topics / مواضيع: February 2025

ACERUMEN، زجاجة جرعة واحدة

جديد

عرض تقديمي

10 زجاجات

الموزع أو الشركة المصنعة

زينيث فارما

تعبير

عوامل التوتر السطحي الخفيفة (أسيل ساركوزينات الصوديوم وإستر السكروز)، مرطب، صبغة نباتية، مواد مساعدة qsp 100%. تركيبة ملونة بدون مواد حافظة، من أصل طبيعي.

حالة

تم تسويقه

الدفع لكل نقرة

58.00 درهم

تلوين

لا أحد

المؤشرات

A-Cerumen هو محلول لطيف لتنظيف الأذن يعتمد على المواد الخافضة للتوتر السطحي الموصى بها للأطفال من سن 6 أشهر والبالغين:

لإذابة سدادات شمع الأذن؛

عند الاستخدام المنتظم، لتسهيل إزالة شمع الأذن ومنع تكوّن السدادات.

سيقوم A-Cerumen بترطيب ثم إذابة سدادات شمع الأذن (شمع الأذن المجفف والمضغوط). وبمجرد التخلص من شمع الأذن هذا، يمكن إفراز شمع الأذن المستخدم للحماية والتزييت مرة أخرى للقيام بدوره.

طبيعة المنتج

جهاز طبي

كبسولة ACDigest

جديد

عرض تقديمي

نفطة 30

الموزع أو الشركة المصنعة

لم يتم ابلاغه

تعبير

طين | فحم

حالة

تم تسويقه

الدفع لكل نقرة

59.00 درهم

المؤشرات

ثقل وانتفاخ

طبيعة المنتج

مكمل غذائي

أكوبريل 5 مجم، قرص مقسم

جديد

عرض تقديمي

صندوق يحتوي على 28

الجرعة

5 ملغ

برينسيبس

نعم

الموزع أو الشركة المصنعة

فايزر المغرب

تعبير

كوينابريل

صف علاجي

دواء مضاد لارتفاع ضغط الدم من عائلة مثبطات الإنزيم المحول للأنجيوتنسين

حالة

تم تسويقه

رمز ATC

ج09أأ06

الدفع مقابل المشاهدة

37.50 درهم

سعر المستشفى

23.40 درهم

تلوين

لديه

المؤشرات

- ضغط دم مرتفع؛

- قصور القلب الاحتقاني.

طبيعة المنتج

الدواء

أكوبريل 20 مجم، قرص مغلف، محزز

جديد

عرض تقديمي

صندوق يحتوي على 28

الجرعة

20 مليجرام

برينسيبس

نعم

الموزع أو الشركة المصنعة

فايزر المغرب

تعبير

كوينابريل

صف علاجي

دواء مضاد لارتفاع ضغط الدم من عائلة مثبطات الإنزيم المحول للأنجيوتنسين

حالة

تم تسويقه

رمز ATC

ج09أأ06

الدفع مقابل المشاهدة

70.10 درهم

سعر المستشفى

43.80 درهم

تلوين

لديه

المؤشرات

- ضغط دم مرتفع؛

- قصور القلب الاحتقاني.

طبيعة المنتج

الدواء

أكارد 50 مجم، أقراص مغلفة بغشاء

جديد

عرض تقديمي

صندوق يحتوي على 28

الجرعة

50 ملغ

الموزع أو الشركة المصنعة

ام سي فارما

تعبير

لوسارتان

صف علاجي

مضاد مستقبلات الأنجيوتنسين II

حالة

تم تسويقه

رمز ATC

سي09سي ايه 01

الدفع مقابل المشاهدة

77.20 درهم

سعر المستشفى

48.20 درهم

تلوين

لديه

المؤشرات

يستخدم لوسارتان

لعلاج ارتفاع ضغط الدم الأساسي.

ارتفاع ضغط الدم مع تضخم البطين الأيسر

تقليل خطر الإصابة بالسكتة الدماغية لدى مرضى ارتفاع ضغط الدم مع تضخم البطين الأيسر

قصور القلب

قصور القلب الخفيف إلى المتوسط، عادة بالاشتراك مع مدرات البول والديجيتاليس، عندما يكون العلاج بمثبطات الإنزيم المحول للأنجيوتنسين بسبب الآثار الجانبية المحددة لمثبطات الإنزيم المحول للأنجيوتنسين (السعال) غير مناسب. لا تشكل الآثار الجانبية التي تحدث بعد العلاج بمثبطات الإنزيم المحول للأنجيوتنسين ونتيجة للتأثير العام على نظام الرينين أنجيوتنسين الألدوستيرون (على سبيل المثال الفشل الكلوي التدريجي، فرط بوتاسيوم الدم) مؤشرا لاستخدام لوسارتان.

اعتلال الكلية عند مرضى السكري من النوع الثاني

لعلاج اعتلال الكلية السكري عند مرضى السكري من النوع الثاني المصابين بارتفاع ضغط الدم وارتفاع مستوى الكرياتينين في المصل وبروتينية البول (نسبة ألبومين البول/الكرياتينين ≥300 مجم/جم).

طبيعة المنتج

الدواء

أبسترال 400 ميكروجرام، قرص تحت اللسان [P][SS]

جديد

عرض تقديمي

صندوق من 10

الجرعة

400 ميكروجرام

برينسيبس

نعم

الموزع أو الشركة المصنعة

سوثيما

تعبير

الفنتانيل

صف علاجي

مسكنات الأفيون

حالة

تم تسويقه

رمز ATC

ن02ا ب03

الدفع مقابل المشاهدة

876.00 درهم

سعر المستشفى

582.00 درهم

تلوين

المؤشرات

علاج الألم المفاجئ لدى المرضى البالغين باستخدام المورفين لعلاج آلام السرطان المزمنة. الألم الانتيابي هو تفاقم مؤقت للألم المزمن والذي يمكن السيطرة عليه بالعلاج الأساسي.

تحذيرات

يجب إخبار المرضى ومقدمي الرعاية بأن دواء ABSTRAL يحتوي على مادة فعالة بجرعة قد تكون قاتلة للطفل. لذلك، يجب أن تبقى كافة الأقراص بعيدًا عن متناول الأطفال وبصرهم.

نظرًا للآثار الجانبية الخطيرة المحتملة لعلاجات المواد الأفيونية مثل ABSTRAL، يجب إعلام المرضى ومقدمي الرعاية بأهمية تناول ABSTRAL بشكل صحيح وإبلاغهم بالتدابير التي يجب اتخاذها في حالة ظهور أعراض الجرعة الزائدة.

قبل البدء في استخدام ABSTRAL، يجب تثبيت العلاج بالمورفين طويل المفعول المستخدم للسيطرة على الألم المزمن.

لم تتم دراسة ABSTRAL في المرضى الذين يعانون من آفات الفم أو التهاب الغشاء المخاطي. قد يكون هناك خطر التعرض الجهازي المتزايد للدواء لدى هؤلاء المرضى، لذا يوصى باتخاذ الحذر بشكل خاص أثناء تحديد الجرعة.

لا ينبغي أن يسبب إيقاف العلاج بـ ABSTRAL أي آثار ملحوظة، ولكن أعراض الانسحاب المحتملة تشمل: القلق، والرعشة، والتعرق، والشحوب، والغثيان والقيء.

كما هو الحال مع المواد الأفيونية الأخرى، إذا كان التحكم في الألم غير كافٍ استجابة لزيادة جرعة الفنتانيل، فيجب النظر في إمكانية الإصابة بفرط الحساسية للألم الناجم عن المواد الأفيونية. يوصى بتقليل جرعة الفنتانيل أو تعليق العلاج أو إعادة تقييم العلاج.

التعود والاعتماد

من المرجح أن يحدث التعود والاعتماد الجسدي و/أو النفسي مع الاستخدام المتكرر للأدوية التي تعتمد على المورفين مثل الفنتانيل. من المعروف أن الإدمان على المواد الأفيونية منشأه طبي.

اكتئاب الجهاز التنفسي

مثل جميع المواد الأفيونية، يرتبط ABSTRAL بخطر الإصابة باكتئاب الجهاز التنفسي ذي الأهمية السريرية. يجب إجراء مرحلة المعايرة بحذر خاص عند المرضى الذين يعانون من مرض الانسداد الرئوي المزمن أو أمراض أخرى (مثل الوهن العضلي الشديد) مما يجعلهم عرضة للاكتئاب التنفسي، بسبب زيادة خطر الاكتئاب التنفسي الذي قد يؤدي إلى توقف التنفس. يجب إعطاء ABSTRAL بحذر شديد فقط للمرضى الذين قد يكونون حساسين بشكل خاص للتأثيرات الدماغية لفرط ثاني أكسيد الكربون، مثل المرضى الذين يعانون من علامات ارتفاع الضغط داخل الجمجمة، أو ضعف الوعي، أو الغيبوبة أو أورام المخ

نظرًا لأن المورفين يمكن أن يخفي المسار السريري لدى المرضى الذين يعانون من إصابات في الرأس، فيجب استخدامه في هذا الوضع فقط إذا كان ضروريًا للغاية.

امراض القلب

يمكن أن يسبب الفنتانيل بطء القلب. يجب استخدامه بحذر عند المرضى الذين لديهم تاريخ من بطء ضربات القلب أو بطء ضربات القلب الموجود مسبقًا.

المرضى المسنين

تشير البيانات التي تم الحصول عليها بعد الإعطاء الوريدي للفنتانيل إلى احتمال حدوث انخفاض في تصفيته وزيادة في نصف عمره لدى المرضى المسنين، الذين قد يكونون أكثر حساسية للمادة الفعالة من المرضى الأصغر سنا. يجب مراقبة المرضى المسنين أو المصابين بالهزال أو الضعفاء بعناية بحثًا عن علامات التسمم بالفنتانيل، مع تقليل الجرعة إذا لزم الأمر. يجب إعطاء ABSTRAL بحذر للمرضى الذين يعانون من ضعف في وظائف الكبد أو الكلى، وخاصة أثناء مرحلة المعايرة

قد يؤدي استخدام ABSTRAL في المرضى الذين يعانون من ضعف في وظائف الكبد أو الكلى إلى زيادة التوافر البيولوجي للفنتانيل وتقليل تصفيته الجهازية، مما قد يؤدي إلى زيادة وإطالة التأثيرات الشبيهة بالمورفين.

