China ; epidemiology ; Humans ; Venous Thromboembolism ; diagnosis ; drug therapy ; epidemiology

Lung cancer is the first leading cause of morbidity and mortality in the world. Venous thromboembolism (VTE) is a recognized complication in patients with lung cancer, which is one of the leading cause of death in lung cancer patients. The cancer-related, patient-related and treatment-related factors are the main causes of VTE in lung cancer patients. Malignant cells can directly activate blood coagulation by producing tissue factor (TF), cancer procoagulance (CP), inflammatory factors and cytokines; And the one of predominant mechanisms in cancer-related thrombosis is the overexpression of TF. The 10th edition of the antithrombotic therapy guidelines for VTE with cancer patients (AT-10) published in 2016 by American College of Chest Physicians (APCC) recommended that anticoagulant therapy is the basic treatment for patients with lung cancer complicated with VTE; And low molecular-weight-heparin (LMWH) is preferred as an anticoagulant drug, but can be use with caution due to increasing risk of bleeding.
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Anticoagulants ; pharmacology ; therapeutic use ; Humans ; Lung Neoplasms ; complications ; Risk Factors ; Venous Thromboembolism ; complications ; drug therapy

PURPOSE: This study aimed to investigate clinical characteristics of venous thromboembolism (VTE) in cancer patients. METHODS: We retrospectively analyzed clinical characteristics in patients with VTE confirmed with cancer. Multivariable logistic regression was used to identify differences associated with the development, between the pulmonary embolism (PE) and deep vein thrombosis (DVT) groups. RESULTS: From January 2009 to December 2014, a total of 103 patients with VTE were included in the final analysis: mean age, 70.6+/-11.8 years; female, 56.3%. Most of the patients had a solid cancer (95.1%), and half of all patients had distant metastasis (50.5%). Proportion of patients with VTE who received chemotherapy within a year was 64.1%. Central venous catheters were applied to 59 patients within 6 weeks before the diagnosis of VTE. The proportion of patients with DVT only among VTE patients was 21.4%. In logistic regression analysis, central venous catheter insertion (OR=2.66, 95% CI=1.09, 6.49; p=.032), as well as lung metastasis (OR=2.94; 95% CI=1.06, 8.18; p=.039) were significant predictors for PE rather than DVT only. CONCLUSION: VTE developed in patients with advanced stage cancer. Further studies analyzing the effects of prophylactic anticoagulation in patients with cancer in regards to development of VTE are recommended.
Central Venous Catheters ; Diagnosis ; Drug Therapy ; Female ; Humans ; Logistic Models ; Lung ; Neoplasm Metastasis ; Pulmonary Embolism ; Retrospective Studies ; Risk Factors* ; Venous Thromboembolism* ; Venous Thrombosis

BACKGROUND: Pancreatic cancer is among the most common malignancies associated with venous thromboembolism (VTE). Asian patients are known to have a lower incidence of VTE compared to Caucasian patients. However, few studies have investigated the incidence of VTE in Asian patients with pancreatic cancer. METHODS: This retrospective review of medical records was performed on 505 patients with histopathologically proven advanced stage pancreatic cancer, from January 2006 to December 2012, at Soonchunhyang University Hospitals. RESULTS: Ninety-four patients (18.6%) had at least one pulmonary embolism (PE), deep vein thrombosis (DVT), or splanchnic vein thrombosis (SVT); 38 patients had isolated SVT; and 56 patients (11.1%) had at least one classic VTE (PE and/or DVT of lower extremities). Patients with more advanced stages of pancreatic cancer (distant metastatic stage, recurrence) or who had received chemotherapy had a higher incidence of classic VTE. Patients who were simultaneously diagnosed with pancreatic cancer and classic VTE had a poorer prognosis than patients with subsequent VTEs. There was a significant difference in overall survival (OS) between the presence and absence of a concurrent classic VTE diagnosis (median: OS, 2.1 mo vs. 10.7 mo; P < 0.001). Even when VTE included SVT, the result was similar (P < 0.001). CONCLUSION: In Korean patients with advanced pancreatic cancer, the incidence of VTEs is comparable to that of Caucasian patients. We also found that pancreatic cancer patients with concurrent VTEs had a poor prognosis compared to patients who developed VTEs later.
Asian Continental Ancestry Group ; Diagnosis ; Drug Therapy ; Hospitals, University ; Humans ; Incidence* ; Medical Records ; Pancreatic Neoplasms* ; Prognosis ; Pulmonary Embolism ; Retrospective Studies ; Thrombosis ; Veins ; Venous Thromboembolism* ; Venous Thrombosis

