Parenteral anticoagulation in patients with cancer who have no therapeutic or prophylactic indication for anticoagulation

Akl, Elie A.; Gunukula, Sameer; Barba, Maddalena; Yosuico, Victor E D; Doormaal, Frederiek F. van; Kuipers, Saskia; Middeldorp, Saskia; Dickinson, Heather O; Bryant, Andrew; Schünemann, Holger J.

doi:10.1002/14651858.cd006652.pub3

Cited by 62 publications

(40 citation statements)

References 151 publications

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“…According to the recommendations for VTE prophylaxis and treatment in patients with cancer issued by ASCO in the year of 2007, it has been around 10 years since the study of malignant cancer, blood coagulation dysfunction and anticoagulation therapy in both animals and patients. From reviews published by Cochrane collaboration center (24)(25)(26), several conclusions could be reached. Firstly, it is clear that anticoagulation therapy for cancer could reduce the incidence of VTE, while whether it could have longterm effect of survival is unclear.…”

Section: Discussionmentioning

confidence: 99%

Effect of Huisheng oral solution on coagulation function in perioperative period in patients with primary lung cancer

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Effect of Huisheng oral solution on coagulation function in perioperative period in patients with primary lung cancer

et al. 2017

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“…Although warfarin reduced the incidence of VTE at the expense of higher rates of minor and major bleeding, there was no effect on survival (Akl et al , ). The second Cochrane review published in 2011 examined studies comparing periods of unfractionated heparin (one study) or LMWH (eight studies) at different doses and for different periods of time versus placebo or no treatment (Akl et al , ). A survival benefit was observed at 24 months but not at 12 months, accompanied by a significant reduction in VTE without an increase in bleeding (Akl et al , ).…”

Section: Thromboprophylaxis and Cancermentioning

confidence: 99%

“…The second Cochrane review published in 2011 examined studies comparing periods of unfractionated heparin (one study) or LMWH (eight studies) at different doses and for different periods of time versus placebo or no treatment (Akl et al , ). A survival benefit was observed at 24 months but not at 12 months, accompanied by a significant reduction in VTE without an increase in bleeding (Akl et al , ). More recently, no difference in survival was found in an RCT of patients with advanced malignancy that compared LMWH with placebo (van Doormaal et al , ).…”

Section: Thromboprophylaxis and Cancermentioning

confidence: 99%

Guideline on aspects of cancer‐related venous thrombosis

et al. 2015

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SummaryThe guideline was drafted by a writing group identified by the Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology (BCSH). All the authors are consultants in haematology in the UK. A search was performed of PubMed and Embase using the term 'cancer' combined with 'thrombosis', 'treatment', 'prophylaxis' and 'clinical presentation'. The search covered articles published up until December 2014. Only human studies were included and articles not written in English were excluded. References in recent reviews were also examined. The writing group produced the draft guideline, which was subsequently revised by consensus by members of the Haemostasis and Thrombosis Task Force of the BCSH and the BCSH executive. The guideline was then reviewed by the sounding board of the British Society for Haematology (BSH). This comprises 50 or more members of the BSH who have reviewed the guidance and commented on the content and application to the UK setting. The 'GRADE' system was used to quote levels and grades of evidence, details of which can be found at: http://www.bcshguidelines.com/ BCSH_PROCESS/EVIDENCE_LEVELS_AND_GRADES_OF_ RECOMMENDATION/43_GRADE.html. The objective of this guideline is to provide healthcare professionals with clear guidance on the prevention and management of venous thromboembolism (VTE) in patients with cancer and to advise on an approach to screening for cancer in patients with unprovoked VTE in whom cancer was not initially suspected based on clinical grounds.

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“…110,116 Clinically, hypercoagulability has been linked to the increased incidence of certain cancers, 120,121 or their poor prognosis and diminished therapeutic response 122,123 whereas anticoagulation with lowmolecular-weight heparin (LMWH) produced a survival advantage in some cancer patients. 12,[124][125][126][127][128][129] However, extension and translation of these findings has been relatively slow, in spite of the emerging potential of new anticoagulants. 130 Although some concerns in this regard may be related to the hemostatic safety of some of these agents, 12 there are also questions surrounding the robustness of anticancer effects as well as their magnitude and variability.…”

Section: Role Of Coagulation System In Local and Systemic Aggressivenmentioning

confidence: 99%

Genetic Basis of Thrombosis in Cancer

D’Asti

Magnus

Meehan

et al. 2014

Semin Thromb Hemost

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Genetically altered cancer cells both provoke and respond to changes in their microenvironment, stroma, and vasculature. This includes local and systemic activation of the coagulation system, which is a part of the functional continuum involving inflammation, angiogenesis, and tissue repair programs, often reactivated in cancer. These responses coevolve with, and contribute to, the malignant process. Cancer coagulopathy is not only a source of comorbidity and mortality in cancer patients, but it also affects the disease biology including processes of tumor growth, initiation, dormancy, invasion, angiogenesis, metastasis, and therapeutic responsiveness. Notably, genetic and cellular differences between different cancer types are paralleled by a degree of diversity in the related coagulation system perturbations. Although some of these differences may be unspecific, iatrogenic, or indirect in nature, others are affected by oncogenic pathways (RAS, EGFR, HER2, MET, PTEN, and TP53) activated in cancer cells due to driver mutations of critical genes. Such mutations cooperate with hypoxia, cellular differentiation, and other influences to alter the expression of tissue factor, protease-activated receptors (e.g., PAR-1 and PAR-2), coagulation factors (FII and FVII), and other molecules related to the hemostatic system. Oncogenic pathways also control secretion of some of these entities from cancer cells, either as soluble proteins, or as cargo of extracellular vesicles/microparticles. Moreover, emerging evidence suggests that the expression profiles of coagulation-related genes differ between molecularly and genetically distinct subgroups of specific malignancies such as glioblastoma multiforme and medulloblastoma. Certain hereditary thrombophilias may also affect cancer pathogenesis. We suggest that mechanisms of cancer coagulopathy may be more diverse and genetically modulated than hitherto realized. If so, a possibility may exist to deliver more personalized, biologically based, anticoagulation, and thereby improve patient survival.

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Parenteral anticoagulation in patients with cancer who have no therapeutic or prophylactic indication for anticoagulation

Cited by 62 publications

References 151 publications

Effect of Huisheng oral solution on coagulation function in perioperative period in patients with primary lung cancer

Effect of Huisheng oral solution on coagulation function in perioperative period in patients with primary lung cancer

Guideline on aspects of cancer‐related venous thrombosis

Genetic Basis of Thrombosis in Cancer

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