ينبغي توخي الحذر بشكل خاص في علاج المرضى الذين يعانون من نقص حجم الدم أو انخفاض ضغط الدم.

متلازمة السيروتونين:

ينصح بالحذر عند تناول ABSTRAL مع الأدوية التي تؤثر على أنظمة الناقل العصبي السيروتونين.

قد يتطور متلازمة السيروتونين، وهي حالة قد تهدد الحياة، مع الاستخدام المتزامن للأدوية السيروتونينية مثل مثبطات إعادة امتصاص السيروتونين الانتقائية (SSRIs) ومثبطات إعادة امتصاص السيروتونين والنورادرينالين (SNRIs)، بالإضافة إلى الأدوية التي تضعف عملية التمثيل الغذائي للسيروتونين (بما في ذلك مثبطات أحادي الأمين أوكسيديز [MAOIs]). يمكن أن يحدث هذا بالجرعات الموصى بها.

قد يصاحب متلازمة السيروتونين تغيرات في الحالة العقلية (مثل التحريض والهلوسة والغيبوبة)، وعدم استقرار الجهاز العصبي اللاإرادي (مثل عدم انتظام ضربات القلب وضغط الدم غير المستقر وفرط الحرارة)، واضطرابات عصبية عضلية (مثل فرط المنعكسات وعدم التنسيق والتصلب)، و/أو أعراض الجهاز الهضمي (مثل الغثيان والقيء والإسهال).

في حالة الاشتباه في الإصابة بمتلازمة السيروتونين، يجب التوقف عن العلاج بـ ABSTRAL.

موانع الاستعمال

• فرط الحساسية للمادة الفعالة أو لأي من المواد المساعدة المذكورة في القسم 6.1.

• المرضى الذين لم يتلقوا العلاج بالمورفين الأساسي، بسبب زيادة خطر الاكتئاب التنفسي.

• اكتئاب تنفسي حاد أو أمراض انسداد رئوي حاد.

• علاج الآلام الحادة غير الآلام الاختراقية.

الجرعات وطريقة الإعطاء

الجرعة: يتم تخصيص دواء ABSTRAL للمرضى الذين يعتبرون قادرين على تحمل العلاج الأساسي بالمورفين لعلاج آلام السرطان المزمنة. يمكن اعتبار المرضى الذين يتلقون ما لا يقل عن 60 ملغ من المورفين يوميًا عن طريق الفم، أو ما لا يقل عن 25 ميكروغرام من الفنتانيل في الساعة عبر الجلد، أو ما لا يقل عن 30 ملغ من الأوكسيكودون يوميًا عن طريق الفم، أو ما لا يقل عن 8 ملغ من الهيدرومورفون يوميًا عن طريق الفم، أو جرعة مسكنة متساوية من نوع آخر من المورفين لمدة أسبوع واحد على الأقل متسامحين مع المورفين.

طريقة الإعطاء:

طريقة الإعطاء

يجب وضع أقراص ABSTRAL تحت اللسان مباشرة تحت اللسان، إلى أقصى حد ممكن. لا ينبغي بلع أقراص ABSTRAL تحت اللسان، ولكن يجب تركها لتذوب تمامًا تحت اللسان، دون مضغها أو مصها. يجب توجيه المرضى بعدم تناول الطعام أو الشراب حتى يذوب القرص تحت اللسان تمامًا.

يمكن للمرضى الذين يعانون من جفاف الفم استخدام الماء لترطيب الغشاء المخاطي للفم قبل تناول أبسترال.

المواد المؤثرة عقليا

نعم

خطر محتمل للإدمان أو الإساءة

نعم

طبيعة المنتج

الدواء

أبسترال 200 ميكروجرام، قرص تحت اللسان [P] [SS]

جديد

عرض تقديمي

صندوق من 10

الجرعة

200 ميكروجرام

برينسيبس

نعم

الموزع أو الشركة المصنعة

سوثيما

تعبير

الفنتانيل

صف علاجي

مسكنات الأفيون

حالة

تم تسويقه

رمز ATC

ن02ا ب03

الدفع مقابل المشاهدة

876.00 درهم

سعر المستشفى

582.00 درهم

تلوين

المؤشرات

يستخدم دواء DUROGESIC عند البالغين

في علاج الألم المزمن الشديد الذي يتطلب تناول المواد الأفيونية بشكل مستمر لفترة طويلة.

عند الأطفال

العلاج طويل الأمد للألم المزمن الشديد عند الأطفال من عمر سنتين الذين يتلقون العلاج الأفيوني.

المواد المؤثرة عقليا

نعم

خطر محتمل للإدمان أو الإساءة

نعم

طبيعة المنتج

الدواء

أبسترال 100 ميكروجرام، قرص تحت اللسان [P] [SS]

جديد

عرض تقديمي

صندوق من 10

الجرعة

100 ميكروجرام

برينسيبس

نعم

الموزع أو الشركة المصنعة

سوثيما

تعبير

الفنتانيل

صف علاجي

مسكنات الأفيون

حالة

تم تسويقه

رمز ATC

ن02ا ب03

الدفع مقابل المشاهدة

876.00 درهم

سعر المستشفى

582.00 درهم

تلوين

المؤشرات

تحذيرات

قبل البدء في استخدام ABSTRAL، يجب تثبيت العلاج بالمورفين طويل المفعول المستخدم للسيطرة على الألم المزمن.

التعود والاعتماد

اكتئاب الجهاز التنفسي

امراض القلب

المرضى المسنين

ينبغي توخي الحذر بشكل خاص في علاج المرضى الذين يعانون من نقص حجم الدم أو انخفاض ضغط الدم.

متلازمة السيروتونين:

ينصح بالحذر عند تناول ABSTRAL مع الأدوية التي تؤثر على أنظمة الناقل العصبي السيروتونين.

في حالة الاشتباه في الإصابة بمتلازمة السيروتونين، يجب التوقف عن العلاج بـ ABSTRAL.

موانع الاستعمال

• فرط الحساسية للمادة الفعالة أو لأي من المواد المساعدة المذكورة في القسم 6.1.

• المرضى الذين لم يتلقوا العلاج بالمورفين الأساسي، بسبب زيادة خطر الاكتئاب التنفسي.

• اكتئاب تنفسي حاد أو أمراض انسداد رئوي حاد.

• علاج الآلام الحادة غير الآلام الاختراقية.

الجرعات وطريقة الإعطاء

طريقة الإعطاء:

طريقة الإعطاء

يمكن للمرضى الذين يعانون من جفاف الفم استخدام الماء لترطيب الغشاء المخاطي للفم قبل تناول أبسترال.

المواد المؤثرة عقليا

نعم

خطر محتمل للإدمان أو الإساءة

نعم

طبيعة المنتج

الدواء

أبيراتيرون جي تي 250 مجم، قرص

جديد

عرض تقديمي

صندوق يحتوي على 120

الجرعة

250 ملجم

الموزع أو الشركة المصنعة

أطلس فارم

تعبير

أبيراتيرون

صف علاجي

مضاد للورم، مثبط تخليق الأندروجين (مثبط CYP17A1)

حالة

تم تسويقه

رمز ATC

ل02بكس0

الدفع مقابل المشاهدة

10411.00 درهم

سعر المستشفى

10215.00 درهم

تلوين

لديه

المؤشرات

يشار إليه بالاشتراك مع بريدنيزون أو بريدنيزولون في:

- علاج سرطان البروستاتا الحساس للهرمون النقيلي عالي الخطورة الذي تم تشخيصه حديثًا (mHSPC) لدى الرجال البالغين، بالاشتراك مع العلاج بالحرمان من الأندروجين (ADT).

- علاج سرطان البروستاتا النقيلي المقاوم للإخصاء (mCRPC) في الرجال البالغين الذين لا تظهر عليهم أعراض أو تظهر عليهم أعراض خفيفة بعد فشل العلاج بالحرمان من الأندروجين والذين لم يتم الإشارة إلى العلاج الكيميائي لهم سريريًا بعد.

- علاج سرطان البروستات النقيلي المقاوم للإخصاء (mCR

أبيرانات 250 مجم، قرص

جديد

عرض تقديمي

صندوق يحتوي على 120 زجاجة

الجرعة

250 ملجم

الموزع أو الشركة المصنعة

أمانيس فارما (أسهم فارما السابقة)

تعبير

أبيراتيرون

صف علاجي

العلاج الهرموني ومضادات الهرمونات الأخرى والعوامل ذات الصلة

حالة

تم تسويقه

كود ATC

L02BX03

الدفع مقابل المشاهدة

10411.00 درهم

سعر المستشفى

10215.00 درهم

تلوين

المؤشرات

يشار إليه بالاشتراك مع بريدنيزون أو بريدنيزولون من أجل:

- علاج سرطان البروستاتا الحساس للهرمون النقيلي عالي الخطورة الذي تم تشخيصه حديثًا (mHSPC)

لدى الرجال البالغين بالاشتراك مع العلاج بالحرمان من الأندروجين

(ADT) (انظر القسم 5.1)

- علاج سرطان البروستاتا النقيلي المقاوم للإخصاء (mCRPC) لدى

الرجال البالغين الذين لا تظهر عليهم أعراض أو تظهر عليهم أعراض طفيفة بعد فشل العلاج بالحرمان من الأندروجين

والذين لم تتم

الإشارة إلى العلاج الكيميائي لهم سريريًا بعد (انظر القسم 5.1)

- علاج سرطان البروستاتا النقيلي المقاوم للإخصاء (mCRPC) لدى

الرجال البالغين الذين تقدم مرضهم أثناء العلاج الكيميائي القائم على الدوسيتاكسيل أو بعده