Object We aimed to compare the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonist (VKA) in the prevention and treatment of thrombotic diseases in patients with active cancer. Methods: To find randomized controlled trials (RCT) in which NOACs were compared VKAs in active cancer, we searched the electronic databases (PubMed, Web of Science and Clinical Trials) up to May 2019 and and languages restricted to Chinese and English. According to the screening strategy, two researchers independently screened and extracted literature, evaluated the quality of literature, the suitability of collected cross study data for analysis, and tested the heterogeneity. The relative risk (RR) and 95% confidence interval (95%CI) of major bleeding, clinically related non-major bleeding, VTE, stroke and all-cause mortality in active cancer patients with VTE, active cancer patients with non-valvular atrial fibrillation (NVAF) was calculated and the results were compared between NOAC with VKA. Results: A total of 9 RCTs were included, including 5 cancers with VTE (5/9) and 4 cancers with NVAF (4/9). A total of 5 867 patients were included. After excluding 1 818 (30.99%) patients with cancer history, 4 049 (68.86%) patients with active cancer were statistically analyzed. Among them, 2 278 (56.26%) received NOAC treatment, 1 771 patients (43.74%) received VKA treatment. The quality of the included documents was high (all scores were>5 points), and the data of each included document could be summarized and analyzed (P>0.05). The heterogeneity of main outcome events was very low (I² = 0). In VTE patients with active cancer, NOACs were more effective in reducing recurrence of VTE （RR=0.55, 95%CI 0.36 -0.84; P = 0.005) and clinically related non-major bleeding (RR=0.77, 95%CI 0.60 -0.98; P = 0.03) than VKAs. In NVAF patients with active cancer, efficacy of NOACs and VKAs was similar in terms of reducing VTE, stroke, clinically related non-major bleeding, major bleeding and all-cause mortality events (P>0.05). Conclusions: For patients with active cancer accompanied by VTE, NOAC may has more advantages in efficacy and safety compared to VKA in the prevention and treatment of thrombotic diseases.
Administration, Oral ; Anticoagulants/therapeutic use* ; Atrial Fibrillation/drug therapy* ; Humans ; Neoplasms/drug therapy* ; Randomized Controlled Trials as Topic ; Venous Thromboembolism/prevention & control* ; Vitamin K/therapeutic use*

BACKGROUND: Low-molecular-weight heparin (LMWH) is the standard treatment for venous thromboembolism (VTE) in patients with active cancer. However, use of factor Xa inhibitors, such as rivaroxaban, is increasing on the basis of limited clinical evidence. The present single-center study compared the incidence of bleeding and other treatment outcomes in gastrointestinal and pancreatobiliary cancer (GI tract cancer) patients administered rivaroxaban or LMWH for the treatment of VTE. METHODS: Retrospective data from 281 GI tract cancer patients who were treated for VTE with rivaroxaban (n = 78) or LMWH (n = 203) between 1 January 2012 and 31 December 2016, were analyzed. Primary end-point was the incidence of major and clinically relevant bleeding. Secondary outcomes included the incidence of recurrent VTE and mortality. RESULTS: Clinically relevant bleeding occurred in 19 patients (24.4%) in the rivaroxaban group and 31 (15.3%) in the LMWH group (P = 0.074). No inter-group difference was observed for rate of VTE recurrence (3.8% with rivaroxaban vs. 3.9% with LMWH; P > 0.999) or incidence of major bleeding (5.1% with rivaroxaban vs. 8.9% with LMWH; P = 0.296). Multivariate Cox proportional hazards analysis for age, cancer type, metastasis, history of chemotherapy or recent surgery, and Eastern Cooperative Oncology Group performance status revealed a 1.904-fold higher risk of bleeding with rivaroxaban than LMWH (1.031–3.516; P = 0.040). No significant inter-group difference was found in terms of hazard ratio for all-cause mortality. CONCLUSION: Compared to LMWH, rivaroxaban was associated with a higher incidence of clinically relevant bleeding in GI tract cancer patients presenting with VTE.
Colorectal Neoplasms ; Drug Therapy ; Factor Xa Inhibitors ; Gastrointestinal Tract ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Humans ; Incidence ; Mortality ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Rivaroxaban ; Stomach Neoplasms ; Venous Thromboembolism

Although inflammatory bowel disease (IBD) is a chronic disorder that mainly affects the gastrointestinal tract, extraintestinal complications can occur in IBD patients. Among many extraintestinal complications, venous thromboembolism (VTE) is particularly a feared complication due to its significant morbidity and mortality. IBD patients have about 2 to 3 fold higher risk of developing VTE compared with the general population, and the current management guidelines for IBD patients propose recommendations for the prevention of VTE. This review aims to summarize clinical characteristics of VTE in IBD patients and to outline strategies for preventing and treating VTE in these patients.
Anticoagulants/*therapeutic use ; Heparin, Low-Molecular-Weight/therapeutic use ; Humans ; Inflammatory Bowel Diseases/complications/*diagnosis ; Platelet Aggregation Inhibitors/therapeutic use ; Risk Factors ; Venous Thromboembolism/*drug therapy/etiology/prevention & control

