AS-IV) is one of the primary active ingredients that can be isolated from the traditional Chinese herbal medicine, Astragalus membranaceus. This study uses both in vitro and in vivo tools to investigate whether AS-IV alleviates DOX induced cardiomyopathy. We found that AS-IV supplementation alleviates body weight loss, myocardial injury, apoptosis of cardiomyocytes, cardiac fibrosis and cardiac dysfunction in DOX-treated mice. Also, DOX-induced cardiomyocyte injury and apoptosis were effectively improved by AS-IV treatment in vitro. NADPH oxidase (NOX) plays an important role in the progress of the oxidative signal transduction and DOX-induced cardiomyopathy. In this study, we found that AS-IV treatment relieves DOX-induced NOX2 and NOX4 expression and oxidative stress in cardiomyocytes. In conclusion, AS-IV, an antioxidant, attenuates DOX-induced cardiomyopathy through the suppression of NOX2 and NOX4.

PMID: 31229536 [PubMed - indexed for MEDLINE]

30 January 2020

12:31

Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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MMP inhibitors attenuate doxorubicin cardiotoxicity by preventing intracellular and extracellular matrix remodeling.

Cardiovasc Res. 2020 Jan 29;:

Authors: Chan BYH, Roczkowsky A, Cho WJ, Poirier M, Sergi C, Keschrumrus V, Churko JM, Granzier H, Schulz R

Abstract

BACKGROUND: Immune checkpoint inhibitor (ICI)-associated early cardiac adverse events (CAEs), mostly acute and fulminant myocarditis, have been well characterized and mainly occur during the first 90 days after ICI therapy initiation. ICI-associated late CAEs (occurring after the first 90 days of treatment) have not yet been described.

METHODS: First, we compared characteristics of a cohort involving early (defined as a CAE time to onset (TTO) of <90

RESULTS: In the cohort study, compared with early CAE cases (n=19, median TTO of 14 days), late ICI-associated CAE cases (n=19, median TTO of 304 days) exhibited significantly more left ventricular systolic dysfunction (LVSD) and heart failure (HF) and less frequent supraventricular arrhythmias. In VigiBase, compared with early cases (n=437, 73.3%, median TTO 21 days), the late ICI-associated CAE reports (n=159, 26.7%, median TTO 178 days) had significantly more frequent HF (21.1% vs 31.4%, respectively, p=0.01). Early and late ICI-associated CAE cases had similarly high mortality rates (40.0% vs 44.4% in the cohort and 30.0% vs 27.0% in VigiBase, respectively).

CONCLUSIONS: Late CAEs could occur with ICI therapy and were mainly revealed to be HF with LVSD.

TRIAL REGISTRATION NUMBERS: NCT03678337, NCT03882580, and NCT03492528.

PMID: 31988143 [PubMed - in process]

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Astragaloside IV alleviates doxorubicin induced cardiomyopathy by inhibiting NADPH oxidase derived oxidative stress.

//www.ncbi.nlm.nih.gov/corehtml/query/egifs/https:--linkinghub.elsevier.com-ihub-images-PubMedLink.gif Related Articles

Astragaloside IV alleviates doxorubicin induced cardiomyopathy by inhibiting NADPH oxidase derived oxidative stress.

Eur J Pharmacol. 2019 Sep 15;859:172490

Authors: Lin J, Fang L, Li H, Li Z, Lyu L, Wang H, Xiao J

Tumor-targeted therapies such as trastuzumab have led to significant improvements in survival of human epidermal growth factor receptor 2

Abstract

Tumor-targeted therapies such as trastuzumab have led to significant improvements in survival of human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, these therapies have also been associated with significant left ventricular dysfunction. The incidence of trastuzumab-induced heart failure has decreased significantly since the initial reports, in large part due to improved screening, closer monitoring for early changes in left ventricular function, and a significant decrease in the concurrent administration of anthracyclines. The mechanism of trastuzumab cardiotoxicity is still not well understood, but current knowledge suggests that ErbB2 inhibition in cardiac myocytes plays a key role. In addition to trastuzumab and other HER2-targeted agents, vascular endothelial growth factor inhibitors, proteasome inhibitors, and immune checkpoint inhibitors are all additional classes of drugs used with great success in the treatment of solid tumors and hematologic malignancies. Yet these, too, have been associated with cardiac toxicity that ranges from a mild asymptomatic decrease in ejection fraction to fulminant myocarditis. In this review, we summarize the cardiotoxic effects of tumor-targeted and immunotherapies with a focus on HER2 antagonists.

PMID: 31988685 [PubMed - in process]

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The Burgeoning Field of Cardio-Oncology.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):241-242

Authors: Trachtenberg BH

PMID: 31988683 [PubMed - in process]

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Barry H. Trachtenberg Leads Issue on Cardio-Oncology.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):240

Authors:

PMID: 31988682 [PubMed - in process]

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Late cardiac adverse events in patients with cancer treated with immune checkpoint inhibitors.