ABSTRACT

The synergy between radiotherapy and immunotherapy in treating thoracic cancers presents a potent therapeutic advantage, yet it also carries potential risks. The extent and nature of cumulative cardiac toxicity remain uncertain, prompting the need to discern its mechanisms and devise effective mitigation strategies. Radiation alone or in combination with an anti- Programmed cell death protein1 (PD-1) antibody significantly reduced cardiac function in C57BL/6J mice, and this pathologic effect was aggravated by anti-PD-1 (anti-PD-1 + radiation). To examine the cellular mechanism that causes the detrimental effect of anti-PD-1 upon cardiac function after radiation, AC16 human cardiomyocytes were used to study cardiac apoptosis and cardiac autophagy. Radiation-induced cardiomyocyte apoptosis was significantly promoted by anti-PD-1 treatment, while anti-PD-1 combined radiation administration blocked the cardiac autophagic flux. Adenosine 5'-triphosphate (ATP) (a molecule that promotes lysosomal acidification) not only improved autophagic flux in AC16 human cardiomyocytes, but also attenuated apoptosis induced by radiation and anti-PD-1 treatment. Finally, ATP administration in vivo significantly reduced radiation-induced and anti-PD-1-exacerbated cardiac dysfunction. We demonstrated for the first time that anti-PD-1 can aggravate radiation-induced cardiac dysfunction via promoting cardiomyocyte apoptosis without affecting radiation-arrested autophagic flux. ATP enhanced cardiomyocyte autophagic flux and inhibited apoptosis, improving cardiac function in anti-PD-1/radiation combination-treated animals.

PMID:37842574 | PMC:PMC10570000 | DOI:10.1016/j.heliyon.2023.e20660

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03:09

PubMed articles on: Cardio-Oncology

Nuclear medicine imaging methods of early radiation-induced cardiotoxicity: a ten-year systematic review

Front Oncol. 2023 Oct 9;13:1240889. doi: 10.3389/fonc.2023.1240889. eCollection 2023.

ABSTRACT

Background: Almonertinib, a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), is commonly used as a first-line treatment for non-small cell lung cancer (NSCLC) patients with EGFR T790M mutations. Rivaroxaban and apixaban are a selective, direct factor Xa inhibitor used to treat venous thromboembolism (VTE), which is a frequent complication of NSCLC. Rivaroxaban and apixaban are substrates of CYP3A4, P-gp and BCRP, whereas almonertinib is an inhibitor of P-gp and BCRP. Rivaroxaban or apixaban are often prescribed together with almonertinib in NSCLC patients, but clear information on pharmacokinetic drug interaction is lacking. Therefore, this study aimed to unravel the extent of interactions between almonertinib-rivaroxaban and almonertinib apixaban in rats, and whether the pharmacokinetic interaction can be mitigated by rivaroxaban and apixaban dose adjustment. Methods: Rats were divided into ten groups (n = 6) that received rivaroxaban (2 mg/kg) (group 1), apixaban (0.5 mg/kg) (group 2), almonertinib (15 mg/kg) (group 3, group 4), almonertinib with rivaroxaban (2 mg/kg) (group 5), almonertinib with rivaroxaban (1 mg/kg) (group 6), almonertinib with apixaban (0.5 mg/kg) (group 7), almonertinib with apixaban (0.25 mg/kg) (group 8), rivaroxaban (2 mg/kg) with almonertinib (group 9), apixaban (0.5 mg/kg) with almonertinib (group 10). The concentrations of drugs were determined by an ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). The levels of messenger RNA were determined using quantitative real-time polymerase chain reaction (qRT-PCR). Results and Discussion: The results indicate that almonertinib increased the Cmax and AUC0-t of 2 mg/kg rivaroxaban by 3.30 and 3.60-fold, 1 mg/kg rivaroxaban by 1.28 and 1.90-fold. Almonertinib increased the Cmax and AUC0-t of 0.5 mg/kg apixaban by 2.69 and 2.87-fold, 0.25 mg/kg apixaban by 2.19 and 2.06-fold. In addition, rivaroxaban also increased systemic exposure to almonertinib. The results of qRT-PCR showed that almonertinib reduced the expression of Cyp3a1 in liver and intestine, and Abcb1a, Abcg2 in intestine and kidney. The pharmacokinetic results suggest that it is important to take special care of the interactions of these drugs in clinical applications.

PMID:37860116 | PMC:PMC10582335 | DOI:10.3389/fphar.2023.1263975

03:09

PubMed articles on: Cancer & VTE/PE

Clinical Care of Pediatric Patients with or At-Risk of Post-Thrombotic Syndrome: Guidance from the ISTH SSC Subcommittee on Pediatric and Neonatal Thrombosis and Haemostasis

J Thromb Haemost. 2023 Oct 20:S1538-7836(23)00780-8. doi: 10.1016/j.jtha.2023.10.012. Online ahead of print.

NO ABSTRACT

PMID:37866514 | DOI:10.1016/j.jtha.2023.10.012

03:09

PubMed articles on: Cardio-Oncology

ATP protects anti-PD-1/radiation-induced cardiac dysfunction by inhibiting anti-PD-1 exacerbated cardiomyocyte apoptosis, and improving autophagic flux

Heliyon. 2023 Oct 5;9(10):e20660. doi: 10.1016/j.heliyon.2023.e20660. eCollection 2023 Oct.

ABSTRACT

Treating cancer patients with deep venous thrombosis/venous thromboembolism (DVT/VTE) can be challenging as patients are frequently unable to receive the standard therapy of anticoagulation due to the increased risk of bleeding complications seen in this population. Similarly, the hesitation of interventionalists to use thrombolytic agents due to bleeding risks limits percutaneous intervention options as well. Further, outcome data and guidelines do not exist for oncologic patients and often treatment is tailored to patient-specific factors after multidisciplinary discussion. This article reviews specific factors to consider when planning percutaneous treatment of cancer patients with DVT/VTE, focusing on the iliocaval system.

PMID:37865450 | DOI:10.1016/j.tvir.2023.100900

03:09

PubMed articles on: Cancer & VTE/PE

The prevalence of relevant drug-drug interactions and associated clinical outcomes in patients with cancer-associated thrombosis on concurrent anticoagulation and anticancer or supportive care therapies

Thromb Res. 2023 Oct 11;231:128-134. doi: 10.1016/j.thromres.2023.10.004. Online ahead of print.

ABSTRACT

Atrial fibrillation (AF) can increase thrombosis, especially arterial thrombosis, and some studies show that AF patients have a higher risk of developing pulmonary embolism (PE). The objective of our study is to investigate whether there is a direct causal effect of AF on PE. A two-sample Mendelian randomization (MR) approach was utilized to determine whether there is a causal relationship between AF and PE. European population-based consortia provided statistical data on the associations between Single Nucleotide Polymorphisms (SNPs) and relevant traits. The AF dataset was obtained from genome-wide association studies (GWAS) comprising 60,620 cases and 970,216 controls, while a GWAS of 1846 cases and 461,164 controls identified genetic variations associated with PE. Estimation of the causal effect was mainly performed using the random effects inverse-variance weighted method (IVW). Additionally, other tests such as MR-Egger intercept, MR-PRESSO, Cochran's Q test, "Leave-one-out," and funnel plots were conducted to assess the extent of pleiotropy and heterogeneity. Using 70 SNPs, there was no evidence to suggest an association between genetically predicted AF and risk of PE with multiplicative random-effects IVW MR analysis (odds ratio = 1.0003, 95% confidence interval: 0.9998-1.0008, P = 0.20). A null association was also observed in other methods. MR-Egger regression and MR-PRESSO respectively showed no evidence of directional (intercept, - 2.25; P = 0.94) and horizontal(P-value in the global heterogeneity test = 0.99) pleiotropic effect across the genetic variants. No substantial evidence was found to support the causal role of AF in the development of PE. Causal effect of atrial fibrillation on pulmonary embolism: a Mendelian randomization study. AF atrial fibrillation, PE pulmonary embolism, GWAS genome-wide association studies, SNPs single nucleotide polymorphisms, OR odds ratio, CI confidence interval.

PMID:37839022 | DOI:10.1007/s11239-023-02903-w

03:09

PubMed articles on: Cancer & VTE/PE

Catheter Directed Thrombectomy and Other Deep Venous Interventions in Cancer Patients

Tech Vasc Interv Radiol. 2023 Jun;26(2):100900. doi: 10.1016/j.tvir.2023.100900. Epub 2023 Aug 5.

ABSTRACT

This study aims to summarize the available data and determine if the presence of venous thromboembolism (VTE) immune-related adverse event (irAE) in patients with immune checkpoint inhibitor (ICI) therapy is associated with improved treatment efficacy and clinical outcomes, which in turn was used to help optimize patient selection for anticoagulation therapy and inform rational treatment strategies for overcoming the mechanisms of ICI resistance. PubMed, Embase, Web of Science, and Cochrane Library were searched up to March 18, 2023, for studies assessing the relationship between VTE irAE development during ICI therapy and cancer outcomes. Seven primary articles with a total of 4437 patients were included in the overall survival (OS) meta-analysis. Patients with VTE had a significant increase in overall mortality compared to patients without VTE in adjusted hazard ratios (HRs 1.36, 95% confidence interval [CI] 1.06-1.75, P = .02). In the studies where immortal time bias (ITB) was accounted for, patients with VTE irAE also had poor OS than those without. HR and the corresponding 95% CI values in the non-ITB group were 2.53 (1.75-3.66, P < .00001) with low heterogeneity (P = .17, I2 = 48%) and 1.21 (1.06-1.37, P = .004) in the ITB group with no heterogeneity (P = .95, I2 = 0%), respectively. Despite the heterogeneity identified, the evidence does suggest that VTE irAE occurrence could be served as a prognostic indicator, with higher frequencies of occurrence associated with poorer OS. However, the fundamental role of this association with clinical consequences should be further investigated in large cohorts and clinical trials.

