Cancer-Associated Thrombosis: Beyond Clinical Practice Guidelines—A Multidisciplinary (SEMI–SEOM–SETH) Expert Consensus

Pachón, Vanessa; Trujillo‐Santos, Javier; Domènech, Pere Pascual i; Gallardo, Enrique; Font, Carme; González‐Porras, José Ramón; Pérez‐Segura, Pedro; Mateo, José; Muñoz, Andrés; Peris, M.L.

doi:10.1055/s-0038-1675577

Cited by 22 publications

(14 citation statements)

References 101 publications

(159 reference statements)

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“…Several VTE risk prediction models have been proposed for outpatients with cancer, such as Khorana, Vienna Cancer and Thrombosis Study, PROTECHT, and CONKO scores, but, to date, the only validated model is the Khorana score, which was used in the CASSINI and AVERT studies . Recently, the ONKOTEV score, which includes the Khorana score, presence of metastatic disease, compression of vascular/lymphatic structures, and history of previous VTE, was developed for ambulatory patients with cancer and showed a time‐dependent area under the curve significantly better than the Khorana score at both 3 months (71.9% vs. 57.9%, p = .001) and 6 months (75.4% vs. 58.6%, p < .001), but it is not yet validated . Given the patients and tumor characteristics of our cohort we consider that it is representative of the overall population of patients with carcinoma of the pancreas diagnosed in Western populations .…”

Section: Discussionmentioning

confidence: 99%

ONKOTEV Score as a Predictive Tool for Thromboembolic Events in Pancreatic Cancer—A Retrospective Analysis

et al. 2019

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Background. Venous thromboembolism (VTE) is a frequent complication in patients with cancer and causes considerable morbidity and mortality. The risk of VTE is higher in patients with pancreatic cancer and is often associated with treatment delays or interruptions. Recently, the ONKOTEV score was proposed as a VTE risk predictor model for patients with cancer, but its validation is still ongoing. Patients and Methods. We conducted a retrospective study to determine the incidence of VTE and to evaluate the ONKOTEV score as a VTE predictive tool in a population of patients with pancreatic cancer. Results. Between February 2012 and May 2017, 165 patients were included in the study. The median age was 73 years, 45.5% of patients were female, and 55.8% had stage IV disease. Fifty-one patients had a VTE (30.9%); 23.5% had pulmonary embolism, 25.5% had deep venous thrombosis, and 51.0% had visceral VTE (VsT). At a median follow-up time of 6.3 months, cumulative incidence of VTE was less than 10% for ONKOTEV scores 0 or 1 and approximately 40% and 70% for scores 2 and ≥3, respectively. Conclusion. The high VTE incidence observed in this study is consistent with prior reports. Patients at high risk for VTE with no increase in hemorrhagic risk should be considered for primary thromboprophylaxis. The ONKOTEV score may stratify VTE risk in patients with pancreatic cancer, with ONKOTEV score ≥2 being associated with a higher VTE occurrence. The Oncologist 2020;25:e284-e290 Implications for Practice: Venous thromboembolism (VTE) is a frequent complication of patients with pancreatic cancer and causes considerable morbidity, treatment delays or interruptions, and mortality. Thromboprophylaxis is not used routinely in ambulatory patients. Tools to stratify the risk of VTE are important to help select patients who may benefit from thromboprophylaxis. Recently, the ONKOTEV score was proposed as a VTE risk predictor model for patients with cancer, but its validation is still ongoing. In this patient series, ONKOTEV score ≥2 was associated with high VTE occurrence and may stratify VTE risk in patients with pancreatic cancer, suggesting that ONKOTEV can be considered to select patients with pancreatic cancer for primary thromboprophylaxis.