J Immunother Cancer. 2020 Jan;8(1):

Authors: Dolladille C, Ederhy S, Allouche S, Dupas Q, Gervais R, Madelaine J, Sassier M, Plane AF, Comoz F, Cohen AA, Thuny FR, Cautela J, Alexandre J

Innovations and discoveries in cancer therapeutics have improved survival rates in patients with various types of malignancies. At the same time

Abstract

Innovations and discoveries in cancer therapeutics have improved survival rates in patients with various types of malignancies. At the same time, physicians are identifying an increased number of patients with treatment-related cardiotoxicity. It is imperative that physicians recognize early treatment-related adverse effects to determine the safest therapeutic options for patients with cancer. This manuscript evaluates the role of cardiovascular imaging and biomarkers in identifying cardiotoxicity trigged by various chemotherapeutic agents and summarizes expert consensus statements regarding cardiotoxicity monitoring.

PMID: 31988686 [PubMed - in process]

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Heart Failure in Relation to Tumor-Targeted Therapies and Immunotherapies.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):250-257

Authors: Agunbiade TA, Zaghlol RY, Barac A

Recent decades have seen an increase in survival rates for cancer patients, partially explained by earlier diagnoses and new chemotherapeutic

Abstract

Recent decades have seen an increase in survival rates for cancer patients, partially explained by earlier diagnoses and new chemotherapeutic agents. However, chemotherapy may be associated with adverse cardiovascular events, including hypertension and pulmonary hypertension, supraventricular and ventricular arrhythmias, cardiomyopathy, and other forms of cardiovascular disease. For patients, the benefits of chemotherapy may be partially obfuscated by deleterious effects on the cardiovascular system, resulting in a significant increase in morbidity and mortality. In this article, we review strategies for prevention and treatment of chemotherapy-related cardiotoxicity.

PMID: 31988687 [PubMed - in process]

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The Role of Cardiovascular Imaging and Serum Biomarkers in Identifying Cardiotoxicity Related to Cancer Therapeutics.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):258-266

Authors: Agha A, Zarifa A, Kim P, Iliescu C, Gladish G, Hassan S, Palaskas N, Durand JB, Lu Y, Lopez-Mattei J

As cancer survival outcomes improve, there is a growing focus on survivorship and long-term morbidity after cancer treatment

Abstract

As cancer survival outcomes improve, there is a growing focus on survivorship and long-term morbidity after cancer treatment. In particular, there has been concern about the long-term effects of radiotherapy on cardiac function. In this review, we discuss the cardiac effects of radiotherapy in the context of potential confounding factors, examine the potential parameters of interest when studying and modeling cardiac injury, highlight current treatment techniques to minimize radiation to the heart, and consider future areas of improvement and study.

PMID: 31988688 [PubMed - in process]

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Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):267-273

Authors: Avila MS, Siqueira SRR, Ferreira SMA, Bocchi EA

The acknowledgement of cardiovascular disease as one of the leading causes of mortality and morbidity among cancer survivors is the cornerstone of the growing

Abstract

The acknowledgement of cardiovascular disease as one of the leading causes of mortality and morbidity among cancer survivors is the cornerstone of the growing field of cardio-oncology. Although standardizing treatment for any given disease is often considered ideal, it is important to recognize the value of pursuing a practical and personalized approach when caring for an oncology patient to minimize the risk of treatment-related cardiotoxicity. We hereby discuss a series of cases that illustrate the ways vascular toxicity can manifest in patients with cancer and, when appropriate, provide scientific evidence that supports clinical decision making. We also raise questions about the complex management of these patients while shedding light on future research in this growing field.

PMID: 31988690 [PubMed - in process]

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Electrophysiologic Complications in Cancer Patients.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):282-288

Authors: Lee DH, Chandrashekhar S, Fradley MG

Abstract

In recent years, dramatic advances in both cancer diagnosis and treatment have led to significantly increased survival rates. As such, cardiovascular toxicities due to oncologic treatments are more frequently identified. Although heart failure and cardiomyopathy have historically been the cardiotoxicities most associated with cancer therapeutics, it is now recognized that all components of the cardiovascular system can be affected. In this review, we discuss electrophysiologic complications of cancer treatments, including atrial and ventricular tachyarrhythmias as well as bradyarrhythmias, and recommend a multidisciplinary approach with both cardiologists and oncologists to provide safe and effective care to these patients.