PMID:37844585 | PMC:PMC10586005 | DOI:10.1177/10760296231206799

03:09

PubMed articles on: Cancer & VTE/PE

Pulmonary Embolism Treatment Evolution: A Comparative Analysis of Pulmonary Embolism Response Team Management at a Single Institution

Am J Cardiol. 2023 Oct 14;208:171-172. doi: 10.1016/j.amjcard.2023.09.003. Online ahead of print.

NO ABSTRACT

PMID:37844520 | DOI:10.1016/j.amjcard.2023.09.003

03:09

PubMed articles on: Cancer & VTE/PE

Causal effect of atrial fibrillation on pulmonary embolism: a mendelian randomization study

J Thromb Thrombolysis. 2023 Oct 15. doi: 10.1007/s11239-023-02903-w. Online ahead of print.

ABSTRACT

BACKGROUND: Nonpersistence in anticoagulation therapy is common and associated with undesirable clinical outcomes in patients with venous thromboembolism (VTE).

METHODS: We investigated preceding clinical events of treatment nonpersistence (e.g., switching, discontinuing, or restarting) in VTE patients with and without active cancer using Korean claims database.

RESULTS: Clinically significant events including thromboembolic events, hepatic function change and surgery preceded treatment nonpersistence, but heterogeneous distributions of clinical events were observed in the presence of active cancer. Patients with active cancer had a low rate of clinical events preceding treatment nonpersistence, and new active cancer diagnosis in the nonactive cancer group was most common before the switch to parenteral anticoagulants from warfarin or non-vitamin K antagonist oral anticoagulants (NOACs).

CONCLUSION: These findings suggest that clinically significant events can precede treatment nonpersistence and largely paralleled current guidelines for patients with VTE, whereas heterogeneous distributions of clinical events were observed in the presence of active cancer.

PMID:37882319 | DOI:10.1002/cam4.6626

03:09

PubMed articles on: Cancer & VTE/PE

Associations Between Immune-Related Venous Thromboembolism and Efficacy of Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis

Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231206799. doi: 10.1177/10760296231206799.

ABSTRACT

BACKGROUND: The safety and efficacy of direct-acting oral anticoagulants (DOACs) for therapeutic anticoagulation in the setting of primary or metastatic brain cancer is not known.

OBJECTIVE: To conduct a meta-analysis and systematic review of studies that compare the risk of intracranial hemorrhage (ICH) in patients with brain cancer treated with DOACs vs. LMWH.

METHODS: A literature search was conducted using PubMed, EMBASE, and Cochrane databases. Summary statistics were obtained by calculating the risk ratio (RR), and heterogeneity across studies was estimated using the I2 statistic. A total of 10 retrospective studies (n=1,638) met criteria for inclusion. The primary endpoint was the pooled RR for ICH in patients with brain tumors receiving anticoagulation with DOACs compared with those receiving LMWH. Secondary analyses included the risk of fatal ICH in each subgroup.

RESULTS: The pooled RR for ICH in patients receiving DOACs vs. those receiving LMWH was 0.65 (95% confidence interval [CI], 0.36-1.17; P = 0.15; I2 = 50%). In studies evaluating primary brain cancer, there was a reduction in risk of ICH with DOACs (RR, 0.35; 95% CI, 0.18-0.69; P = 0.003; I2 = 0%). In patients with metastatic brain cancer, there was no difference in the risk of ICH with type of anticoagulation (RR, 1.05; 95% CI, 0.71-1.56; P = 0.80; I2 = 0%). The overall risk of fatal ICH was not different between anticoagulants.

DISCUSSION: The risk of ICH in patients with brain cancer receiving therapeutic anticoagulation varies by anticoagulation agent and diagnosis of primary or metastatic disease.

PMID:37866517 | DOI:10.1016/j.jtha.2023.10.011

03:09

PubMed articles on: Cancer & VTE/PE

Heterogeneous distributions in clinical events preceding anticoagulant treatment nonpersistence in patients with venous thromboembolism stratified by active cancer: A nationwide cohort study

Cancer Med. 2023 Oct 26. doi: 10.1002/cam4.6626. Online ahead of print.

ABSTRACT

BACKGROUND Pulmonary embolism secondary to deep vein thrombosis (DVT) with cor pulmonale is commonly associated with risk factors including surgery, cancer, and prolonged immobility. Cocaine is known to cause vasoconstriction and has a prothrombotic effect. Prolonged and heavy use of cocaine can also cause inflammation and liver damage. However, data on its potential role in causing pulmonary embolism and direct hepatotoxicity in cases of episodic use are scarce. CASE REPORT A 34-year-old man with no significant medical history except for episodic cocaine use presented in respiratory distress. Workup revealed submassive pulmonary embolism with pulmonary infarctions complicated by pneumonia, hypoxemic respiratory failure, and anemia. He was treated with anticoagulation and intensive care. On day 5 of hospitalization, the patient had an acute hepatic injury. His alanine aminotransferase level peaked at over 2000 IU/L on day 7, until finally tapering. Liver failure was found to be secondary to cocaine use. Liver enzyme levels improved with supportive care. He was discharged with apixaban and continued liver enzyme monitoring. CONCLUSIONS When investigating the cause of venous thromboembolism and transaminitis, evaluating cocaine use via patient history or laboratory analysis of cocaine and its metabolites should be considered. Cocaine is known to cause vasoconstriction and has a prothrombotic effect, although data on its potential role in causing pulmonary embolism and direct hepatotoxicity in cases of episodic use are scarce. Further investigation, such as cohort studies, could help strengthen our understanding of the relationship between cocaine use, acute hepatic injury, and pulmonary embolism.

PMID:37872733 | DOI:10.12659/AJCR.941360

03:08

PubMed articles on: Cancer & VTE/PE

Comparison of Direct Oral Anticoagulants versus Low Molecular Weight Heparin in Primary and Metastatic Brain Cancers: A Meta-Analysis and Systematic Review

J Thromb Haemost. 2023 Oct 20:S1538-7836(23)00779-1. doi: 10.1016/j.jtha.2023.10.011. Online ahead of print.

ABSTRACT

D-dimer, a soluble fibrin degradation product that originates from plasmin-induced degradation of cross-linked fibrin, is an important biomarker of coagulation activation and secondary fibrinolysis that is routinely used to rule out venous thromboembolism (VTE), to evaluate the risk of VTE recurrence as well as the optimal duration of anticoagulant therapy. Besides VTE, D-dimer may be high due to physiologic conditions, including aging, pregnancy and strenuous physical activity. In addition, several disorders have been associated with increased D-dimer levels, spanning from disseminated intravascular coagulation to infectious diseases and cancers. Thus, it is far from unusual for hematologists to have to deal with ambulatory individuals presenting with increased Ddimer without signs or symptoms of thrombus formation. To the management of these cases by the hematologist is dedicated this narrative review.

PMID:37881856 | DOI:10.3324/haematol.2023.283966

03:08

PubMed articles on: Cancer & VTE/PE

Episodic Cocaine Use as a Cause of Venous Thromboembolism and Acute Liver Injury

Am J Case Rep. 2023 Oct 24;24:e941360. doi: 10.12659/AJCR.941360.

ABSTRACT

BACKGROUND: Aponermin, a circularly permuted tumor necrosis factor-related apoptosis-inducing ligand, is a potential death receptor 4/5-targeted antitumour candidate. Previous phase 1/2 studies have demonstrated the efficacy of aponermin in patients with relapsed or refractory multiple myeloma (RRMM). To confirm the superiority of aponermin plus thalidomide and dexamethasone (aponermin group) over placebo plus thalidomide and dexamethasone (placebo group) in RRMM, a randomized, double-blinded, placebo controlled phase 3 trial was performed.

METHODS: Four hundred seventeen patients with RRMM who had previously received at least two regimens were randomly assigned (2:1) to receive aponermin, thalidomide, and dexamethasone or placebo, thalidomide, and dexamethasone. The primary endpoint was progression-free survival (PFS). Key secondary endpoints included overall survival (OS) and overall response rate (ORR).

RESULTS: A total of 415 patients received at least one dose of trial treatment (276 vs. 139). The median PFS was 5.5 months in the aponermin group and 3.1 months in the placebo group (hazard ratio, 0.62; 95% confidence interval [CI], 0.49-0.78; P < 0.001). The median OS was 22.4 months for the aponermin group and 16.4 months for the placebo group (hazard ratio, 0.70; 95% CI, 0.55-0.89; P = 0.003). Significantly higher rates of ORR (30.4% vs. 13.7%, P < 0.001) and very good partial response or better (14.1% vs. 2.2%, P < 0.0001) were achieved in the aponermin group than in the placebo group. Treatment with aponermin caused hepatotoxicity in some patients, as indicated by the elevated alanine transaminase, aspartate transaminase, or lactate dehydrogenase levels (52.2% vs. 24.5%, 51.1% vs. 19.4% and 44.9% vs. 21.6%, respectively), mostly grade 1/2, transient and reversible. The main grade 3/4 adverse events included neutropenia, pneumonia and hyperglycemia. The incidence of serious adverse events was similar between the two groups (40.6% vs. 37.4%). There was no evidence that aponermin leads to hematological toxicity, nephrotoxicity, cardiotoxicity, or secondary tumors.

CONCLUSIONS: Aponermin plus thalidomide and dexamethasone significantly improved PFS, OS and ORR with manageable side effects in RRMM patients who had received at least two prior therapies. These results support the use of aponermin, thalidomide, and dexamethasone as a treatment option for RRMM patients.

TRIAL REGISTRATION: The trial was registered at http://www.chictr.org.cn as ChiCTR-IPR-15006024, 17/11/2014.

PMID:37838670 | PMC:PMC10576321 | DOI:10.1186/s12885-023-11489-8

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03:08

PubMed articles on: Cancer & VTE/PE

How we manage a high D-dimer

Haematologica. 2023 Oct 26. doi: 10.3324/haematol.2023.283966. Online ahead of print.

