Risk of recurrent cancer-associated thrombosis after discontinuation of anticoagulant therapy

Barca-Hernando, María; Lopez-Ruz, Sergio; Marín-Romero, Samira; García-García, Víctor; Eliias-Hernandez, Teresa; Candelera, Remedios Otero; Carrier, Marc; Jara-Palomares, Luis

doi:10.1016/j.rpth.2023.100115

Cited by 7 publications

(3 citation statements)

References 24 publications

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“…11 On the other hand, a retrospective study that evaluated the risk factors of recurrent VTE after discontinuation of anticoagulation in 311 patients with CAT, found that the presence of metastasis was associated with a higher risk of recurrent VTE (sub-distribution hazard ratio: 3.8, 95% CI 1.54-Bleeding, Thrombosis and Vascular Biology 2024; 3(s1):114 o n l y 9.52; P=0.0039). 26 Likewise, a systematic review of 10 studies (6 observational and 4 retrospectives) that included 4,791 patients with CAT found a significantly higher risk of VTE recurrence in patients with metastasis (RR 1.4, 95% CI 1.1-1.7; P=0.01). 8 This work has several limitations.…”

Section: Discussion and Future Researchmentioning

confidence: 99%

Location of metastasis and complications in patients with venous thromboembolism and cancer: systematic review

Barca-Hernando,

Garcia-Garcia,

Jara-Palomares

2024

Bleed Thromb Vascul Biol

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According to current guidelines, patients with venous thromboembolism (VTE) and active cancer should receive prolonged anticoagulant treatment (>6 months). In patients with cancer-associated thrombosis (CAT), metastasis is a factor in recurrent VTE and bleeding; however, the function of metastasis location remains unclear. In order to assess the risk of complications (such as bleeding or recurrent VTE) based on the location of metastases in patients with CAT, we conducted a systematic review. The PubMed database search was used to perform a systematic review. MESH terms pertaining to metastasis, VTE, and neoplasms were employed. Patients with CAT who were at least eighteen years old and receiving therapeutic doses of anticoagulants were included, as were details regarding the locations of metastases and the availability of patients who had complications (bleeding or recurrent VTE). Among the 1,447 articles found by the search, 7 retrospective studies met all eligibility requirements and were added to the analysis. The majority of these studies addressed brain metastases. Studies found that intracranial hemorrhage occurred between 4% and 19% of the time. In the context of brain metastases and VTE, other studies examined the safety and effectiveness of direct oral anticoagulants in comparison to low-molecular-weight heparin. This systematic review draws attention to the paucity of data regarding the impact of metastasis location on complications in CAT patients. Further research is required to assess the effect of metastasis location on the risk of VTE complications in patients with CAT.

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Section: Discussion and Future Researchmentioning

confidence: 99%

Location of metastasis and complications in patients with venous thromboembolism and cancer: systematic review

Barca-Hernando,

Garcia-Garcia,

Jara-Palomares

2024

Bleed Thromb Vascul Biol

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“…However, the evidence was moderate or low [98]. When discontinuing the anticoagulant therapy, patients with a metastatic disease are at greater risk of VTE recurrence at 6 and 12 months; however, with regard to incidental VTE, the risk is lower in this time period [99]. RIETE registry's data analysis displayed a more consistent risk of subsequent VTE events in cancer patients with superficial vein thrombosis (SVT) than in cancer patients with DVT during the first 3 months of anticoagulant therapy [100].…”

Section: Could Doacs Be Used As a Substitute For Classic Anticoagulan...mentioning

confidence: 94%

Direct-Acting Oral Anticoagulant Therapy in Cancer Patients—A Review

Górnicki

Bułdyś

Zielińska³

et al. 2023

Cancers

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Venous thromboembolism (VTE) is an important aspect in cancer patients. There are various pharmacological methods used for thrombotic event treatment. DOACs (direct-acting oral anticoagulants) are gaining popularity among both physicians and researchers and are slowly starting to replace VKAs (vitamin K antagonists), thus becoming a substitute or alternative option for LMWHs (low-molecular-weight heparins). In this article, we present DOACs’ main therapeutic advantages and disadvantages in patients with cancer. The only major concern with using DOACs is the higher risk of bleeding; however, there are discrepancies in this matter. There are still some types of cancer for which DOACs are not recommended. Specific cancer types may influence the efficacy of DOAC therapy. Additionally, race and ethnicity may affect therapy in cancer patients with DOACs. A sizeable number of clinical trials are focused on comparing DOACs with other anticoagulants. The current guidelines of different scientific associations are not unanimous in their DOAC assessments. There is still a need for more evidence of DOACs’ potential advantages over other methods of anticoagulation in cancer patients to facilitate their position in this recommendation. This literature review presents the current state of knowledge about the use of DOACs in patients with neoplastic growth.

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“…The thromboembolic risk is markedly increased in patients with concurrent AF and CKD, compared to those with either condition alone [22]. Cancer patients, particularly those with metastatic disease or primary GI and genitourinary malignancies, are at an increased risk of VTE recurrence as well as bleeding, making the management of anticoagulant therapy especially challenging [23][24][25]. These complexities underline the need for safer anticoagulants, preferably with minimal renal clearance and enhanced efficacy, with FXI inhibitors emerging as potential solutions.…”

Section: Elderly Patients and Patients With Comorbidities Requiring A...mentioning

confidence: 99%

Novel horizons in anticoagulation: the emerging role of factor XI inhibitors across different settings

Cohen,

Santagata,

Ageno

2024

haematol

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Anticoagulants have long been fundamental in preventing and treating thromboembolic disorders, with a recent shift of focus towards direct oral anticoagulants, thanks to their ease of use, efficacy, and safety. Despite these advancements, bleeding complications remain a major concern with any anticoagulant, highlighting the need for safer drugs. Factor XI (FXI) inhibitors have emerged as promising agents in this regard, offering a novel approach by targeting upstream factors in the coagulation system. Phase 2 trials have shown encouraging outcomes, indicating a reduced bleeding risk compared to traditional anticoagulants, particularly in the context of cardiovascular disease management when combined with antiplatelet therapy. However, the variability in findings and limited efficacy data call for a cautious interpretation pending phase 3 trial insights. These trials are essential for validating the potential of FXI inhibitors to balance bleeding risk reduction and maintain anticoagulant efficacy. This review explores the pharmacology, potential indications, clinical data, and future directions of FXI inhibitors, providing a perspective on their evolving role in anticoagulant therapy. It also provides a detailed analysis of data from published clinical trials on FXI inhibitors in various indications. Preliminary data from ongoing trials is also outlined. As the field moves forward, a cautiously optimistic outlook can be expected, focusing on comprehensive data from phase 3 trials to define the role of FXI inhibitors in various clinical scenarios.

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Risk of recurrent cancer-associated thrombosis after discontinuation of anticoagulant therapy

Cited by 7 publications

References 24 publications

Location of metastasis and complications in patients with venous thromboembolism and cancer: systematic review

Location of metastasis and complications in patients with venous thromboembolism and cancer: systematic review

Direct-Acting Oral Anticoagulant Therapy in Cancer Patients—A Review

Novel horizons in anticoagulation: the emerging role of factor XI inhibitors across different settings

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