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Section: Discussionmentioning

confidence: 99%

ONKOTEV Score as a Predictive Tool for Thromboembolic Events in Pancreatic Cancer—A Retrospective Analysis

et al. 2019

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“…The main clinical practice guidelines recognize LMWH as the standard treatment of care for CAT. Treatment should start early after diagnosis with a median duration treatment of 3–6 months [ 8 , 9 ]. This specific group of patients presents high healthcare and non-healthcare resource utilization.…”

Section: Introductionmentioning

confidence: 99%

Cost of Venous Thromboembolic Disease in Patients with Lung Cancer: COSTECAT Study

Rubio-Salvador

Escudero‐Vilaplana

Rodriguez

et al. 2021

IJERPH

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Background: Patients with lung cancer (LC) are at significantly higher risk of developing venous thromboembolism (VTE), which may lead to increased use of health resources and the cost of the disease management. The main aim of the study was to determine the cost of the management of VTE events in patients with LC treated with Low Molecular Weight Heparins (LMWH) in Spain. Methods: Costecat was an observational, ambispective pharmacoeconomic study. Patients with LC, with a first episode of VTE (symptomatic or incidental) in treatment with LMWH, were recruited from six third-level hospitals and followed up for six months. Sociodemographic, clinical and resource use variables of VTE-related implications and its treatment were collected. Direct healthcare costs and direct non-healthcare costs were recorded. Data collection was documented in an electronic case report. Costs (€2018) were estimated from the healthcare perspective. Statistical analysis was performed using the statistical program R 3.4.3 version (30 November 2017). Results: Forty-seven patients were included. Mean age was 65.4 years, 66.0% were male. The percentage of patients with LC who had metastatic disease was 78.7%. Twenty-three patients (48.9%) needed hospital admissions due to thromboembolic episode. Total average cost of patients with cancer associated VTE (CAT) was €10,969.6 per patient/semester. The hospitalizations represent 65.8% of total costs (7207.3 € SD 13,996.9 €), followed by LMWH therapy which represents 18.6% (2033.8 € SD:630.5 €). Conclusions: Venous thromboembolism episodes induce an economic impact on patients and healthcare systems. Direct healthcare costs are the major burden of the total cost, in which hospitalizations are the main drivers of cost.

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“…19 In fact, various risk assessment models have been developed to identify patients with cancer at high risk for VTE events. 20 The purpose of this narrative review is to summarize recent evidence from randomized controlled trials about the safety and efficacy of prophylactic anticoagulation in ambulatory patients with lung cancer, focusing on the use of low molecular weight heparins (LMWHs) or DOACs. In addition, we aim to provide a summary of currently available risk stratification models for assessment of VTE risk, focusing on patients with lung cancer.…”

Section: Introductionmentioning

confidence: 99%

“…19 In fact, various risk assessment models have been developed to identify patients with cancer at high risk for VTE events. 20…”

Section: Introductionmentioning

confidence: 99%

Do we need prophylactic anticoagulation in ambulatory patients with lung cancer? A review

et al. 2020

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Venous thromboembolism is a common complication of malignancy. Lung cancer is considered one of the most thrombogenic cancer types. Primary thromboprophylaxis is not currently recommended for all ambulatory patients with active cancer. In the present narrative review we aim to summarize recent data on the safety and efficacy of primary thromboprophylaxis as well as on venous thromboembolism risk assessment, focusing on ambulatory patients with lung cancer. A potential benefit from prophylactic anticoagulation with low molecular weight heparins in terms of venous thromboembolism risk reduction and increased overall survival in patients with lung cancer, without a significant increase in bleeding risk, has been reported in several studies. Recent studies also reveal promising results of direct oral anticoagulants regarding their efficacy as primary thromboprophylaxis in patients with cancer, including those with lung cancer. However, the use of different study methodologies and the heterogeneity of study populations among the trials limit the extraction of definite results. More randomized, controlled trials, restricted to a well-characterized population of patients with lung cancer, are greatly anticipated. The use of risk assessment tools for stratification of venous thromboembolic risk is warranted. The development of an accurate and practical risk assessment model for patients with lung cancer represents an unmet need.

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Cancer-Associated Thrombosis: Beyond Clinical Practice Guidelines—A Multidisciplinary (SEMI–SEOM–SETH) Expert Consensus

Cited by 22 publications

References 101 publications

ONKOTEV Score as a Predictive Tool for Thromboembolic Events in Pancreatic Cancer—A Retrospective Analysis

ONKOTEV Score as a Predictive Tool for Thromboembolic Events in Pancreatic Cancer—A Retrospective Analysis

Cost of Venous Thromboembolic Disease in Patients with Lung Cancer: COSTECAT Study

Do we need prophylactic anticoagulation in ambulatory patients with lung cancer? A review

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