PURPOSE: The risk factors for venous thromboembolism (VTE) in diffuse large B-cell lymphoma (DLBCL) are not clear although thrombosis can be associated with host status, tumor burden, and inflammatory activity. We assessed the effect of those factors on VTE in a cross-sectional study of patients enrolled in a prospective cohort study. MATERIALS AND METHODS: We analyzed the occurrence of VTE in 322 patients with newly diagnosed DLBCL who received rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) between 2008 and 2011. Serum levels of inflammatory cytokines were measured from serum samples archived at diagnosis. RESULTS: With a median follow-up duration of 41.9 months, VTE was documented in 34 patients (10.6%). A comparison of baseline characteristics indicated the group with VTE had higher percentage of old age, stage III/IV and extranodal involvements than the group without VTE (p < 0.05). Thus, the International Prognostic Index was significantly associated with VTE, but the Khorana score was not. A univariate competing risk factor analysis for VTE revealed that increased levels of inflammatory cytokines such as interleukin (IL)-6 and IL-10 were also associated with VTE (p < 0.05) in addition to host and tumor burden. However, a multivariate analysis showed that two host factors including age (> or = 60 years) and poor performance were independent risk factors for VTE. CONCLUSION: Among potential risk factors for VTE including tumor burden and inflammatory activity, age and performance status had a strong impact on the occurrence of VTE in patients with DLBCL who received R-CHOP.
B-Lymphocytes* ; Cohort Studies ; Cross-Sectional Studies* ; Cyclophosphamide ; Cytokines ; Diagnosis ; Doxorubicin ; Drug Therapy ; Follow-Up Studies ; Humans ; Interleukin-10 ; Interleukins ; Lymphoma, B-Cell* ; Multivariate Analysis ; Prednisone ; Prospective Studies ; Risk Factors ; Thrombosis ; Tumor Burden* ; Venous Thromboembolism* ; Vincristine

BACKGROUNDWarfarin is the most commonly prescribed anticoagulant worldwide. Factors which influence warfarin's inter-individual requirements including age, weight, and genetic factors explained about 50% of dose variance, and unidentified factors still remain. The aim of this study was to explore whether white blood cell count affects warfarin dose requirements.

METHODSThree hundred and twenty-two patients suffering from venous thromboembolism (VTE) and taking warfarin were recruited in this study. Genotyping of selected genes was conducted and other information was collected using the Epidata software. Dosing algorithms were constructed by multivariate linear regression analyses.

RESULTSIn addition to well-known factors such as age, body weight, CYP2C9*3, and VKORC1 c.1173C > T, white blood cell counts negatively related to warfarin dose requirements and contributed to warfarin variability in Han Chinese by about 0.6%.

CONCLUSIONWhite blood cell count has a small but significant contribution to warfarin dose requirements in Han Chinese.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anticoagulants ; administration & dosage ; therapeutic use ; Asian Continental Ancestry Group ; Female ; Genotype ; Humans ; Leukocytes ; Linear Models ; Male ; Middle Aged ; Venous Thromboembolism ; blood ; drug therapy ; genetics ; Warfarin ; administration & dosage ; therapeutic use ; Young Adult

BACKGROUND/AIMS: Venous thromboembolic events (VTEs) are common events in patients with advanced cancer. We analyzed the clinical characteristics of VTEs in advanced pancreatic and biliary tract cancer to determine the clinical significance, especially in palliative settings. METHODS: Seventy-nine patients with advanced pancreatic cancer or biliary tract cancer who had thromboembolic events were retrospectively reviewed. We investigated the correlation between clinical course and thromboembolic events, and the laboratory risk factors, such as complete blood count profile. RESULTS: The 79 patients consisted of 40 men (50.6%) and 39 women (49.4%) with a median age of 65 years old (range: 41–80). Forty-three patients (54.4%), had thromboembolic events without any symptoms. Pulmonary thromboembolism occurred in only 31 cases (39.2%), and combined thrombosis at more than two sites occurred in 17 cases (21.5%). Of the 51 patients with active chemotherapy, 45 showed progressive disease. The median survival times were 11.9 weeks in all patients, 15.3 weeks in the treatment group, and 3.4 weeks in the palliative group. There was no difference in survival time between patients treated with dalteparin only and those treated with dalteparin combined with thrombolytic intervention. CONCLUSIONS: VTE can be poor prognostic indicator in pancreatic and biliary tract cacner patients, suggestive of progressive disease and a sign of short life expectancy, requiring hospice and terminal care.
Biliary Tract Neoplasms* ; Biliary Tract* ; Biomarkers* ; Blood Cell Count ; Dalteparin ; Drug Therapy ; Female ; Hospices ; Humans ; Life Expectancy ; Male ; Pancreatic Neoplasms ; Pulmonary Embolism ; Retrospective Studies ; Risk Factors ; Terminal Care ; Thrombosis ; Venous Thromboembolism