ABSTRACT

Doxorubicin (DOX) is a topoisomerase II inhibitor used in cancer therapy. Despite its efficacy, DOX causes serious adverse effects, such as short- and long-term cardiotoxicity. This work aimed to assess the short- and long-term cardiotoxicity of DOX and the role of inflammation and antioxidant defenses on that cardiotoxicity in a mice model. Adult CD-1 male mice received a cumulative dose of 9.0 mg/kg of DOX (2 biweekly intraperitoneal injections (ip), for 3 weeks). One week (1W) or 5 months (5M) after the last DOX administration, the heart was collected. One week after DOX, a significant increase in p62, tumor necrosis factor receptor (TNFR) 2, glutathione peroxidase 1, catalase, inducible nitric oxide synthase (iNOS) cardiac expression, and a trend towards an increase in interleukin (IL)-6, TNFR1, and B-cell lymphoma 2 associated X (Bax) expression was observed. Moreover, DOX induced a decrease on nuclear factor erythroid-2 related factor 2 (Nrf2) cardiac expression. In both 1W and 5M, DOX led to a high density of infiltrating M1 macrophages, but only the 1W-DOX group had a significantly higher number of nuclear factor κB (NF-κB) p65 immunopositive cells. As late effects (5M), an increase in Nrf2, myeloperoxidase, IL-33, tumor necrosis factor-α (TNF-α), superoxide dismutase 2 (SOD2) expression, and a trend towards increased catalase expression were observed. Moreover, B-cell lymphoma 2 (Bcl-2), cyclooxygenase-2 (COX-2), and carbonylated proteins expression decreased, and a trend towards decreased p38 mitogen-activated protein kinase (MAPK) expression were seen. Our study demonstrated that DOX induces adverse outcome pathways related to inflammation and oxidative stress, although activating different time-dependent response mechanisms.

PMID:37833616 | DOI:10.1007/s10753-023-01908-0

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03:08

PubMed articles on: Cardio-Oncology

Aponermin or placebo in combination with thalidomide and dexamethasone in the treatment of relapsed or refractory multiple myeloma (CPT-MM301): a randomised, double-blinded, placebo-controlled, phase 3 trial

BMC Cancer. 2023 Oct 14;23(1):980. doi: 10.1186/s12885-023-11489-8.

ABSTRACT

INTRODUCTION: Patients with myeloproliferative neoplasms (MPNs) and atrial fibrillation (AF) are at increased risk of thrombosis and bleeding. However, the risk of thrombosis and bleeding in patients with AF and MPN compared with the general population with AF is unclear. Additionally, traditional risk scores (CHA2DS2-VASC and HAS-BLED) for risk/benefit estimation of thromboprophylaxis in AF do not account for MPN status. Therefore, we aimed to investigate bleeding and thrombosis risk in patients with MPN hospitalized for AF.

METHODS: We utilized the National Readmission Database (NRD) to identify patients with AF with and without MPN. Primary bleeding and thrombosis outcomes were in-hospital or 30-day readmission for bleeding or thrombosis, respectively. We propensity score (PS) matched patients with and without MPN. Risk of primary outcomes in MPN was assessed in PS matched cohort using logistic regression. Receiver operating characteristic (ROC) curve used to evaluate predictive ability of CHA2DS2-VASC and HAS-BLED of primary thrombosis and bleeding outcomes, respectively.

RESULTS: 24,185 patients without MPN were matched with 1,617 patients with MPN and variables were balanced between groups. Patients with MPN were at increased risk of meeting the thrombosis (OR 1.98, 95% CI 1.23-3.21) but not bleeding (OR 0.87, 95% CI 0.63-1.19) primary outcomes. In MPN, CHA2DS2-VASC predicted thrombosis (C-statistic 0.66, 95% CI 0.54-0.78) but HAS-BLED was a poor predictor of bleeding (C-statistic 0.55, 95% CI 0.46-0.64).

CONCLUSION: In patients with AF, MPN was associated with increased risk of bleeding and thrombosis. HAS-BLED scores did not accurately predict bleeding in MPN. Further investigation is needed to refine risk scores in MPN.

PMID:37839025 | DOI:10.1007/s11239-023-02900-z

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03:08

PubMed articles on: Cardio-Oncology

The Role of Nrf2 and Inflammation on the Dissimilar Cardiotoxicity of Doxorubicin in Two-Time Points: a Cardio-Oncology In Vivo Study Through Time

Inflammation. 2023 Oct 14. doi: 10.1007/s10753-023-01908-0. Online ahead of print.

ABSTRACT

BACKGROUND: Current treatment of acute leukemia is based on anthracycline chemotherapy. Anthracyclines, despite improving patient survival, have serious cardiotoxicity and therefore cardiac monitoring should be a priority. The purpose of this study is to explore the possible early predictors of anthracycline-induced subclinical cardiotoxicity(AISC)in acute leukemia patients.

METHODS: We conducted a prospective observational study involving 51 patients with acute leukemia treated with anthracycline. Demographic data, clinical variables, echocardiography variables and biochemical variables were collected at baseline and after 3 cycles of chemotherapy. Patients were divided into the AISC and No-AISC groups according to changes of global longitudinal peak systolic strain. Regression models and receiver operating characteristic curve analysis were used to explore the relationship between the variables and AISC.

RESULT: 17 of the patients suffered subclinical cardiotoxicity after 3 cycles of anthracycline treatment. Multiple logistic regression analysis showed a significant association of DBil (OR 0.612, 95% CI 0.409-0.916, p = 0.017), TBil (OR 0.841, 95% CI 0.717-0.986, p = 0.033), PLT (OR 1.012, 95% CI 1.002-1.021, p = 0.016) and Glu (OR 1.873, 95% CI 1.009-3.475, p = 0.047) with the development of AISC. After 3 cycles of chemotherapy, there was a significant difference in PLT between the AISC and NO-AISC groups. Moreover, the dynamic changes in PLT from baseline to after 3 cycles of chemotherapy were each statistically significant in the AISC and NO-AISC groups. The combination of PLT and N-terminal pro-B-type natriuretic peptide (NT-proBNP) had the highest area under curves (AUC) for the diagnosis of AISC than PLT and NT-proBNP alone (AUC = 0.713, 95%CI: 0.56-0.87, P = 0.017).

CONCLUSION: Total bilirubin (TBil), direct bilirubin (DBil), platelets (PLT) and blood glucose (Glu) are independent influencing factors for AISC in acute leukemia patients receiving anthracycline therapy. Bilirubin may be a protective factor and PLT may be a contributing factor for AISC. The combination of baseline PLT and baseline NT-proBNP shows satisfactory predictive ability for AISC in acute leukemia cases treated with 3 cycles of chemotherapy.

PMID:37833648 | PMC:PMC10571315 | DOI:10.1186/s12885-023-11060-5

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03:08

PubMed articles on: Cardio-Oncology

In-Hospital and readmission outcomes of patients with myeloproliferative neoplasms and atrial fibrillation: insights from the National Readmissions Database

J Thromb Thrombolysis. 2023 Oct 15. doi: 10.1007/s11239-023-02900-z. Online ahead of print.

ABSTRACT

BACKGROUND: With population aging, the prevalence of both cancer and atrial fibrillation (AF) have increased. However, there is scarce epidemiological data concerning the comorbid state of cancer and AF in low- and middle-income countries, including China.

OBJECTIVE: We aimed to evaluate the site-, sex-, and age-specific profiles of cancer and AF comorbidities in Chinese populations.

METHODS: Data from the Shanghai Municipal Health Commission database between 2015 and 2020 were screened, covering all medical records of Shanghai residents with medical insurance. Site-specific cancer profiles were evaluated for the population with AF relative to the age- and sex-adjusted population of residents without AF. The sex distribution and peak age of cancer diagnosis were also assessed.

RESULTS: A total of 25,964,447 adult patients were screened. Among them, 22,185 patients presented cancers comorbid with AF (median 77, IQR 67-82 years of age; men: n=13,631, 61.44%), while 839,864 presented cancers without AF (median 67, IQR 57-72 years of age; men: n=419,020, 49.89%), thus yielding a higher cancer prevalence among residents with AF (8.27%) than among those without AF (6.05%; P<.001).

CONCLUSIONS: Patients with AF are associated with increased prevalence, heightened male predominance, and younger peak age of cancer. Further studies are needed to determine whether early screening of specific cancers is cost-effective and beneficial for patients with AF.

PMID:37847541 | DOI:10.2196/40149

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03:08

PubMed articles on: Cardio-Oncology

Influencing factors of anthracycline-induced subclinical cardiotoxicity in acute leukemia patients

BMC Cancer. 2023 Oct 13;23(1):976. doi: 10.1186/s12885-023-11060-5.

ABSTRACT

Preterm infants with oxygen supplementation are at high risk for bronchopulmonary dysplasia (BPD), a neonatal chronic lung disease. Inflammation with macrophage activation is central to the pathogenesis of BPD. CXCL10, a chemotactic and pro-inflammatory chemokine, is elevated in the lungs of infants evolving BPD and in hyperoxia-based BPD in mice. Here, we tested if CXCL10 deficiency preserves lung growth after neonatal hyperoxia by preventing macrophage activation. To this end, we exposed Cxcl10 knockout (Cxcl10-/-) and wild-type mice to an experimental model of hyperoxia (85% O2)-induced neonatal lung injury and subsequent regeneration. In addition, cultured primary human macrophages and murine macrophages (J744A.1) were treated with CXCL10 and/or CXCR3 antagonist. Our transcriptomic analysis identified CXCL10 as a central hub in the inflammatory network of neonatal mouse lungs after hyperoxia. Quantitative histomorphometric analysis revealed that Cxcl10-/- mice are in part protected from reduced alveolar. These findings were related to the preserved spatial distribution of elastic fibers, reduced collagen deposition, and protection from macrophage recruitment/infiltration to the lungs in Cxcl10-/- mice during acute injury and regeneration. Complimentary, studies with cultured human and murine macrophages showed that hyperoxia induces Cxcl10 expression that in turn triggers M1-like activation and migration of macrophages through CXCR3. Finally, we demonstrated a temporal increase of macrophage-related CXCL10 in the lungs of infants with BPD. In conclusion, our data demonstrate macrophage-derived CXCL10 in experimental and clinical BPD that drives macrophage chemotaxis through CXCR3, causing pro-fibrotic lung remodeling and arrest of alveolarization. Thus, targeting the CXCL10-CXCR3 axis could offer a new therapeutic avenue for BPD.

