Assessing Risk of Venous Thromboembolism in the Patient With Cancer

Khorana, Alok A.; Connolly, Gregory C.

doi:10.1200/jco.2009.22.3271

Cited by 469 publications

(409 citation statements)

References 107 publications

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“…3,18,19 However, lymph node metastases are not usually regarded as an established risk factor. 5,20,21 Studies of patients in the Californian Cancer Registry investigated the association between VTE and local, regional, and distant disease in a group of different cancer sites 19 and in several single tumor entities. [22][23][24][25][26][27] The risk was highest in patients with metastatic disease, but was also slightly elevated in patients with regional disease, compared to those with localized cancer only.…”

Section: Introductionmentioning

confidence: 99%

Regional lymph node metastases are a strong risk factor for venous thromboembolism: results from the Vienna Cancer and Thrombosis Study

Dickmann

Ahlbrecht

et al. 2013

Haematologica

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Section: Introductionmentioning

confidence: 99%

Regional lymph node metastases are a strong risk factor for venous thromboembolism: results from the Vienna Cancer and Thrombosis Study

Dickmann

Ahlbrecht

et al. 2013

Haematologica

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“…85 It is important, therefore, to identify subgroups of ambulatory cancer patients for whom the risk of VTE and the benefits of thrombosis prophylaxis (improved morbidity, reduced mortality, more consistent delivery of cancer therapy, enhanced quality of life, and decreased use of health care resources) justify the risk, cost, and inconvenience of primary prophylaxis.…”

Section: D-dimer Testing For Venous Thromboembolism Risk Stratificatimentioning

confidence: 99%

D-Dimer Assays in Diagnosis and Management of Thrombotic and Bleeding Disorders

Bates

2012

Semin Thromb Hemost

103

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).D-dimer is a global indicator of coagulation activation and fibrinolysis and, therefore, an indirect marker of thrombotic activity. This specific cross-linked fibrin degradation product is formed through the sequential action thrombin, activated factor XIII (FXIIIa), and plasmin (►Fig. 1). 1-3 First, thrombin, generated when coagulation is activated, converts fibrinogen to fibrin and activates FXIII. Second, FXIIIa covalently crosslinks D-domains in adjacent fibrin monomers. Third, plasmin (formed on the fibrin surface by plasminogen activation) cleaves substrate fibrin at specific sites, and when it cleaves fibrin cross-linked by FXIIIa, it generates D-dimer. D-dimer is cleared through the kidneys and the reticuloendothelial system and has a plasma half-life of approximately 8 hours. 4 Low levels of D-dimer can be found circulating under normal physiologic conditions, while pathologically elevated levels can be found in any condition associated with enhanced fibrin formation and fibrinolysis (►Table 1). 1-3 The utility of D-dimer measurement has been evaluated in several clinical situations; however, the D-dimer assays have been best validated for the exclusion of venous thromboembolism (VTE) and the diagnosis and monitoring of disseminated intravascular coagulation (DIC). This article will review the available evidence for the utilization of D-dimer antigen measurement in the management of thrombotic and bleeding disorders. Measurement of D-DimerThe presence of D-dimer in plasma can be detected using monoclonal antibodies that recognize an epitope present in FXIIIa-cross-linked fragment D-domain of fibrin but not in fibrinogen degradation products or noncross-linked fibrin degradation products. Many different D-dimer assays have been developed and marketed. All of these tests rely on the use of monoclonal antibodies to detect D-dimer molecules. In general, three techniques are available to assay D-dimer (►Fig. 2). 1-3 These are (1) enzyme-linked immunosorbent assays (ELISAs) that rely on antibody capture and labeling of D-dimer; (2) a whole-blood agglutination assay (SimpliRED, Siemens Healthcare Diagnostics, Newcastle, DE), that uses a bispecific antibody conjugate with binding sites for both D-dimer and a red cell antigen and is performed on whole blood; (3) latex agglutination assays that also use bispecific antibodies with specificity for the latex particle and D-dimer antigen. Earlier latex agglutination assays for D-dimer were qualitative or semiquantitative; however, newer automated, quantitative D-dimer assays (which are immunoturbidometric assays) are performed on routine, automated coagulation instruments. It is important to recognize that results are not comparable between different assays, even between those of similar formats. Potential reasons for the lack of comparable results are listed in ►Table 2. Numeric results of D-dimerAbstract D-dimer is a global indicator of coagulation activation and fibrinolysis and, therefore, an indirect marker of thrombotic activity. The utility of D-dimer measur...

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“…VTE incidence varies across cancer stages; the incidence of VTE in colorectal cancer is largely confined to patients with advanced disease [2,4,12,14]. A high predisposition for the development of VTE exists for patients with colon cancer with the following principal risk factors: hospitalization, regional stage or metastatic disease, number of chronic comorbid conditions, systemic chemotherapy, prior VTE, African American race, and advanced age [2,4,[15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Impact of Venous Thromboembolism on Mortality of Elderly Medicare Patients with Stage III Colon Cancer

et al. 2012

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After completing this course, the reader will be able to:1. Identify the prevalence of adjuvant chemotherapy utilization in elderly patients with stage III colon cancer.2. Discuss the prevalence and impact of venous thromboembolism in elderly patients with stage III colon cancer.3. Identify potential for development of a clinical trial to study the clinical benefit and impact on cancer-specific and all-cause mortality of thromboprophylaxis during adjuvant chemotherapy in elderly patients with stage III colon cancer.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground. The improvement in survival rates for patients with colon cancer has shifted the focus from examining cancer-specific mortality to exploring all-cause mortality. Adverse events such as venous thromboembolism (VTE) affect overall survival times and the net clinical benefit of cancer management strategies.Methods. This retrospective study used Surveillance, Epidemiology and End Results (SEER) Medicare data to examine VTE incidence and mortality rates for elderly

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Assessing Risk of Venous Thromboembolism in the Patient With Cancer

Abstract: Identifying patients with cancer who are most at risk for VTE is essential to better target thromboprophylaxis, with the eventual goal of reducing the burden as well as the consequences of VTE for patients with cancer.

Cited by 469 publications

References 107 publications

Regional lymph node metastases are a strong risk factor for venous thromboembolism: results from the Vienna Cancer and Thrombosis Study

Regional lymph node metastases are a strong risk factor for venous thromboembolism: results from the Vienna Cancer and Thrombosis Study

D-Dimer Assays in Diagnosis and Management of Thrombotic and Bleeding Disorders

Impact of Venous Thromboembolism on Mortality of Elderly Medicare Patients with Stage III Colon Cancer

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