PMID: 31988689 [PubMed - in process]

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Cardiovascular Toxicities of Radiation Therapy.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):274-281

Authors: Lewis GD, Farach A

SIGNIFICANCE: The cardiac side effects of hematological treatments are a major issue of the growing population of cancer survivors, often affecting

Abstract

SIGNIFICANCE: The cardiac side effects of hematological treatments are a major issue of the growing population of cancer survivors, often affecting patient survival even more than the tumor for which the treatment was initially prescribed. Among the most cardiotoxic drugs are anthracyclines, highly potent anti-tumor agents, which still represent a mainstay in the treatment of hematological and solid tumors. Unfortunately, diagnosis, prevention and treatment of cardiotoxicity are still unmet clinical needs which call for a better understanding of the molecular mechanism behind the pathology. Recent Advances: This review article will discuss recent findings on the pathomechanisms underlying the cardiotoxicity of anthracyclines, spanning from DNA and mitochondrial damage to calcium homeostasis, autophagy and apoptosis. Special emphasis will be given to the role of reactive oxygen species and their interplay with major signaling pathways.

CRITICAL ISSUES: Although new promising therapeutic targets and new drugs have started to be identified, their efficacy has been mainly proven in preclinical studies and requires clinical validation.

FUTURE DIRECTIONS: Future studies are awaited to confirm the relevance of recently uncovered targets, as well as identifying new druggable pathways, in more clinically relevant models, including for example human induced pluripotent stem cell-derived cardiomyocytes.

PMID: 31989842 [PubMed - as supplied by publisher]

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Future Directions in Cardio-Oncology.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):300-302

Authors: Trachtenberg BH

PMID: 31988691 [PubMed - in process]

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Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment? CME.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):289-299

Authors: Alvarez-Cardona J, Mitchell J, Lenihan D

Abstract

CRITICAL ISSUES: Although new promising therapeutic targets and new drugs have started to be identified, their efficacy has been mainly proven in preclinical studies and requires clinical validation.

PMID: 31989842 [PubMed - as supplied by publisher]

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Future Directions in Cardio-Oncology.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):300-302

Authors: Trachtenberg BH

PMID: 31988691 [PubMed - in process]

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Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment? CME.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):289-299

Authors: Alvarez-Cardona J, Mitchell J, Lenihan D

BACKGROUND: Primary Hepatic Epithelioid Haemangioendothelioma (HEHE) and Primary Hepatic Angiosarcoma (PHA) are rare mesenchymal

Abstract

BACKGROUND: Primary Hepatic Epithelioid Haemangioendothelioma (HEHE) and Primary Hepatic Angiosarcoma (PHA) are rare mesenchymal tumours with different malignant potential. Whereas HEHE demonstrates low to intermediate malignant potential, PHA is an aggressive malignancy with poor prognosis. The knowledge of typical imaging features of these lesions may facilitate correct diagnosis; however, the ultimate diagnosis of HEHE and PHA is based on histopathologic examination.

DISCUSSION: The most typical findings helpful in diagnosing HEHE are: Presence of multiple, confluent nodules located at the liver periphery (in young to middle-aged woman), retraction of the liver capsule, marked hyperintensity on T2-weighted images, "target-sign" appearance, progressive centripetal contrast enhancement, and relatively high Apparent Diffusion Coefficient (ADC) values. More than ≥50% of nodules are hyper- or isointense on Hepatobiliary Phase (HBP) images.

CONCLUSION: The imaging features suggestive of PHA are: Occurrence of metastases (lungs, spleen) at the time of diagnosis, presence of a large dominant mass with smaller satellites, heterogeneity and areas of haemorrhage in a dominant mass, progressive contrast enhancement, slightly elevated ADC values as compared to other malignant liver tumours.

PMID: 31989904 [PubMed - in process]

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Signaling pathways underlying anthracycline cardiotoxicity.

Antioxid Redox Signal. 2020 Jan 28;:

Authors: Sala V, Della Sala A, Hirsch E, Ghigo A

BACKGROUND AND PURPOSE: We conducted a phase I trial of alisertib, an oral aurora kinase inhibitor, with fractionated stereotactic

Abstract

BACKGROUND AND PURPOSE: We conducted a phase I trial of alisertib, an oral aurora kinase inhibitor, with fractionated stereotactic re-irradiation therapy (FSRT) for patients with recurrent high grade glioma (HGG).

MATERIALS AND METHODS: Adult patients with recurrent HGG were enrolled from Feb 2015 to Feb 2017. Patients were treated with concurrent FSRT and alisertib followed by maintenance alisertib. Concurrent alisertib dose was escalated from 20 mg to 50 mg twice daily (BID).

