Increased dose primary thromboprophylaxis in ambulatory patients with advanced pancreatic ductal adenocarcinoma, a single centre cohort study

Maraveyas, Anthony; Haque, Farzana; Muazzam, Iqtedar A; Ilyas, Waqas; Bozas, George

doi:10.1186/s12959-020-00222-1

Cited by 3 publications

(3 citation statements)

References 32 publications

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“…Although a consensus has emerged on anticoagulant applications following definitive pancreatectomy, in the metastatic setting, prophylactic anticoagulation use remains controversial [ 32 , 33 ]. The challenge relates to the difficulty of adequately capturing and measuring risk for an individual patient, making it difficult to know which patients are most likely to benefit from an anticoagulant strategy.…”

Section: Discussionmentioning

confidence: 99%

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

Huang

Shih

Chen

et al. 2023

Cancers

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Background: Pancreatic cancer can induce a hypercoagulable state which may lead to clinically apparent thrombosis. However, the effect of anticoagulants remains ambiguous. This study aimed to investigate the potential effect of long-term systemic anticoagulant usage on hospitalization outcomes of patients with pancreatic cancer. Methods: This retrospective study extracted all data from the U.S. Nationwide Inpatient Sample (NIS) database from 2005 to 2018. We included hospitalized adults ≥18 years old with a pancreatic cancer diagnosis identified by International Classification of Diseases ninth revision (ICD-9) and tenth revision (ICD-10) codes. We utilized diagnostic codes ICD9 V58.61 and ICD10 Z79.01, i.e., ‘long-term use of anticoagulant’, to identify individuals who were on a long-term systemic anticoagulant. The study cohort were then further grouped as being with or without long-term systemic use of an anticoagulant. Propensity score matching was performed to balance the characteristics of the two groups. The risks of life-threatening events, e.g., acute myocardial infarction (AMI), acute heart failure (AHF), sepsis, shock, and acute kidney injury (AKI), in-hospital death, and prolonged length of stay (LOS) in the hospital were compared between the groups by univariable and multivariable logistic regression analyses. Results: The study population consisted of 242,903 hospitalized patients with pancreas cancer, 6.5% (n = 15,719) of whom were on long-term systemic anticoagulants. A multivariable regression analysis showed that long-term systemic anticoagulant use was independently associated with lower odds of sepsis (aOR: 0.81, 95% CI: 0.76–0.85), shock (aOR: 0.59, 95% CI: 0.51–0.68), AKI (aOR: 0.86, 95% CI: 0.81–0.91), in-hospital mortality (aOR: 0.65, 95% CI: 0.60–0.70), and prolonged LOS (aOR: 0.84, 95% CI: 0.80–0.89). Conclusions: Long-term systemic anticoagulant use is associated with better clinical outcomes in terms of decreased risks of some life-threatening events, in-hospital death, and prolonged LOS among hospitalized patients with pancreatic cancer in the U.S.

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Section: Discussionmentioning

confidence: 99%

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

Huang

Shih

Chen

et al. 2023

Cancers

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“…VTE risk is already significant in those with advanced pancreatic cancer; if these patients are treated with chemotherapy, it may worsen it. Additionally, low molecular weight heparinas thromboprophylaxis for three months reduced that risk; nonetheless, continued anticoagulation growth may be useful to reduce a potential thromboembolic possibility in the future 61 . CAT has developed possibilities due to added new anticancer agents, immunotherapeutic medications, or chemotherapeutic drug combinations 62 .…”

