Inherited and Acquired Risk Factors for Venous Thromboembolic Disease Among Women Taking Tamoxifen to Prevent Breast Cancer

Duggan, Catherine; Marriott, Kevin; Edwards, Rob; Cuzick, Jack

doi:10.1200/jco.2003.10.111

Cited by 83 publications

(51 citation statements)

References 44 publications

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“…Likewise, women with prior CHD have a higher risk of VTEs during ERT, 17 presumably as a result of activation of platelets, blood coagulation, and increase in fibrin turnover. [21][22][23] In our study, the relative risk of VTEs under tamoxifen was substantially lower than in other prevention trials, including the NSABP-P1 trial, 3 IBIS, 5 and the Multiple Outcomes of Raloxifene Evaluation (MORE) trial of raloxifene. 24 More important, the risk of VTEs was limited to superficial thrombophlebitis and, unlike other prevention trials, both deep venous thrombosis and pulmonary emboli were not increased on tamoxifen.…”

Section: Decensi Et Al Tamoxifen and Vte In Healthy Women 653mentioning

confidence: 83%

“…In IBIS, serious VTEs increased significantly on tamoxifen (odds ratio [OR]ϭ4.7; 95% CI, 2.2 to 10.1) within 3 months of major surgery, fracture, or after immobility. 5 Garber et al 16 have recently shown that the risk of serious VTEs in the National Surgical Adjuvant Breast and Bowel Project-P1 (NSABP-P1) trial was associated with a high body mass index and with a genetic predisposition due to a mutation in factor V Leiden or prothrombin G20210A, although no evidence for a statistically significant gene-bytreatment interaction was noted.…”

Section: Discussionmentioning

confidence: 99%

“…Insight into the factors associated with VTE risk during tamoxifen use was recently provided by the International Breast Cancer Intervention Study (IBIS), wherein major VTEs increased significantly during tamoxifen therapy within 3 months of major surgery, immobilization, or fracture. 5 In addition, recent studies have suggested that atherosclerosis may induce VTEs or that the 2 conditions share common risk factors. 6 Indeed, studies have found an association between hyperlipidemia, hypertension, and VTEs.…”

Section: See P 539mentioning

confidence: 99%

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Effect of Tamoxifen on Venous Thromboembolic Events in a Breast Cancer Prevention Trial

et al. 2005

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Background-Tamoxifen, a selective estrogen-receptor modulator, increases venous thromboembolic events (VTE), but the factors explaining this risk are unclear. Atherosclerosis may induce VTE, or the 2 conditions may share common risk factors. We assessed the effect of tamoxifen on VTE in a breast cancer prevention trial and studied its association with risk factors for VTE. Methods and Results-The incidence of VTE was studied in 5408 hysterectomized women randomly assigned to tamoxifen 20 mg/d or placebo for 5 years. There were 28 VTEs on placebo and 44 on tamoxifen therapy (hazard ratio [HR]ϭ1.63; 95% confidence interval [CI], 1.02 to 2.63), 80% of which were superficial phlebitis, accounting for all of the excess due to tamoxifen within 18 months from randomization. Compared with placebo, the risk of VTE on tamoxifen was higher in women aged 55 years or older, women with a body mass index Ն25 kg/m 2 , elevated blood pressure, total cholesterol Ն250 mg/dL, current smoking, and a family history of coronary heart disease (CHD). Of the 685 women with a CHD risk score Ն5 who entered the trial, 1 in the placebo arm and 13 in the tamoxifen arm developed VTE (log-rank Pϭ0.0013). In multivariate regression analysis, age Ն60 years, height Ն165 cm, and diastolic blood pressure Ն90 mm Hg had independent detrimental effects on VTE risk during tamoxifen therapy, whereas transdermal estrogen therapy concomitant with tamoxifen was not associated with any excess of VTE (HRϭ0.64; 95% CI, 0.23 to 1.82). Conclusions-Women with conventional risk factors for atherosclerosis have a higher risk of VTE during tamoxifen therapy. This information should be incorporated into counseling women on its risk-benefit ratio, particularly in the prevention setting. (Circulation. 2005;111:650-656.)

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Section: Decensi Et Al Tamoxifen and Vte In Healthy Women 653mentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: See P 539mentioning

confidence: 99%

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Effect of Tamoxifen on Venous Thromboembolic Events in a Breast Cancer Prevention Trial

et al. 2005

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“…It was also demonstrated to improve DFS after completion of standard tamoxifen therapy [101]. Letrozole, in contrast to tamoxifen, which acts as a partial estrogen agonist, is not associated with an increased incidence of uterine cancer and venous thromboembolism in long-term use [9,102].…”

Section: Ovulation Induction With Aromatase Inhibitorsmentioning

confidence: 99%

Fertility Preservation in Young Women Undergoing Breast Cancer Therapy

2006

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“…There are several reports on the increased incidence of TE associated with tamoxifen [2,3]. Some authors have also indicated that the risk of TE is increased two-to threefold during tamoxifen use for breast cancer chemoprevention [4,5].…”

Section: Introductionmentioning

confidence: 99%

The effects of tamoxifen on homocysteine levels in breast cancer patients

Eroğlu¹,

Eğin

Akar

2009

Open Medicine

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AbstractTamoxifen is widely used in the treatment of breast cancer and associated with an increased risk of thromboembolism (TE). An elevated homocysteine is one of the risk factors for TE. The aim of the study was to assess the effect of tamoxifen on serum homocysteine levels in breast cancer patients. We performed a case-control study in 20 female subjects to evaluate the relationship between homocysteine levels, and 5,10-methylenetetrahyrofolate reductase (MTHFR) C677T and dihydrofolate reductase (DHFR) 19-bp intron-1 deletion polymorphisms in breast cancer patients and in control subjects. It was observed that homocysteine levels were decreased during tamoxifen therapy, but this finding was not statistically significant. There was also no statistically significant difference in homocysteine levels between the two groups (p> 0.05). MTHFR C677T and DHFR 19-bp deletion polymorphisms were not associated with serum homocysteine value in either group.

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Inherited and Acquired Risk Factors for Venous Thromboembolic Disease Among Women Taking Tamoxifen to Prevent Breast Cancer

Abstract: Tamoxifen and prior surgery, fracture, or immobilization were associated with a significantly increased risk of developing a VTE. Factor V Leiden and prothrombin mutations were not associated with thrombosis in this population.

Cited by 83 publications

References 44 publications

Effect of Tamoxifen on Venous Thromboembolic Events in a Breast Cancer Prevention Trial

Effect of Tamoxifen on Venous Thromboembolic Events in a Breast Cancer Prevention Trial

Fertility Preservation in Young Women Undergoing Breast Cancer Therapy

The effects of tamoxifen on homocysteine levels in breast cancer patients

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