RESULTS: 17 patients were enrolled. Median follow-up was 11 months. Median FSRT dose was 35 Gy. There were 6, 6, 3, and 2 patients enrolled in 20 mg, 30 mg, 40 mg, and 50 mg cohort, respectively. Only one DLT was observed. One patient in the 20 mg cohort had severe headache (Grade 3) resolved with steroids. There was no non-hematological grade 3 or higher toxicity. There were two Grade 4 late toxicities (one with grade 4 neutropenia and leukopenia, one with pulmonary embolism). One patient developed radiation necrosis (Grade 3). Sixteen patients finished concurrent treatment and received maintenance therapy (median cycles was 3, range 1-9). OS for all cohorts at 6 months was 88.2% with median survival time of 11.1 months. PFS at 6 months was 35.3% with median time to progression of 4.9 months. The trial stopped early due to closure of alisertib program with only 2 of 3 planned patients enrolled in the 50 mg cohort.

CONCLUSION: Re-irradiation with FSRT combined with alisertib is safe and well tolerated for HGG with doses up to 40 mg BID. Although no DLT observed in the 50 mg cohort, this cohort was not fully enrolled and MTD was not reached. Clinical outcomes appear comparable to historical results. (NCT02186509).

PMID: 30825962 [PubMed - indexed for MEDLINE]

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Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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Magnetic Resonance Imaging of Uncommon Hepatic Mesenchymal Tumours: Haemangioendothelioma and Angiosarcoma.

Curr Med Imaging Rev. 2019;15(4):362-368

Authors: Cieszanowski A, Anysz-Grodzicka A, Podgorska J, Jagielska B, Pałucki J

The risk of venous thromboembolism (VTE) is higher in myeloma patients receiving immunomodulatory compounds. A VTE

Abstract

The risk of venous thromboembolism (VTE) is higher in myeloma patients receiving immunomodulatory compounds. A VTE prophylaxis using low-molecular-weight heparin or aspirin is therefore proposed. Apixaban is an oral direct anti-Xa. Several studies have shown the efficacy and safety of apixaban in VTE prophylaxis compared to enoxaparin. The objective of this prospective phase 2 pilot study was to assess the risk of VTE and bleeding in patients with myeloma treated with immunomodulatory compounds lenalidomide (len) or thalidomide (thal), using apixaban in a preventive scheme. Myeloma patients requiring Melphalan-Prednisone-Thalidomide in the first line, or Lenalidomide-Dexamethasone in the relapse setting received apixaban, 2.5 mg x 2/day for 6 months. Venous (pulmonary embolism-PE, or symptomatic proximal or distal deep vein thrombosis-DVT, or all proximal asymptomatic events detected by systematic proximal bilateral compression ultrasound) or arterial thrombotic events, and bleeding events (ISTH 2005) were registered. One hundred and four patients were enrolled (mean age 69.8 ± 7.8 years), 11 in first line and 93 in relapse. Two venous thrombotic events were observed, for example, an asymptomatic proximal DVT and a symptomatic distal DVT, in the context of apixaban stopped 14 days before, due to lenalidomide-induced thrombocytopenia. No PE or arterial cardiovascular events were reported. Only one major and 11 CRNM hemorrhages were reported. These data must now be confirmed on a randomized large study.

PMID: 30859608 [PubMed - indexed for MEDLINE]

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Phase I trial of alisertib with concurrent fractionated stereotactic re-irradiation for recurrent high grade gliomas.

//www.ncbi.nlm.nih.gov/corehtml/query/egifs/https:--linkinghub.elsevier.com-ihub-images-PubMedLink.gif Related Articles

Phase I trial of alisertib with concurrent fractionated stereotactic re-irradiation for recurrent high grade gliomas.

Radiother Oncol. 2019 03;132:135-141

Authors: Song A, Andrews DW, Werner-Wasik M, Kim L, Glass J, Bar-Ad V, Evans JJ, Farrell CJ, Judy KD, Daskalakis C, Zhan T, Shi W

Older patients, especially those with malignancy, may have an increased risk of pulmonary embolism (PE). However, few studies have evaluated the clinical

