Asymptomatic “breakthrough” thrombosis and anticoagulant “failure”: Keep calm and carry on

Olson, Sven R.; Shatzel, Joseph J.; DeLoughery, Thomas G.

doi:10.1002/rth2.12218

“…Primary treatment failure occurs within 3 months of the initial VTE diagnosis 20 . In early studies on VTE treatments, radiographic progression of VTE based on various criteria is common with treatment (up to 15%), although usually asymptomatic 181 . In clinical trials comparing direct oral anticoagulant treatment with other anticoagulant strategies, the rate of recurrent symptomatic VTE was ≤3.5% with either treatment strategy 182 – 187 .…”

Section: Acquired Risk Factorsmentioning

confidence: 99%

Epidemiology and prevention of venous thromboembolism

Lutsey

¹

,

Zakai

²

2022

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Venous thromboembolism, that consists of the interrelated conditions deep-vein thrombosis and pulmonary embolism, is an under-appreciated vascular disease. In Western regions, approximately 1 in 12 individuals will be diagnosed with venous thromboembolism in their lifetime. Rates of venous thromboembolism are lower in Asia, but data from other regions are sparse. Numerous risk factors for venous thromboembolism have been identified, which can be classified as acute or subacute triggers (provoking factors that increase the risk of venous thromboembolism) and basal or acquired risk factors (which can be modifiable or static). Approximately 20% of individuals who have a venous thromboembolism event die within 1 year (although often from the provoking condition), and complications are common among survivors. Fortunately, opportunities exist for primordial prevention (prevention of the development of underlying risk factors), primary prevention (management of risk factors among individuals at high risk of the condition) and secondary prevention (prevention of recurrent events) of venous thromboembolism. In this Review, we describe the epidemiology of venous thromboembolism, including the incidence, risk factors, outcomes and opportunities for prevention. Meaningful health disparities exist in both the incidence and outcomes of venous thromboembolism. We also discuss these disparities as well as opportunities to reduce them.

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“…Asymptomatic early thrombus propagation can occur in any patient despite adequate anticoagulation. 12 This usually occurs in patients with high clot burden in whom anticoagulation has not had adequate time to be effective. In patients with cancer and the question of recurrent VTE, multiple factors need to be assessed.…”

Section: Anticoagulant Choice In Cancer Patientsmentioning

confidence: 99%

Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy

Al‐Samkari

¹

,

Connors

²

2019

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The association between malignancy and thrombosis has been recognized for over a century and a half. Patients with cancer have an elevated risk of both initial and recurrent venous thromboembolism (VTE) compared with patients without cancer owing to cancer- and patient-specific factors. Recurrent VTE is common despite anticoagulation, presenting additional management challenges. Patients with cancer also have an increased risk of bleeding when on anticoagulants compared with patients without cancer. This bleeding risk is heightened by the thrombocytopenia common in patients with hematologic malignancies and those treated with intensive myelosuppressive chemotherapy regimens. Despite the advancements in cancer-directed therapy made over the past 15 years, numerous large studies have confirmed that bleeding and VTE recurrence rates remain high in cancer patients. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult, because management of cancer-associated thrombosis requires anticoagulation despite known increased risks for bleeding. In the context of challenging illustrative cases, this review will describe management approaches to clinical scenarios in which data are sparse: cancer patients with recurrent VTE despite anticoagulation and cancer patients with a new VTE in the setting of severe thrombocytopenia.

show abstract

Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy

Al‐Samkari

¹

,

Connors

²

2019

View full text Add to dashboard Cite

The association between malignancy and thrombosis has been recognized for over a century and a half. Patients with cancer have an elevated risk of both initial and recurrent venous thromboembolism (VTE) compared with patients without cancer owing to cancer- and patient-specific factors. Recurrent VTE is common despite anticoagulation, presenting additional management challenges. Patients with cancer also have an increased risk of bleeding when on anticoagulants compared with patients without cancer. This bleeding risk is heightened by the thrombocytopenia common in patients with hematologic malignancies and those treated with intensive myelosuppressive chemotherapy regimens. Despite the advancements in cancer-directed therapy made over the past 15 years, numerous large studies have confirmed that bleeding and VTE recurrence rates remain high in cancer patients. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult, because management of cancer-associated thrombosis requires anticoagulation despite known increased risks for bleeding. In the context of challenging illustrative cases, this review will describe management approaches to clinical scenarios in which data are sparse: cancer patients with recurrent VTE despite anticoagulation and cancer patients with a new VTE in the setting of severe thrombocytopenia.

show abstract

Asymptomatic “breakthrough” thrombosis and anticoagulant “failure”: Keep calm and carry on

Cited by 4 publications

References 23 publications

Epidemiology and prevention of venous thromboembolism

Epidemiology and prevention of venous thromboembolism

Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy

Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy

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