Section: Therapy Using Chemicals (Chemotherapy)mentioning

confidence: 99%

Untitled

2023

IJPSR

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Thrombosis is one of the major causes of death and disability worldwide. Cancer patients are commonly thrombophilia or prothrombotic since they have abnormalities in all three factors of Virchow's triad, which lead to thromboembolism. Venous thrombosis (VT) is a chronic disorder that has the potential to be fatal and cause considerable complications. Venous thromboembolism (VTE) may potentially be the first indication of an undetected cancer in individuals. The rate of VTE and the risk of complications are much higher in the cancer patient groups. Arterial thrombosis is more likely to form when the plaque on the wall of the arteries consists a significant quantity of lipids covered by a layer of connective tissue. Thrombus formation in arteries may result in a heart attack or stroke. The hemostasis phase (liquid blood quickly hardens and forms a clot following injury to the blood vessel wall) spirals out of control. As a result, many blood clots form in the blood vessels that provide blood to various organs. Patients display paradoxically both excessive and inadequate clotting. The coagulation cascade begins when one of these proteins is proteolytically cleaved. Clotting factors then activate the subsequent clotting factor, and so forth. The production of many blood clots depletes the body's platelets and clotting components. Cancer patients have a 5-fold greater incidence of VTE. Thrombosis is the second most common, but often preventable, cause of mortality among cancer patients. Age-related variables such as reduced activity due to increased age, less energy to perform activities, increased inactivity, and overall coagulation activation raise one's risk. The risk of thromboembolism varies according to the histologic subtype of cancer. Anticancer drugs can cause a prothrombotic condition by a variety of mechanisms. VTE is three times more common in individuals with non-small cell lung cancer with adenocarcinoma. Individuals with cancer are more likely to experience increased frequency of hemostatic conditions. Cancer promotes the activation of blood coagulation, resulting in thrombophilia. Various biomarkers may be useful in determining people with cancer at high risk of acquiring venous thromboembolism. P-Selectin has also been shown to play a part in the interactions between tumours and their host cells as well as immunity from malignant cells. INTRODUCTION:Thrombosis is one of the large causes of loss and ill health worldwide 1, 2 .

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“…Moreover, thromboprophylaxis with LMWH for 3 months decreased that risk, however, further anticoagulation expansion may be helpful to limit a future thromboembolic risk. 30 Because there are growing risks of CAT due to additional new antineoplastic drugs, immunotherapies, or chemotherapy combinations, a prospective registry named TESCO and promoted by the Spanish Society of Medical Oncology data highlight the evolution of CAT, with new agents and thrombotic risk factors. 31 Radiotherapy.…”

Section: Cancer Treatmentmentioning

confidence: 99%

Cancer-Associated Thrombosis: Risk Factors, Molecular Mechanisms, Future Management

Hamza

Mousa

2020

Clin Appl Thromb Hemost

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Venous thromboembolism (VTE) is a major health problem in patients with cancer. Cancer augments thrombosis and causes cancer-associated thrombosis (CAT) and vice versa thrombosis amplifies cancer progression, termed thrombosis-associated cancer (TAC). Risk factors that lead to CAT and TAC include cancer type, chemotherapy, radiotherapy, hormonal therapy, anti-angiogenesis therapy, surgery, or supportive therapy with hematopoietic growth factors. There are some other factors that have an effect on CAT and TAC such as tissue factor, neutrophil extracellular traps (NETs) released in response to cancer, cancer procoagulant, and cytokines. Oncogenes, estrogen hormone, and thyroid hormone with its integrin αvβ3 receptor promote angiogenesis. Lastly, patient-related factors can play a role in development of thrombosis in cancer. Low-molecular-weight heparin and direct oral anticoagulants (DOACs) are used in VTE prophylaxis and treatment rather than vitamin K antagonist. Now, there are new directions for potential management of VTE in patients with cancer such as euthyroid, blockade of thyroid hormone receptor on integrin αvβ3, sulfated non-anticoagulant heparin, inhibition of NETs and stratifying low and high-risk patients with significant bleeding problems with DOACs.

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Increased dose primary thromboprophylaxis in ambulatory patients with advanced pancreatic ductal adenocarcinoma, a single centre cohort study

Cited by 3 publications

References 32 publications

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

Systemic Anticoagulation and Inpatient Outcomes of Pancreatic Cancer: Real-World Evidence from U.S. Nationwide Inpatient Sample

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Cancer-Associated Thrombosis: Risk Factors, Molecular Mechanisms, Future Management

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