Abstract

Older patients, especially those with malignancy, may have an increased risk of pulmonary embolism (PE). However, few studies have evaluated the clinical characteristics and prognosis of older patients. We evaluated the clinical characteristics, prognosis, and risk factors in older patients with lung cancer complicated with PE. This was a single-center, prospective cohort study. Older patients (≥65 years) with lung cancer admitted in Beijing Hospital from January 2006 to December 2016 were enrolled. The patients were divided into two groups according to the presence of PE using propensity score matching (PSM). After PSM, one hundred and six patients (53 per group) with an average age of (77.3 ± 10.9) years were enrolled. Adenocarcinoma was the most common histology in patients with PE (52.8%, n = 28), and most lung cancer patients were in stages III and IV (59.4%, n = 63). Patients with PE were stratified to low risk (52.8%, n = 28), intermediate-low risk (24.5%, n = 13), intermediate-high risk (15.1%, n = 8), high-risk (7.5%, n = 4) subgroups. Most PE patients presented with dyspnea (75.5%), and the majority of patients (86.8%, n = 46) developed PE within 3 months after the diagnosis of cancer. The median follow-up time was 23.7 months (12.0-62.0 months), and 7 patients (6.6%) were lost to follow-up. During the follow-up period, 92 patients (86.8%) died, including 8 cases (8.7%) of PE-related death, 73 (79.3%) of tumor death, and 11 (11.9%) of unknown cause. There were significant differences in all-cause mortality (94.3% vs. 83.0%) and PE-related mortality (15.1% vs. 0) between the PE and control groups, but the rate of tumor-related mortality (75.5% vs. 66.0%) was comparable between the groups. Among the 92 patients who died, the mortality rates at 3, 6, 12, and > 12 months after tumor diagnosis were 33.0% (33/106), 57.5% (61/106), 78.3% (83/106), and 89.6% (95/106), respectively. Kaplan-Meier survival analysis showed that the median overall survival time was significantly different between the PE and the control groups (4.3 vs. 9.2 months, P = 0.0015). Multivariate stepwise logistic regression analysis showed that age ≥ 77 years (OR = 2.58, 95%CI: 1.66-4.01), clinical stage III-IV (OR = 2.21, 95%CI: 1.03-4.74), adenocarcinoma (OR = 3.24, 95%CI: 1.75-6.00), high D-dimer (≥600 mg/L) (OR = 2.73, 95%CI: 1.25-5.96), and low partial pressure of oxygen (PaO2; <75 mmhg)

PMID: 31988400 [PubMed - in process]

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Apixaban for the prevention of thromboembolism in immunomodulatory-treated myeloma patients: Myelaxat, a phase 2 pilot study.

//www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--media.wiley.com-assets-7388-69-wiley-full-text.png Related Articles

Apixaban for the prevention of thromboembolism in immunomodulatory-treated myeloma patients: Myelaxat, a phase 2 pilot study.

Am J Hematol. 2019 06;94(6):635-640

Authors: Pegourie B, Karlin L, Benboubker L, Orsini-Piocelle F, Tiab M, Auger-Quittet S, Rodon P, Royer B, Leleu X, Bareau B, Cliquennois M, Fuzibet JG, Voog E, Belhadj-Merzoug K, Decaux O, Rey P, Slama B, Leyronnas C, Zarnitsky C, Boyle E, Bosson JL, Pernod G, IFM Group

The acknowledgement of cardiovascular disease as one of the leading causes of mortality and morbidity among cancer survivors is the cornerstone of the

Abstract

PMID: 31988690 [PubMed - in process]

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Prognosis and risk factors in older patients with lung cancer and pulmonary embolism: a propensity score matching analysis.

Sci Rep. 2020 Jan 27;10(1):1272

Authors: Junjun L, Pei W, Ying Y, Kui S

Background: The propensity to develop venous thromboembolism (VTE) on the basis of individual tumor biological features remains unknown.

Abstract

Background: The propensity to develop venous thromboembolism (VTE) on the basis of individual tumor biological features remains unknown.

Objectives: We conducted a whole transcriptome RNA sequencing strategy, focusing on a single cancer type (lung cancer), to identify biomarkers of cancer-associated VTE.

Methods: Twelve propensity-matched patients, 6 each with or without VTE, were identified from a prospective institutional review board-approved registry at the Cleveland Clinic with available tissue from surgical excision of a primary lung mass between 2010 and 2015. Patients were propensity matched based on age, sex, race, history of prior cancer, date of cancer diagnosis, stage, histology, number of lines of chemotherapy, and length of follow-up. RNA sequencing was performed on tumor tissue, and gene set enrichment analysis (GSEA) was performed on differentially expressed genes.

Results: We identified 1037 genes with differential expression. In patients with VTE, 869 genes were overexpressed and 168 were underexpressed compared to patients without VTE. Of these, 276 overexpressed and 35 underexpressed were significantly different (Q < 0.05).

Conclusions: These differentially expressed genes and associated pathways provide biologic insights into cancer-associated VTE and may provide insignts to develop new risk stratification schemes, prevention, or treatment strategies.

PMID: 31989093 [PubMed]

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Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment? CME.

Methodist Debakey Cardiovasc J. 2019 Oct-Dec;15(4):289-299

Authors: Alvarez-Cardona J, Mitchell J, Lenihan D

Background: Pulmonary embolism (PE) in children carries a significant morbidity and mortality. We examined previously described factors in

Abstract

Background: Pulmonary embolism (PE) in children carries a significant morbidity and mortality. We examined previously described factors in 2 cohorts of children tested for PE and identified novel factors.

Methods: We combined data from 2 retrospective cohorts. Patients up to age 21 years were included who underwent imaging or D-dimer testing for PE, with positive radiologic testing being the gold standard. Combined predictor variables were examined by univariate analysis and then forward stepwise multivariable logistic regression.

