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      Thrombotic complications in patients with cancer: Advances in pathogenesis, prevention, and treatment—A report from ICTHIC 2021

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          Abstract

          Venous thromboembolism (VTE) is a common complication in cancer patients, resulting in deep vein thrombosis (DVT) or pulmonary embolism (PE), and is responsible for high morbidity and mortality. This article discusses evidence and future perspectives on pathogenesis and prevention and treatment of thrombotic complications in patients with cancer. In April 2021, international basic researchers and clinicians met for the virtual edition of the 10th International Conference on Thrombosis & Hemostasis Issues in Cancer. Pathogenic mechanisms, markers and scores for risk assessment, diagnosis and therapy issues, current prophylaxis recommendations, and special settings, such as palliative care, pediatrics, and COVID‐19 patients were discussed. Emerging areas of interest in cancer associated VTE are the role of immunotherapy, platelet activation markers, genetic alterations and real‐world systems‐based approaches to prevention and treatment.

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          Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update

          Nigel S. Key, Alok A. Khorana, Nicole M. Kuderer … (2020)
          PURPOSE To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. METHODS PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018. ASCO convened an Expert Panel to review the evidence and revise previous recommendations as needed. RESULTS The systematic review included 35 publications on VTE prophylaxis and treatment and 18 publications on VTE risk assessment. Two RCTs of direct oral anticoagulants (DOACs) for the treatment of VTE in patients with cancer reported that edoxaban and rivaroxaban are effective but are linked with a higher risk of bleeding compared with low-molecular-weight heparin (LMWH) in patients with GI and potentially genitourinary cancers. Two additional RCTs reported on DOACs for thromboprophylaxis in ambulatory patients with cancer at increased risk of VTE. RECOMMENDATIONS Changes to previous recommendations: Clinicians may offer thromboprophylaxis with apixaban, rivaroxaban, or LMWH to selected high-risk outpatients with cancer; rivaroxaban and edoxaban have been added as options for VTE treatment; patients with brain metastases are now addressed in the VTE treatment section; and the recommendation regarding long-term postoperative LMWH has been expanded. Re-affirmed recommendations: Most hospitalized patients with cancer and an acute medical condition require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for all outpatients with cancer. Patients undergoing major cancer surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Patients with cancer should be periodically assessed for VTE risk, and oncology professionals should provide patient education about the signs and symptoms of VTE. Additional information is available at www.asco.org/supportive-care-guidelines .
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            Development and validation of a predictive model for chemotherapy-associated thrombosis.

            Alok A. Khorana, Nicole M Kuderer, Eva Culakova … (2008)
            Risk of venous thromboembolism (VTE) is elevated in cancer, but individual risk factors cannot identify a sufficiently high-risk group of outpatients for thromboprophylaxis. We developed a simple model for predicting chemotherapy-associated VTE using baseline clinical and laboratory variables. The association of VTE with multiple variables was characterized in a derivation cohort of 2701 cancer outpatients from a prospective observational study. A risk model was derived and validated in an independent cohort of 1365 patients from the same study. Five predictive variables were identified in a multivariate model: site of cancer (2 points for very high-risk site, 1 point for high-risk site), platelet count of 350 x 10(9)/L or more, hemoglobin less than 100 g/L (10 g/dL) and/or use of erythropoiesis-stimulating agents, leukocyte count more than 11 x 10(9)/L, and body mass index of 35 kg/m(2) or more (1 point each). Rates of VTE in the derivation and validation cohorts, respectively, were 0.8% and 0.3% in low-risk (score = 0), 1.8% and 2% in intermediate-risk (score = 1-2), and 7.1% and 6.7% in high-risk (score >/= 3) category over a median of 2.5 months (C-statistic = 0.7 for both cohorts). This model can identify patients with a nearly 7% short-term risk of symptomatic VTE and may be used to select cancer outpatients for studies of thromboprophylaxis.
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              Mechanisms of adverse effects of anti-VEGF therapy for cancer

              T Kamba, D McDonald-McGinn (2007)
              Advances in understanding the role of vascular endothelial growth factor (VEGF) in normal physiology are giving insight into the basis of adverse effects attributed to the use of VEGF inhibitors in clinical oncology. These effects are typically downstream consequences of suppression of cellular signalling pathways important in the regulation and maintenance of the microvasculature. Downregulation of these pathways in normal organs can lead to vascular disturbances and even regression of blood vessels, which could be intensified by concurrent pathological conditions. These changes are generally manageable and pose less risk than the tumours being treated, but they highlight the properties shared by tumour vessels and the vasculature of normal organs.
              Article 0 comments Cited 238 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Anna Falanga:
                ORCID: https://orcid.org/0000-0002-5007-3457
                annafalanga@yahoo.com , @AnnaFalanga19
                Alok A. Khorana:
                ORCID: https://orcid.org/0000-0002-9509-0998
                @aakonc
                Journal
                Journal ID (nlm-ta): Res Pract Thromb Haemost
                Journal ID (iso-abbrev): Res Pract Thromb Haemost
                Journal ID (doi): 10.1002/(ISSN)2475-0379
                Journal ID (publisher-id): RTH2
                Title: Research and Practice in Thrombosis and Haemostasis
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2475-0379
                Publication date (Electronic): 01 July 2022
                Publication date Collection: July 2022
                Volume: 6
                Issue: 5 ( doiID: 10.1002/rth2.v6.5 )
                Electronic Location Identifier: e12744
                Affiliations
                [ 1 ] Division of Immunohematology and Transfusion Medicine Hospital Papa Giovanni XXIII Bergamo Italy
                [ 2 ] Department of Medicine and Surgery University of Milan Bicocca Milan Italy
                [ 3 ] Department of Hematology and Bone Marrow Transplantation Rambam Health Care Campus Haifa Israel
                [ 4 ] Taussig Cancer Institute Cleveland Clinic Lerner College of Medicine Cleveland Clinic Cleveland Ohio USA
                [ 5 ] James P Wilmot Cancer Center and University of Rochester Rochester NY USA
                Author notes
                [*] [* ] Correspondence

                Anna Falanga, Hospital Papa Giovanni XXIII, Piazza OMS, 1, Bergamo, Italy.

                Email: annafalanga@ 123456yahoo.com

                Author information
                https://orcid.org/0000-0002-5007-3457
                https://orcid.org/0000-0002-9509-0998
                Article
                Publisher ID: RTH212744
                DOI: 10.1002/rth2.12744
                PMC ID: 9248072
                PubMed ID: 35794962
                SO-VID: 5152581c-b475-49f2-82e8-042632271135
                Copyright © © 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date revision received : 28 March 2022
                Date received : 21 December 2021
                Date accepted : 03 May 2022
                Page count
                Figures: 0, Tables: 0, Pages: 8, Words: 6063
                Funding
                Funded by: Servizi Congressuali ed Eventi Culturali (C.E.C.) srl, Italy
                Categories
                Subject: Review Article
                Subject: Review Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date July 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:01.07.2022

                Keywords: cancer‐associated thrombosis,coagulation,hemostasis,risk factor,venous thromboembolism
                Data availability:
                Keywords: cancer‐associated thrombosis, coagulation, hemostasis, risk factor, venous thromboembolism

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