Frequency of arterial thromboembolism in populations with malignancies: A systematic review

Yu, James; Li, Allen; Laureano, Marissa; Crowther, Mark

doi:10.1016/j.thromres.2019.10.004

Cited by 20 publications

(20 citation statements)

References 32 publications

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“…The incidence of ATE in patients with lung cancer is approximately 6.3%-10.9% ( 5 , 41 ). Studies have suggested that the risk of ATE may be the greatest during the peri-diagnosis period, which is similar to results in VTE studies ( 5 , 45 , 46 ). A recent study retrospectively analyzed an ALK positive cohort in NSCLC patients.…”

Section: Discussionmentioning

confidence: 99%

“…With prolonged survival, the aging of the cancer population and the introduction of thrombogenic anti-cancer treatments increase the incidence of VTE in cancer patients ( 2 ). In addition, patients diagnosed with lung cancer are at an increased risk for arterial thromboembolism (ATE), but the impact on the generation of ATE is less severe than that on the generation of VTE ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Driver Genes Associated With the Incidence of Venous Thromboembolism in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Qian

Zheng

et al. 2021

Front. Oncol.

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BackgroundThe association between driver genes and the incidence of thromboembolic events (TEs) in patients diagnosed with non-small-cell lung cancer (NSCLC) needs to be quantified to guide clinical management.MethodsWe interrogated PubMed, Embase, Web of Science and Cochrane library databases for terms related to venous thromboembolism (VTE) and arterial thromboembolism (ATE) in patients diagnosed with non-small-cell lung cancer harboring driver genes. This search was conducted for studies published between 1 January, 2000 and 31 December, 2020. A random-effects meta-analysis was performed to analyze the pooled incidence and odds ratios of VTE in patients with different driver genes.ResultsOf the 2,742 citations identified, a total of 25 studies that included 21,156 patients met eligibility criteria. The overall pooled incidence of VTE in patients with driver genes was 23% (95% CI 18-29). Patients with ROS1 rearrangements had the highest incidence of VTE (37%, 95%CI 23-52). ALK rearrangements were associated with increased VTE risks (OR=2.08,95% CI 1.69-2.55), with the second highest incidence of VTE (27%, 95%CI 20-35). Both groups of patients with EGFR and KRAS mutations did not show a significantly increased risk for VTE (OR=1.33, 95% CI 0.75-2.34; OR=1.31, 95% CI 0.40-4.28).ConclusionsALK rearrangements were shown to be associated with increased VTE risks in patients diagnosed with non-small lung cancer, while there was no significant relation observed between VTE risks and EGFR or KRAS mutations in lung cancer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Driver Genes Associated With the Incidence of Venous Thromboembolism in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Qian

Zheng

et al. 2021

Front. Oncol.

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“…These risk factors may enable to select high-risk patients who could benefit from thromboprophylaxis or alternative therapeutic strategies. 6,7,44 Currently, evidence on risk-adapted strategies for the prevention of arterial events in cancer patients is lacking.…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Risk Assessment Models for Thrombosis and Anticoagulant-Related Bleeding in Ambulatory Cancer Patients

Candeloro

Guman

Kraaijpoel

et al. 2021

Semin Thromb Hemost

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Cancer patients have a high risk of developing venous thromboembolism and arterial thrombosis, along with an increased risk of anticoagulant-related bleeding with primary and secondary prophylaxis of cancer-associated thrombosis. Decisions on initiation, dosing, and duration of anticoagulant therapy for prevention and treatment of cancer-associated thrombosis are challenging, as clinicians have to balance patients' individual risk of (recurrent) thrombosis against the risk of bleeding complications. For this purpose, several dedicated risk assessment models for venous thromboembolism in cancer patients have been suggested. However, most of these scores perform poorly and have received limited to no validation. For bleeding and arterial thrombosis, no risk scores have been developed specifically for cancer patients, and treatment decisions remain based on clinical gestalt and rough and unstructured estimation of the risks. The aims of this review are to summarize the characteristics and performance of risk assessment scores for (recurrent) venous thromboembolism and discuss available data on risk assessment for bleeding and arterial thrombosis in the cancer population. This summary can help clinicians in daily practice to make a balanced decision when considering the use of risk assessment models for cancer-associated venous thromboembolism. Future research attempts should aim at improving risk assessment for arterial thrombosis and anticoagulant-related bleeding in cancer patients.

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“…20 A systematic review of the frequency of ATE in patients with cancer searched the MEDLINE, Embase, CENTRAL, and Web of Science data to 28 January 2019. 21 Included were studies comparing the frequency of ATE in populations with cancer versus controls. Studies examining the frequency of ATE in the context of cancer therapies were excluded.…”

Section: Survey Of the Recent Literature: Epidemiologymentioning

confidence: 99%

Cancer-Associated Atherothrombosis: The Challenge

Naschitz

2021

Int J Angiol

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The association between venous thrombosis and malignancy, having typical features of a paraneoplastic syndrome, has been established for a century. Currently, it is recognized that arterial thromboembolism (ATE) may also behave as a paraneoplastic syndrome. Recent matched cohort studies, systematic reviews, and observational studies concur in showing an increased incidence of acute coronary events, ischemic stroke, accelerated peripheral arterial disease, and in-stent thrombosis during the 6-month period before cancer diagnosis, peaking for 30 days immediately before cancer diagnosis. Cancer patients with ATE are at higher risk of in-hospital and long-term mortality as compared with noncancer patients. In the present review, we focus on the epidemiology, clinical variants and presentation, morbidity, mortality, primary and secondary prevention, and treatment of cancer-associated ATE. The awareness that cancer can be a risk factor for ATE and that cancer therapy can initiate cardiovascular complications make it mandatory to identify high-risk patients, modify preexistent cardiovascular risk factors, and adopt effective antithrombotic prophylaxis. For ATE prophylaxis, modifiable patient-related risk factors and oncology treatment–related factors are levers for intervention. Statins and platelet antiaggregants have been studied, but their efficacy for prevention of cancer-associated ATE remains to be demonstrated. Results of revascularization procedures for cancer-associated ATE are worse than for ATE in noncancer patients. It is important that a multidisciplinary approach is adopted for making informed decisions, by involving the vascular surgeon, interventional radiologist, oncologist, and palliative medicine, as well as the patients and their family.

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Frequency of arterial thromboembolism in populations with malignancies: A systematic review

Cited by 20 publications

References 32 publications

Driver Genes Associated With the Incidence of Venous Thromboembolism in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Driver Genes Associated With the Incidence of Venous Thromboembolism in Patients With Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Risk Assessment Models for Thrombosis and Anticoagulant-Related Bleeding in Ambulatory Cancer Patients

Cancer-Associated Atherothrombosis: The Challenge

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