PMID:37876024 | PMC:PMC10594718 | DOI:10.1186/s41232-023-00301-6

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03:08

PubMed articles on: Cardio-Oncology

Cancer and Atrial Fibrillation Comorbidities Among 25 Million Citizens in Shanghai, China: Medical Insurance Database Study

JMIR Public Health Surveill. 2023 Oct 17;9:e40149. doi: 10.2196/40149.

ABSTRACT

BACKGROUND: Recent advances in the treatment of breast cancer have resulted in improved overall cancer survival; however, cancer therapy related cardiac dysfunction is considered a major adverse effect of several chemotherapeutic agents, particularly anthracyclines. Hence, there is a need to develop proper cardioprotective strategies to limit myocardial injury following chemotherapy.

OBJECTIVE: To evaluate the effect of statin therapy on prevention of anthracycline- induced cardiotoxicity in female patients with breast cancer.

PATIENTS AND METHODS: The current study is a prospective, randomized, single-blind, placebo-controlled trial in which we enrolled a total of 110 female patients with newly diagnosed breast cancer who received anthracycline based chemotherapy. Patients were randomly assigned in 1:1 ratio into two groups, study group in which patients received 40 mg of oral atorvastatin and control group in which patients received placebo. A comprehensive echocardiographic examination was performed to all patients prior to receiving the chemotherapy and after 6 months, assessment of LV ejection fraction was done by 3D-echocardiography. All echocardiographers were blinded to all the patients' characteristics and assignment to either group.

RESULTS: The mean age of patients assigned to the control group was 49.8±10.51 years old, while patients assigned to the intervention group had mean age of 47.84± 9.16 years old, both the control group and the intervention group were similar in demographic data and baseline clinical characteristics. There was a highly significant difference between the two groups regarding both the absolute LVEF assessed by 3D- echocardiography at 6 months and the percentage of change compared to baseline values, patients assigned to the control group had mean LVEF of 52.92% at 6 months with percentage of change reaching -7.06%, while those assigned to the intervention group had mean LVEF reaching 56.22% at 6 months with a percentage of change reaching -3.64% (P-value: 0.008 and 0.004 for the absolute value and percentage of change respectively). There was a significant difference between the two groups regarding incidence of development of cancer therapy related cardiac dysfunction (CTRCD); defined as drop in LVEF more than 10% and to a value below 53% assessed by 3D echocardiography, among the control group 15 patients (30%) developed CTRCD after 6 months from starting Anthracyclines based chemotherapy, while, among the intervention group only 6 patients (12%) developed CTRCD. (P-value= 0.027) CONCLUSION: : Prophylactic use of atorvastatin may prevent the development of cancer therapy related cardiac dysfunction in breast cancer patients receiving anthracycline based chemotherapy.

PMID:37858847 | DOI:10.1016/j.cpcardiol.2023.102130

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03:08

PubMed articles on: Cardio-Oncology

CXCL10 deficiency limits macrophage infiltration, preserves lung matrix, and enables lung growth in bronchopulmonary dysplasia

Inflamm Regen. 2023 Oct 24;43(1):52. doi: 10.1186/s41232-023-00301-6.

ABSTRACT

BACKGROUND: Cardiotoxicity among breast cancer survivors is associated with chemotherapy and radiation therapy. The risk of cardiovascular disease (CVD) among Asian, Native Hawaiian and Pacific Islander (ANHPI) breast cancer survivors in the US is unknown.

METHODS: We used the SEER-Medicare linked database to estimate the risk of CVD among older breast cancer survivors. ICD diagnosis codes were used to identify incident CVD outcomes. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) comparing ANHPI to Non-Hispanic White (NHW) breast cancer patients for CVD, and among ANHPI race and ethnicity groups.

RESULTS: A total of 7,122 ANHPI breast cancer survivors and 21,365 NHW breast cancer survivors were identified. The risks of incident heart failure and ischemic heart disease were lower among ANHPI compared to NHW breast cancer survivors (HRheart failure=0.72, 95%CI=0.61, 0.84; HRheart disease=0.74, 95%CI=0.63, 0.88). Compared to Japanese breast cancer patients, Filipino, Asian Indian and Pakistani, and Native Hawaiian breast cancer survivors had higher risks of heart failure. ischemic heart disease and death. Among ANHPI breast cancer survivors, risk factors for heart failure included older age, higher comorbidity score, distant cancer stage and chemotherapy.

CONCLUSIONS: Our results support heterogeneity in CVD outcomes among breast cancer survivors among ANHPI race and ethnicity groups. Further research is needed to elucidate the disparities experienced among ANHPI cancer survivors.

IMPACT: Filipino, Asian Indian and Pakistani, and Native Hawaiian breast cancer patients had higher risks of heart failure, ischemic heart disease and death among ANHPI breast cancer patients.

PMID:37843411 | DOI:10.1158/1055-9965.EPI-23-0679

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03:08

PubMed articles on: Cardio-Oncology

Welcome to the Rising Stars in Cardio-Oncology Special Focus Issue

Future Cardiol. 2023 Sep;19(11):515-517. doi: 10.2217/fca-2022-0111. Epub 2023 Oct 18.

NO ABSTRACT

PMID:37850469 | DOI:10.2217/fca-2022-0111

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03:08

PubMed articles on: Cardio-Oncology

Role of Statin Therapy in Prevention of Anthracycline-Induced Cardiotoxicity: A three dimentional echocardiography study

Curr Probl Cardiol. 2023 Oct 17:102130. doi: 10.1016/j.cpcardiol.2023.102130. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: One of the most common hemoglobinopathies globally related to blood transfusion and iron overload in the body is thalassemia syndrome. Increasing ferritin levels can cause severe damage to the patient's body organs. This study aims to evaluate the complications of iron overload on vital body organs in patients with transfusion-dependent beta-thalassemia.

METHODS: This descriptive cross-sectional study was performed in Iran University of Medical Sciences Hospitals on patients with a beta-thalassemia major with frequent blood transfusions. To evaluate the effect of iron overload on vital body organs, hematologic and blood analysis, echocardiography with measurement of pulmonary artery pressure (PAP) and ejection fraction (EF) tests, bone densitometry, and audiometric tests were performed for all patients.

RESULTS: Of the 1010 patients participating in this study, 497 (49%) were males, 513 were (51%) females aged 5-74 years, and the majority of participants (85%) were over 20 years old. This study demonstrated that increasing ferritin levels had no notable correlation with sex, cholesterol, low-density lipoprotein, parathyroid hormone, T4, and aspartate aminotransferase. However, elevating ferritin levels had significant correlations with increasing triglyceride, phosphorus, thyroid stimulating hormone, alkaline phosphatase, alanine transaminase, and PAP levels, age, hearing disorders, splenectomy, osteoporosis, and decreasing high-density lipoprotein, body mass index, calcium, and EF levels.

CONCLUSION: Improvement in beta-thalassemia patients' survival and quality of life can be due to multidisciplinary care in a comprehensive unit through regular follow-up and early complication detection.

PMID:37841947 | PMC:PMC10568004 | DOI:10.1002/hsr2.1624

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03:08

PubMed articles on: Cardio-Oncology

Evolving cardiac biomarkers for immune checkpoint inhibitor related myocarditis in cancer patients

Int J Cardiol Heart Vasc. 2023 Oct 8;49:101278. doi: 10.1016/j.ijcha.2023.101278. eCollection 2023 Dec.

ABSTRACT

BACKGROUND: This review focuses on multimodality imaging of cardiotoxicity in cancer patients, with the aim of evaluating the effectiveness of different techniques in detecting and monitoring cardiac changes associated with cancer therapy.

METHODS: Eight studies were included in the review, covering various imaging modalities such as cardiac magnetic resonance imaging, echocardiography, and multigated acquisition scanning.

RESULTS: Cardiac magnetic resonance imaging emerged as the most definitive modality, offering real-time detection, comprehensive assessment of cardiac function, the ability to detect early myocardial changes, and superior detection of cardiotoxicity when compared to the other imaging modalities. The studies also emphasize the importance of parameters such as left ventricular ejection fraction and global longitudinal strain in assessing cardiac function and predicting cardiotoxicity.

CONCLUSION: Due to the common use of HER2 agents and anthracyclines within the breast cancer population, the LVEF as a critical prognostic measurement for assessing heart health and estimating the severity of left-sided cardiac malfunction is a commonly used endpoint. CTRCD rates differed between imaging modalities, with cardiac MRI the most sensitive. The use of multimodal cardiac imaging remains a nuanced area, influenced by local availability, the clinical question at hand, body habits, and medical comorbidities. All of the imaging modalities listed have a role to play in current care; however, focus should be given to increasing the provision of cardiac MRI for breast cancer patients in the future to optimize the detection of CTRCD and patient outcomes thereafter.

PMID:37834939 | PMC:PMC10573256 | DOI:10.3390/jcm12196295

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03:08

PubMed articles on: Cardio-Oncology

Complications in patients with transfusion dependent thalassemia: A descriptive cross-sectional study

Health Sci Rep. 2023 Oct 11;6(10):e1624. doi: 10.1002/hsr2.1624. eCollection 2023 Oct.