Results: The combined data set yielded 1103 patients with 42 unique predictor variables, and 93 PE-positive patients (8.4%), with a median age of 16 years. Univariate analysis retained 17 variables, and multivariable logistic regression found 9 significant variables with increased probability of PE diagnosis: age-adjusted tachycardia, tachypnea, hypoxia, unilateral limb swelling, trauma/surgery requiring hospitalization in previous 4 weeks, prior thromboembolism, cancer, anemia, and leukocytosis.

Conclusion: This combined data set of children with suspected PE discovered factors that may contribute to a diagnosis of PE: hypoxia, unilateral limb swelling, trauma/surgery requiring hospitalization in previous 4 weeks, prior thromboembolism, and cancer, age-adjusted tachycardia, tachypnea, anemia, and leukocytosis. Prospective testing is needed to determine which criteria should be used to initiate diagnostic testing for PE in children.

PMID: 31989094 [PubMed]

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RNA expression and risk of venous thromboembolism in lung cancer.

Res Pract Thromb Haemost. 2020 Jan;4(1):117-123

Authors: Sussman TA, Abazeed ME, McCrae KR, Khorana AA

Introduction: Previous research from the United Kingdom and Spain has identified several areas of unmet clinical and support need for cancer patients

Abstract

Introduction: Previous research from the United Kingdom and Spain has identified several areas of unmet clinical and support need for cancer patients diagnosed with venous thromboembolism. It is not known whether such experiences are restricted to those countries health care systems and culture. We therefore evaluated patients' experience of cancer-associated thrombosis (CAT) within a Canadian setting.

Methods: Purposive sampling of patients with CAT attending a regional thrombosis clinic in Vancouver was undertaken. Semistructured interviews were audio recorded, transcribed, and coded using NVivo software. A deductive approach was taken by applying the framework matrix from the original study to these data on a case-by-case basis.

Results: Twenty patients (10 male, 10 female) aged 39 to 74 (mean, 63) representing a breadth of different cancers participated. Commonalities between the UK and Canadian patients included the traumatic nature of experiencing CAT, the need for information, and adaptive behaviors through ritualization. Two new themes were identified: (1) Patients with incidental pulmonary emboli (iPE) were usually telephoned about their thrombus with little support and suboptimal communication; and (2) cost implications of accessing low-molecular-weight heparin varied according to insurance cover. Patients were sometimes converted to warfarin for financial reasons.

Conclusion: The distress associated with CAT is a common experience across different populations but may be ameliorated by early access to specialist services, information, and support. The current process for managing iPE could be improved with better communication and a dedicated clinical pathway. Funding issues may influence choice of anticoagulant.

PMID: 31989097 [PubMed]

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Clinical variables that increase the probability of pulmonary embolism diagnosis in symptomatic children.

Res Pract Thromb Haemost. 2020 Jan;4(1):124-130

Authors: Hennelly KE, Ellison AM, Neuman MI, Kline JA

Heparin-induced thrombocytopenia (HIT)

Abstract

Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction to heparin products characterized by thrombocytopenia with or without thrombosis. This study aimed to determine the incidence, morbidity, mortality and economic burden of HIT in solid-malignancy-related hospitalizations. We analyzed the National Inpatient Sample Database (NIS), the largest public database of hospital admissions in the United States, from January 2012 to September 2015. The primary outcome of the study was the incidence of HIT. Secondary outcomes included incidence of venous thrombosis (acute deep venous thrombosis and pulmonary embolism), arterial thrombosis (thrombotic stroke, myocardial infarctions and other arterial thromboembolism), mortality associated with HIT, length of stay, total hospital charges and disposition. During the study period, 7 437 049 hospitalizations had an associated diagnosis of solid malignancy. Approximately 0·08% (n = 6225) hospitalizations had a secondary diagnosis of HIT in this population. The standardized incidence of total thrombotic events was higher in the solid malignancy with HIT compared to the solid malignancy without HIT group (24·7% vs. 6·8%, P < 0·001).< 0·001).

PMID: 31990984 [PubMed - as supplied by publisher]

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Patient Experience of Living With Cancer-Associated Thrombosis in Canada (PELICANADA).

Res Pract Thromb Haemost. 2020 Jan;4(1):154-160

Authors: Noble S, Nelson A, Scott J, Berger A, Schmidt K, Swarnkar P, Lee A

OBJECTIVES: To examine and summarize current international guidelines regarding cardiovascular risk reduction before and during cancer

Abstract

OBJECTIVES: To examine and summarize current international guidelines regarding cardiovascular risk reduction before and during cancer therapy, and to discuss the emerging role of cardio-oncology as a subspecialty in cancer care and the role of cardio-oncology rehabilitation.

DATA SOURCES: Published articles and guidelines.

CONCLUSION: With improvements in cancer detection and the use of novel adjuvant therapies, an increasing number of individuals now survive a cancer diagnosis. However, for some the cost is high - many survivors are now at higher risk of death from cardiovascular disease than from recurrent cancer. Cardiovascular morbidity and mortality are common and associated with common cancer therapies serially administered in adult oncology care.

