Role of anticoagulation in the management of tumor thrombus: A 10‐year single‐center experience

Agarwal, Shreya; Mullikin, Dolores; Scheurer, Michael E.; Smith, Valeria; Naik‐Mathuria, Bindi; Guillerman, R. Paul; Foster, Jennifer; Díaz, Rosa; Sartain, Sarah E.

doi:10.1002/pbc.29173

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…However, perioperative anticoagulation for WT with vascular extension is not standard. 21 In our series, only 18% of patients received preoperative anticoagulation, of whom 14% 3 had serious bleeding complications. Postresection, routine prophylactic anticoagulation was uncommon, but did not appear to protect from recurrent bland thrombus.…”

Section: Discussionmentioning

confidence: 64%

“…In addition, thrombectomy, especially that which requires intimal scraping or that results in IVC stenosis and poor resumption of flow given extensive collateralization, may lead to an increased risk of bland thrombus formation and embolization. However, perioperative anticoagulation for WT with vascular extension is not standard 21 . In our series, only 18% of patients received preoperative anticoagulation, of whom 14% 3 had serious bleeding complications.…”

Section: Discussionmentioning

confidence: 72%

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Management and Outcomes of Wilms Tumor with Suprarenal Intravascular Extension

Naik-Mathuria,

Utria,

Ehrlich

et al. 2023

Annals of Surgery

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The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms tumor complicated by inferior vena caval thrombus. Background: The largest series of these patients was published almost 2 decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients, and outcomes have not been reported. Methods: Retrospective review of 19 North American centers between 2009 and 2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed. Results: Of 124 patients, 81% had favorable histology (FH), and 52% were stage IV. IVC thrombus level was infrahepatic in 53 (43%), intrahepatic in 32 (26%), suprahepatic in 14 (11%), and cardiac in 24 (19%). Neoadjuvant chemotherapy using a 3-drug regimen was administered in 82% and postresection radiation in 90%. Thrombus level regression was 45% overall, with suprahepatic level showing the best response (62%). Cardiopulmonary bypass (CPB) was potentially avoided in 67%. The perioperative complication rate was significantly lower after neoadjuvant chemotherapy [(25%) vs upfront surgery (55%); P = 0.005]. CPB was not associated with higher complications [CPB (50%) vs no CPB (27%); P = 0.08]. Two-year event-free survival was 93% and overall survival was 96%, higher in FH cases (FH 98% vs unfavorable histology/anaplastic 82%; P = 0.73). Neither incomplete resection nor viable thrombus cells affected event-free survival or overall survival. Conclusions: Multimodal therapy resulted in excellent outcomes, even with advanced-stage disease and cardiac extension. Neoadjuvant chemotherapy decreased the need for CPB to facilitate resection. Complete thrombectomy may not always be necessary.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 72%

Management and Outcomes of Wilms Tumor with Suprarenal Intravascular Extension

Naik-Mathuria,

Utria,

Ehrlich

et al. 2023

Annals of Surgery

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“…In a study conducted by Agarwal et al, 50 patients with tumor thrombus were examined, 10 of whom were treated with only anticoagulation therapy. Interestingly, only 20% showed symptomatic improvement, while 40% experienced major bleeding, raising questions about the efficacy of relying solely on anticoagulation to manage the complications associated with tumor thrombus [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Mechanical Venous Thrombectomy for Deep Venous Thrombosis in Cancer Patients: A Single-Center Retrospective Study

Patel,

Pal,

Ahmed

et al. 2024

Cardiovasc Intervent Radiol

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Purpose Venous thromboembolism (VTE) is a major contributor to the mortality of cancer patients. Mechanical thrombectomy (MT) is an endovascular technique that physically removes a thrombus without thrombolytics. The purpose of this study was to evaluate safety, efficacy, and clinical outcomes following MT for lower extremity DVT in cancer patients. Methods This single-center, retrospective study evaluated outcomes following MT of lower extremity DVT in cancer patients from November 2019 to May 2023. The primary outcome measure was clinical success, defined as a decrease in Villalta score by at least 2 points following the intervention. Secondary outcomes included repeat intervention-free survival and overall survival. Technical success was defined as restoring venous flow with mild (< 10%) or no residual filling defect. Results In total, 90 patients and 113 procedures were included. Technical and clinical success was achieved in 81% and 87% of procedures performed. Repeat intervention-free survival at 1 month, 3 months, and 6 months post-procedure was 92%, 82%, and 77%, respectively. The complication rate was 2.7%. Pathologic analysis of the extracted thrombus revealed tumor thrombus in 18.4% (18/98) samples. Overall survival for the study cohort was 87% at 1 month, 74% at 3 months, and 62% at 6 months. Patients who were found to have tumor thrombi were noted to have a decreased overall survival compared to patients with non-tumor thrombi (P = 0.012). Conclusion MT is safe and efficacious in reducing cancer patients’ VTE-related symptoms. The high rate of tumor thrombus in thrombectomy specimens suggests this phenomenon is more common than suspected. Graphical Abstract

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“…With immense elation, we read the article "Role of anticoagulation in the management of tumor thrombus: A 10-year single-center experience" by Agarwal et al 1 It was advantageous to read this manuscript, and the author's observations are to be admired. We agree with the utmost conclusion that significant bleeding risks exist after the onset of anticoagulants in the pediatric population for subclinical clots caused by tumors.…”

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confidence: 99%