ABSTRACT

Doxorubicin (DOXO)-cardiotoxicity is a limiting factor for breast cancer chemotherapy. The relationship between microparticles (MPs) and cardiotoxicity remains unclear. MPs can be released under varying pathophysiological conditions. Thereby, this study aimed to assess MPs derived from cardiomyocytes (CardioMPs), platelets (PMPs) and those that expresses tissue factor (TFMPs) in 80 women with breast cancer undergoing DOXO-based chemotherapy, with or without cardiotoxicity in a one-year follow-up. We observed in the cardiotoxicity group higher count of total-MPs at T0 (prior chemotherapy) (p = 0.034), CardioMPs at T0 and T1 (just after chemotherapy) (p = 0.009 and p = 0.0034) and TFMPs at T0 (p = 0.011) compared to non-cardiotoxicity group. The results suggest that MPs could be associated to cardiotoxicity due to DOXO treatment in breast cancer patients.

PMID:37852542 | DOI:10.1016/j.ijcard.2023.131435

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03:08

PubMed articles on: Cardio-Oncology

Multimodal Imaging of Cancer Therapy-Related Cardiac Dysfunction in Breast Cancer-A State-of-the-Art Review

J Clin Med. 2023 Sep 29;12(19):6295. doi: 10.3390/jcm12196295.

ABSTRACT

BACKGROUND: Cardiac lymphoma is a rare disease. Effusive-constrictive pericarditis can be a characteristic of pericardial involvement in patients with this disease. Conversely, a phenotype with electrocardiogram changes similar to those of Brugada syndrome is called Brugada phenocopy, and these changes improve after treatment.

CASE SUMMARY: A 71-year-old man was transported to our hospital with chest pain, hypotension, and ST-segment elevation in V1 and V2 leads during maintenance dialysis for renal failure. After arrival at the hospital, his ST-segment elevation disappeared, and emergency coronary angiography scan revealed no significant coronary artery stenoses or obstructions. His computed tomography and echocardiography scans revealed pericardial effusion and an intrapericardial mass. Further, his blood pressure dropped and ST-segment elevation recurred during dialysis after 7 days. Thus, pericardiocentesis was performed, but haemodynamic improvement was insufficient, and right catheterization findings suggested effusive-constrictive pericarditis. Meanwhile, flow cytometry of the pericardial fluid suggested the diagnosis of B-cell lymphoma; however, radical chemoradiotherapy was impossible because of cardiogenic shock. The patient died on Day 17. Further, autopsy revealed diffuse large B-cell lymphoma with pericardial and myocardial infiltration.

DISCUSSION: Cardiac lymphoma is rare but can be associated with effusive-constrictive pericarditis, which may be difficult to manage even with pericardial drainage. In such cases, radical treatment, including chemotherapy, should be promptly considered, if possible. Our patient presented with Brugada-type electrocardiogram but no syncope or family history, suggesting Brugada phenocopy and not true Brugada syndrome due to cardiac lymphoma. Notably, temporary improvement in ST-segment elevation was observed despite the absence of treatment.

PMID:37854103 | PMC:PMC10580269 | DOI:10.1093/ehjcr/ytad463

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03:08

PubMed articles on: Cardio-Oncology

Microparticles and cardiotoxicity secondary to doxorubicin-based chemotherapy in breast cancer patients

Int J Cardiol. 2023 Oct 16:131435. doi: 10.1016/j.ijcard.2023.131435. Online ahead of print.

ABSTRACT

Breast cancer is characterized by the uncontrolled proliferation of breast cells, with a high incidence reported in 2020 to have affected over 2 million women. In recent years, the conventional methods of treating breast cancer have involved radiotherapy and chemotherapy. However, the emergence of CDK4/6 inhibitors has shown potential as a promising cancer therapy. Cyclin-dependent kinases (CDK) inhibitors are a class of molecules that impede the formation of an active kinase complex, thereby hindering its activity and consequently halting the progression of the cell cycle. It was discovered that they have a significant impact on impeding the progression of the cancer. This is evident with the Food and Drug Administration's approval of drugs such as palbociclib, ribociclib, and abemaciclib for hormone receptor-positive metastatic breast cancer in combination with specific endocrine therapies. In spite of enormous success in breast cancer treatment, certain obstacles have emerged, such as therapy resistance, side effects, and most of all, cardiotoxicity. Some of these drawbacks have been successfully overcome by dosage reduction, different combinations of the drugs, and the assessment of each patient's condition and suitability prior to treatment. Yet other drawbacks still require tenacious research, especially certain cases of cardiotoxicities. This article delves into the biological mechanisms of CDK4/6 in the cell cycle and cancer, as well as the clinical advantages and most common adverse events (AEs) associated with CDK4/6 inhibitors. The primary objective of this review is to provide a comprehensive analysis of cardiotoxic AEs and elucidate the underlying pathophysiological mechanisms responsible for the cardiotoxicity of CDK4/6 inhibitors.

PMID:37841752 | PMC:PMC10571689 | DOI:10.1177/17588359231205848

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03:08

PubMed articles on: Cardio-Oncology

Brugada phenocopy with altered ST-segment elevation in pericardial diffuse large B-cell lymphoma and effusive-constrictive pericarditis: a case report

Eur Heart J Case Rep. 2023 Oct 17;7(10):ytad463. doi: 10.1093/ehjcr/ytad463. eCollection 2023 Oct.

ABSTRACT

Cancer and cardiovascular disorders are known as the two main leading causes of mortality worldwide. Cardiotoxicity is a critical and common adverse effect of cancer-related chemotherapy. Chemotherapy-induced cardiotoxicity has been associated with various cancer treatments, such as anthracyclines, immune checkpoint inhibitors, and kinase inhibitors. Different methods have been reported for the management of chemotherapy-induced cardiotoxicity. In this regard, sodium-glucose cotransporter-2 inhibitors (SGLT2i), a class of antidiabetic agents, have recently been applied to manage heart failure patients. Further, SGLT2i drugs such as EMPA exert protective cardiac and systemic effects. Moreover, it can reduce inflammation through the mediation of major inflammatory components, such as Nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasomes, Adenosine 5'-monophosphate-activated protein kinase (AMPK), and c-Jun N-terminal kinase (JNK) pathways, Signal transducer and activator of transcription (STAT), and overall decreasing transcription of proinflammatory cytokines. The clinical outcome of EMPA administration is related to improving cardiovascular risk factors, including body weight, lipid profile, blood pressure, and arterial stiffness. Intriguingly, SGLT2 suppressors can regulate microglia-driven hyperinflammation affecting neurological and cardiovascular disorders. In this review, we discuss the protective effects of EMPA in chemotherapy-induced cardiotoxicity from molecular, immunological, and neuroimmunological aspects to preclinical and clinical outcomes.

PMID:37839109 | DOI:10.1016/j.biopha.2023.115686

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03:08

PubMed articles on: Cardio-Oncology

CDK4/6 inhibitors: basics, pros, and major cons in breast cancer treatment with specific regard to cardiotoxicity - a narrative review

Ther Adv Med Oncol. 2023 Oct 11;15:17588359231205848. doi: 10.1177/17588359231205848. eCollection 2023.

ABSTRACT

The present review summarizes the beneficial and detrimental roles of reactive oxygen species in myocardial ischemia/reperfusion injury and cardioprotection. In the first part, the continued need for cardioprotection beyond that by rapid reperfusion of acute myocardial infarction is emphasized. Then, pathomechanisms of myocardial ischemia/reperfusion to the myocardium and the coronary circulation and the different modes of cell death in myocardial infarction are characterized. Different mechanical and pharmacological interventions to protect the ischemic/reperfused myocardium in elective percutaneous coronary interventions and coronary artery bypass grafting, in acute myocardial infarction and in cardiotoxicity from cancer therapy are detailed. The second part keeps the focus on ROS providing a comprehensive overview of molecular and cellular mechanisms involved in ischemia/reperfusion injury. Starting from mitochondria as the main sources and targets of ROS in ischemic/reperfused myocardium, a complex network of cellular and extracellular processes is discussed, including relationships with Ca2+ homeostasis, thiol group redox balance, hydrogen sulfide modulation, cross-talk with NAPDH oxidases, exosomes, cytokines and growth factors. While mechanistic insights are needed to improve our current therapeutic approaches, advancements in knowledge of ROS-mediated processes indicate that detrimental facets of oxidative stress are opposed by ROS requirement for physiological and protective reactions. This inevitable contrast is likely to underlie unsuccessful clinical trials and limits the development of novel cardioprotective interventions simply based upon ROS removal.

PMID:37839355 | PMC:PMC10590874 | DOI:10.1016/j.redox.2023.102894

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03:07

PubMed articles on: Cardio-Oncology

Empagliflozin treatment of cardiotoxicity: A comprehensive review of clinical, immunobiological, neuroimmune, and therapeutic implications

Biomed Pharmacother. 2023 Oct 13;168:115686. doi: 10.1016/j.biopha.2023.115686. Online ahead of print.

ABSTRACT

INTRODUCTION: Due to the cardiotoxicity of cancer treatment and traditional risk factors for cardiovascular disease (CVD) such as obesity, diabetes, dyslipidemia, and hypertension, cancer patients are at higher risk of developing CVD. However, limited research exists on the correlation between chronic kidney disease (CKD) and CVD risk in cancer patients.

METHODS: This cross-sectional study selected cancer patients aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) conducted from 2015 to 2020. Multivariable logistic regression was used to assess the association between CKD and CVD in cancer patients. Additionally, subgroup analyses were conducted to investigate the association among different groups of cancer patients.

RESULTS: We included 1700 adult cancer patients (52.53% were female). After multivariable adjustment for covariates including traditional CVD factors, CKD was significantly associated with CVD, with an odds ratio (95% confidence interval) and P-value of 1.61(1.18,2.19) and 0.004. Subgroup analyses after multivariable adjustment showed a significant correlation between CKD and increased CVD risk in the following populations: age ≥60 years, males, White ethnicity, and individuals with or without traditional CVD factors (obesity, diabetes, dyslipidemia, and hypertension).

CONCLUSIONS: CKD remains a significant factor in the higher risk of CVD among adult cancer patients in the United States, even after adjustment for traditional CVD risk factors. Therefore, to reduce the risk of CVD in cancer patients, it is important to treat CKD as a non-traditional risk factor for CVD and actively manage it.