IMPLICATIONS FOR NURSING PRACTICE: Timely risk-reduction interventions hold promise in reducing cardiovascular morbidity and mortality. Oncology nurses are the key providers to identify baseline risks, perform necessary referrals, provide individualized teaching, and support the patient within the family and community.

PMID: 31983487 [PubMed - as supplied by publisher]

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Modulating the cardiotoxic behaviour of immunoglobulin light chain dimers through point mutations.

//www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--www.tandfonline.com-templates-jsp-_style2-_tandf-images-tandf100x25.gif Related Articles

Modulating the cardiotoxic behaviour of immunoglobulin light chain dimers through point mutations.

Amyloid. 2019;26(sup1):105-106

Authors: Maritan M, Ambrosetti A, Oberti L, Barbiroli A, Diomede L, Romeo M, Lavatelli F, Sormanni P, Palladini G, Bolognesi M, Merlini G, Ricagno S

PMID: 31343361 [PubMed - indexed for MEDLINE]

29 January 2020

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Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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Incidence and outcomes of heparin-induced thrombocytopenia in solid malignancy: an analysis of the National Inpatient Sample Database.

Br J Haematol. 2020 Jan 28;:

Authors: Kumar R, Bhandari S, Singh SRK, Malapati S, Cisak KI

Abstract

BACKGROUND: Described variations of tentorial venous anatomy impact surgical sectioning of the tentorium in skull base approaches; however, described configurations do not consistently explain postoperative complications. To understand the outcomes of 2 clinical cases we studied the tentorial venous anatomy of 2 cadavers.

METHODS: The venous anatomy of the tentorium isolated in 2 uninjected fresh cadaver head specimens with preserved bridging veins was observed by transillumination before and after methylene blue injection of the dural sinuses and tentorial veins. Our findings in cadavers were applied to explain the clinical and radiologic (magnetic resonance imaging and computed tomographic venography) findings in the 2 cases presented.

RESULTS: A consistent transtentorial venous system, arising from transverse and straight sinuses, communicating with supra- and infratentorial bridging veins was seen in the cadaver and patient radiography (magnetic resonance imaging and computed tomographic venography). Our first patient had a cerebellar venous infarct from compromise of the venous drainage from the adjacent brain after ligation of a temporal lobe bridging vein to the tentorium. Our second patient suffered no clinical effects from bilateral transverse sinus occlusion due to drainage through the accessory venous system within the tentorium.

CONCLUSIONS: Herein, we elaborate on transtentorial venous anatomy. These veins, previously reported to obliterate in completed development of the tentorium, remain patent with consistent observed configuration. The same transtentorial venous system was observed in both cases and provided insight to their outcomes. These findings emphasize the importance of the transtentorial venous system physiologically and in surgical approaches.

PMID: 31295599 [PubMed - indexed for MEDLINE]

14:44

Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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Rehabilitation Needs in Cancer Treatment-Related Cardiotoxicity.

Semin Oncol Nurs. 2020 Jan 23;:150986

Authors: Pituskin E, Kirkham AA, Cox-Kennett N, Dimitry R, Dimitry J, Paterson I, Gyenes GT

Abstract

BACKGROUND: Clinically unsuspected venous thromboembolic events (uVTE) detected during routine imaging pose a management challenge due to limited knowledge about their clinical significance. Unsuspected VTE are often referred as "asymptomatic", "incidental" or "clinically silent/occult" VTE.

OBJECTIVE: Understand the epidemiology, management, and outcomes of uVTE in children.

METHODS: A systematic review was performed according to PRISMA guidelines. The search criteria included controlled vocabulary and keywords for VTE, incidental findings, and children (ages ≤21 years).

RESULTS: Among 10,875 articles, 51 studies (7597 children with 758 uVTE) were selected. The studies were heterogeneous, I2 96%; p <.0001.

CONCLUSION: Clinically uVTE were predominantly diagnosed with CVL and their outcomes were generally favorable implying limited benefit of routine surveillance and thromboprophylaxis. Prospective research is needed to clarify the optimal management of iVTE.

PMID: 31984669 [PubMed - as supplied by publisher]

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Tentorial Venous Anatomy: Cadaveric and Radiographic Study with Discussion of Origin and Surgical Significance.

//www.ncbi.nlm.nih.gov/corehtml/query/egifs/https:--linkinghub.elsevier.com-ihub-images-PubMedLink.gif Related Articles

Tentorial Venous Anatomy: Cadaveric and Radiographic Study with Discussion of Origin and Surgical Significance.