PMID:37839394 | DOI:10.1159/000534182

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03:07

PubMed articles on: Cardio-Oncology

Health position paper and redox perspectives on reactive oxygen species as signals and targets of cardioprotection

Redox Biol. 2023 Nov;67:102894. doi: 10.1016/j.redox.2023.102894. Epub 2023 Oct 6.

A 75-year-old man underwent chemoradiotherapy for advanced esophageal cancer. After nine years, he was hospitalized for left pyothorax. Consequently, the patient underwent drainage and window opening surgery. He experienced cardiopulmonary arrest but was resuscitated. Based on cardiac catheterization data, the patient was diagnosed with constrictive pericarditis. Unfortunately, extracorporeal circulation did not improve his condition, and he ultimately died. An autopsy revealed adhesion between the pericardium and pleura, especially the pericardium in contact with the left thoracic cavity, which was markedly thickened. This suggests that constrictive pericarditis, a latent complication of chemoradiotherapy, is aggravated by pyothorax.

PMID:37839880 | DOI:10.2169/internalmedicine.2502-23

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03:07

PubMed articles on: Cardio-Oncology

Association of chronic kidney disease with cardiovascular disease in cancer patients: a cross-sectional study

Cardiorenal Med. 2023 Oct 14. doi: 10.1159/000534182. Online ahead of print.

ABSTRACT

OBJECTIVE: To provide procedure-specific estimates of the risk of symptomatic venous thromboembolism (VTE) and major bleeding, in the absence of thromboprophylaxis, following gynecologic cancer surgery.

DATA SOURCES: We conducted comprehensive searches on Embase, MEDLINE, Web of Science, and Google Scholar for observational studies. We also reviewed reference lists of eligible studies and review articles. We performed separate searches for randomized trials addressing effects of thromboprophylaxis and conducted a web-based survey on thromboprophylaxis practice.

STUDY ELIGIBILITY CRITERIA: Observational studies enrolling ≥50 adult patients undergoing gynecologic cancer surgery procedures reporting absolute incidence for at least one of the following: symptomatic pulmonary embolism, symptomatic deep vein thrombosis, symptomatic VTE, bleeding requiring reintervention (including re-exploration and angioembolization), bleeding leading to transfusion or post-operative hemoglobin <70

STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers independently assessed eligibility, performed data extraction, and evaluated risk of bias of eligible articles. We adjusted the reported estimates for thromboprophylaxis and length of follow-up and used the median value from studies to determine cumulative incidence at 4 weeks post-surgery stratified by patient VTE risk factors, and used the GRADE approach to rate evidence certainty.

RESULTS: We included 188 studies (398,167 patients) reporting on 37 gynecologic cancer surgery procedures. The evidence certainty was generally low to very low. Median symptomatic VTE risk (in the absence of prophylaxis) was <1%2.0% in 13 of 37 (35%). The risks of VTE varied from 0.1% in low VTE risk patients undergoing cervical conization to 33.5% in high VTE risk patients undergoing pelvic exenteration. Estimates of bleeding requiring reintervention varied from <0.1%<1%

CONCLUSIONS: VTE reduction with thromboprophylaxis likely outweighs increase in bleeding requiring reintervention in many gynecologic cancer procedures (e.g., open surgery for ovarian cancer and pelvic exenteration). In some procedures (e.g., laparoscopic total hysterectomy without lymphadenectomy), thromboembolism and bleeding risks are similar, and decisions depend on individual risk prediction and values and preferences regarding VTE and bleeding.

PMID:37827272 | DOI:10.1016/j.ajog.2023.10.006

23:09

PubMed articles on: Cancer & VTE/PE

Causal effect of atrial fibrillation on pulmonary embolism: a mendelian randomization study

J Thromb Thrombolysis. 2023 Oct 15. doi: 10.1007/s11239-023-02903-w. Online ahead of print.

ABSTRACT

PURPOSE: Pulmonary embolism (PE) is a significant contributor to mortality in patients with cancer. Although anticoagulation serves as the cornerstone of treatment for cancer-associated PE, it has not been emphasized in real-world settings. The aim of this study was to examine the impact of suboptimal anticoagulant treatment on the prognosis of cancer-associated PE.

METHODS: A cohort of 356 individuals newly diagnosed with acute PE were enrolled. The primary outcome of the study was recurrent venous thromboembolism (VTE), and the secondary outcomes were all-cause mortality and major bleeding (consisting of a reduction in the hemoglobin level by at least 20 g/L, transfusion of at least 2 units of blood, or symptomatic bleeding in a critical area or organ or fatal bleeding).

FINDINGS: Of the total participants, 156 (43.8%) were diagnosed with cancer. A comparison between the cancer and noncancer groups revealed that patients with cancer were more frequently asymptomatic (41.0% vs 4.5%; P < 0.001), less likely to have right ventricular dysfunction (4.5% vs 14.0%; P = 0.001), received less anticoagulant treatment during hospitalization (85.3% vs 98.5%; P < 0.001), and had a shorter duration of anticoagulation (5.02 [7.40] months vs 14.19 [10.65] months; P < 0.001). In addition, patients with cancer were found to be at a higher risk of recurrent VTE (17.3% vs 4.0%; P < 0.001) and all-cause mortality (23.7% vs 10.5%; P = 0.001). Multiple Cox regression analysis indicated that discontinuation of anticoagulation at 3 months was a significant risk factor for recurrent VTE in the cancer group (HR, 15.815; 95% CI, 3.047-82.079; P = 0.001).

IMPLICATIONS: The brief duration of anticoagulation therapy and elevated likelihood of recurrent VTE serve as cautionary indicators for the need to enhance awareness of standardized anticoagulant treatment for cancer-associated PE. The ultimate goal is to enhance patient prognosis and quality of life.

PMID:37838562 | DOI:10.1016/j.clinthera.2023.09.014

23:09

PubMed articles on: Cancer & VTE/PE

Risk of Thrombosis and Bleeding in Gynecologic Cancer Surgery: Systematic Review and Meta-Analysis

Am J Obstet Gynecol. 2023 Oct 10:S0002-9378(23)00735-4. doi: 10.1016/j.ajog.2023.10.006. Online ahead of print.

ABSTRACT

BACKGROUND: The way in which to prevent recurrent venous thromboembolism (VTE) is an unmet clinical need in cancer patients. International guidelines only provide conditional recommendations and do not specify which anticoagulant and dose should be used. In the last 2 years, we have been using low-dose rivaroxaban to prevent VTE recurrences in cancer patients. The results of this real-life experience are presented in this study.

METHODS: All patients had cancer and had previously completed a cycle of at least six months of full-dose anticoagulation for the treatment of a VTE index event, before receiving a prescription of low-dose rivaroxaban (10 mg once daily) for secondary prevention of VTE. Effectiveness and safety of this therapeutic regimen were evaluated in terms of VTE recurrences, major bleedings (MB), and clinically relevant non-major bleedings (CRNMB).

RESULTS: The analysis included 106 cancer patients. Their median age was 60 years (IQR 50-69). Metastatic cancer was present in 87 patients (82.1%). Six patients (5.7%) had brain metastases. Over a median follow-up time of 333 days (IQR 156-484), the incidence of VTE recurrences was 3.8% (95%CI 1.0-9.4), with a recurrence rate of 4.0 per 100 person-years (95%CI 1.1-10.2). We observed no MB (0.0%) and three CRNMB (2.8%) (95%CI 0.6-8.1).

CONCLUSIONS: Low-dose rivaroxaban is potentially effective and safe in cancer patients that require prevention of recurrent VTE. Large-scale studies are needed to confirm these findings.

PMID:37835070 | PMC:PMC10573527 | DOI:10.3390/jcm12196427

23:09

PubMed articles on: Cancer & VTE/PE

Intensify Standardized Anticoagulation for Cancer-Associated Pulmonary Embolism: From Single-Center Real-World Data

Clin Ther. 2023 Oct 12:S0149-2918(23)00378-8. doi: 10.1016/j.clinthera.2023.09.014. Online ahead of print.

ABSTRACT

Low molecular weight heparins (LMWH) and anti-Xa direct oral anti-coagulants (DOACs) are recommended for the long-term treatment of cancer-associated thrombosis (CAT) based on well-documented randomised controlled trials. Anti-Xa DOACs are viewed as a first choice for the treatment of patients with CAT. A large number of drug-drug interactions have been reported between DOACs and chemotherapy drugs, modifying circulating levels of DOAC leading to fears of increased bleeding risks or thrombotic recurrence. Progresses in anti-neoplastic therapies have improved the prognosis and the survival, thus increasing the prevalence of frail patients with cancer. However, since frailties tend to be excluded from large trials due to multiple co-morbidities, current guidelines are not fully applicable to this population. The management of these frail patients with CAT is particularly complex and requires a risk assessment on a case-by-case basis with specific focus on cancer, patient-related risk factors and drug-drug interactions. In this brief review we have identified age, co-morbidities and co-medications as key factors of frailty that require careful attention and we have developed a therapeutic decision algorithm to help clinicians optimising the use of anti-coagulants in patients with cancer with CAT, especially in case of anti-Xa DOACs concomitant medications. With the evaluation of the bleeding risk according to the type of cancer, and anticipating drug-drug interactions intensity, taking into account patient frailties allows the optimisation of the anti-coagulant choice. A systematic collaboration between oncologists, vascular pathology specialists and pharmacists is warranted to ensure an optimal patient management. Clinical studies are needed to determine the real impact of these interactions.

PMID:37824026 | PMC:PMC10582124 | DOI:10.1007/s40262-023-01298-4

23:09

PubMed articles on: Cancer & VTE/PE

Low-Dose Rivaroxaban to Prevent Recurrences of Venous Thromboembolism in Cancer: A Real-Life Experience with a Focus on Female Patients

J Clin Med. 2023 Oct 9;12(19):6427. doi: 10.3390/jcm12196427.