World Neurosurg. 2019 Nov;131:e38-e45

Authors: Rosenblum JS, Neto M, Essayed WI, Bi WL, Patel NJ, Aziz-Sultan MA, Heiss JD, Al-Mefty O

Background: Venous thromboembolism (VTE)

Abstract

Background: Venous thromboembolism (VTE) is a common complication in cancer patients. We aim to evaluate the effect and safety of direct oral anticoagulants (DOACs) as primary prophylaxis in ambulatory cancer patients.Methods: We conducted a literature search in PubMed, EMBASE and ClinicalTrials for studies that evaluated DOACs for thromboprophylaxis in cancer patients. RevMan 5.3 software was used for this meta-analysis.Results: Three randomized controlled trials (RCTs) with a total of 1465 patients were pooled in the meta-analysis. DOACs significantly reduced the symptomatic VTE incidence during intervention period (RR 0.23, CI 0.11-0.47, P<0.0001,

PMID: 31984870 [PubMed - in process]

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Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: a systematic review.

J Thromb Haemost. 2020 Jan 27;:

Authors: Sharathkumar AA, Biss T, Kulkarni K, Ahuja S, Regan M, Male C, Revel-Vilk S

In this concise review, we discuss some common clinical challenges in the management of patients with cancer-associated venous thromboembolism (VTE

Abstract

In this concise review, we discuss some common clinical challenges in the management of patients with cancer-associated venous thromboembolism (VTE), a frequent complication in patients with cancer that increases morbidity and mortality. While direct oral anticoagulants (DOACs) have been established in clinical practice for anticoagulation in patients with VTE without cancer, their efficacy and safety in patients with cancer have not been assessed in randomized controlled trials until recently. The choice of the appropriate anticoagulant agent in the era of DOACs to treat patients with cancer-associated VTE is based on balancing the risk of recurrence against the risk of bleeding, and potential drug-drug interactions. However, the management of patients is challenged by special scenarios such as incidentally diagnosed pulmonary embolism and catheter-related thrombosis, and sometimes complicated by concomitant thrombocytopenia. We provide guidance for management of cancer-associated VTE in different clinical scenarios in a case-based manner and briefly review recent clinical studies and guidelines to explain our approach to management of the cases.

PMID: 31986545 [PubMed - as supplied by publisher]

13:19

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Pharmacology Focus: Direct Oral Anticoagulants for the Treatment of Cancer-Associated Venous Thromboembolism.

S D Med. 2019 Nov;72(11):537-538

Authors: Lund J, Strain J

PMID: 31985908 [PubMed - in process]

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Direct oral anticoagulants for thromboprophylaxis in ambulatory patients with cancer.

Hematology. 2020 Dec;25(1):63-70

Authors: Wang Y, Wang M, Ni Y, Liang Z

PURPOSE: To evaluate ultrasound-accelerated, catheter-directed thrombolysis (CDT) for treatment of acute submassive pulmonary embolism (PE).

Abstract

PURPOSE: To evaluate ultrasound-accelerated, catheter-directed thrombolysis (CDT) for treatment of acute submassive pulmonary embolism (PE).

MATERIALS AND METHODS: This single-center, retrospective study included patients who underwent CDT for acute submassive PE (N = 113, 52% men/48% women) from 2013 to 2017. Baseline characteristics included history of deep venous thrombosis (12%), history of PE (6%), and history of cancer (18%). Of cohort patients, 88% (n=99) had a simplified PE severity index score of ≥ 1 indicating a high risk of mortality.

RESULTS: A technical success rate of 100% was achieved with 84% of patients having bilateral catheter placements. Average tissue plasminogen activator (tPA) therapy duration was 20.7 hours ± 1.5, and median tPA dose was 21.5 mg. Three patients (2.6%) experienced minor hemorrhagic complications. Mean hospital length of stay was 6 days. Mean pulmonary arterial pressure decreased from 55 mm Hg on presentation to 37 mm Hg (P < .01) 1 day following initiation of thrombolytic therapy. All-cause mortality rate of 4% (n = 4) was noted on discharge, which increased to 6% (n = 7) at 6 months. At 6-month follow-up compared with initial presentation, symptom improvements (93%), physiologic improvements (heart rate 72 beats/min vs 106 beats/min, P < .01), oxygen requirement improvements (fraction of inspired oxygen 20% vs 28%, P < .01), and right ventricular systolic pressure improvements by echocardiography (30 mm Hg vs 47 mm Hg, P < .01) were observed.

CONCLUSIONS: CDT for acute submassive PE was associated with low complications and mortality, decreased right ventricular systolic pressure, high rates of clinical improvement, and improved intermediate-term clinical outcomes.

PMID: 31982316 [PubMed - as supplied by publisher]

28 January 2020

13:19

Cancer & Heart (Cardio-Oncology, Cardiotoxicity, TEV)

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How I Manage Cancer-Associated Thrombosis.

Hamostaseologie. 2020 Jan 27;:

Authors: Moik F, Ay C

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