Splanchnic vein thrombosis predicts worse survival in patients with advanced pancreatic cancer

Afzal, Amber; Luo, Suhong; Gage, Brian F.; Schoen, Martin W.; Carson, Kenneth R.; Thomas, Tanya; Sanfilippo, Kristen M.

doi:10.1016/j.thromres.2019.11.023

Cited by 20 publications

(28 citation statements)

References 35 publications

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“…Screening for PVT is required as part of the current Barcelona Clinic Liver Cancer staging system as the prognosis for patients with HCC and PVT is much worse [8]. Meanwhile, the higher increase in trend of hospitalization in pancreatic adenocarcinomas for SVT-related malignancies is compatible with recent data, as published by Hicks et al [16] and Afzal et al [17], suggesting that SVT is not only a finding of more advanced stages of the disease but is in itself a predictor of mortality leading to more frequent admissions. The high incidence of such occurrence is explained by the pro-thrombotic and pro-angiogenic state associated with both malignancies that are necessary for tumor growth and metastasis.…”

Section: Discussionmentioning

confidence: 61%

Trends and In-Hospital Outcomes of Splanchnic Vein Thrombosis Associated with Gastrointestinal Malignancies: A Nationwide Analysis

Handa

Gupta

Sterpi

et al. 2021

Gastrointest Tumors

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Introduction: Gastrointestinal cancers have a strong association with splanchnic vein thrombosis (SVT), yet the hospitalization data is unknown. Objective and Methods: We analyzed around 78 million discharges from the 2007–2017 Nationwide Inpatient Sample with an inclusion criterion of adult patients admitted for portal or hepatic vein thrombosis as a primary diagnosis with a gastrointestinal or hepatobiliary malignancy as a secondary diagnosis. The outcomes were in-hospital mortality, complication rates, and resource utilization. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. Results: Out of the total 32,324 hospitalizations for SVT, 3,220 (10%) were associated with a GI malignancy, of which hepatocellular carcinoma (HCC) and pancreatic cancer were the most common. Portal vein thrombosis accounted for 95% of these hospitalizations. Admissions for pancreatic cancer-associated SVT have increased by 7.2 times from 2007 to 2017. Patients with SVT and concomitant GI malignancies were significantly older and had a higher comorbidity score than those with SVT without GI malignancy. Risk of inpatient mortality for SVT patients were significantly higher for patients with gastric cancer (rate: 12.1%, OR 8.6, 95% CI: 1.8–39.7) and HCC (rate: 7.6%, OR 2.77, 95% CI 1.5–4.8) as compared to non-GI malignancy-related SVT. Odds of variceal bleeding were significantly higher for patients with HCC (OR 1.67, 95% CI: 1.2–2.34) than patients without GI malignancy. Conclusions: Digestive cancer-associated SVTs constitute 10% of all SVT related hospitalizations and are significantly increasing in the past decade. We report the baseline characteristics and predictors of inpatient mortality in this study.

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Section: Discussionmentioning

confidence: 61%

Trends and In-Hospital Outcomes of Splanchnic Vein Thrombosis Associated with Gastrointestinal Malignancies: A Nationwide Analysis

Handa

Gupta

Sterpi

et al. 2021

Gastrointest Tumors

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“…In this series, 19% of patients receiving anticoagulation experienced a major bleed compared with 8% of patients who did not receive anticoagulation. 95 The ability to fully assess the risk versus benefit ratio of anticoagulation for SVT in this cohort was difficult as recurrent thrombosis was not one of the measured outcomes. 95 In contrast, a prospective multicenter cohort study that enrolled patients (35% with malignancies) with incidentally discovered SVT found that anticoagulant treatment reduced the incidence of thrombotic events (HR: 0.85; 95% CI: 0.76-0.96) without increasing the risk of major bleeding.…”

Section: Splanchnic Vein Thrombosismentioning

confidence: 99%

“…95 The ability to fully assess the risk versus benefit ratio of anticoagulation for SVT in this cohort was difficult as recurrent thrombosis was not one of the measured outcomes. 95 In contrast, a prospective multicenter cohort study that enrolled patients (35% with malignancies) with incidentally discovered SVT found that anticoagulant treatment reduced the incidence of thrombotic events (HR: 0.85; 95% CI: 0.76-0.96) without increasing the risk of major bleeding. 98 Given the paucity of data regarding the benefit of anticoagulation in SVT, ASCO and NCCN guidelines currently recommend offering anticoagulation on a case-by-case basis after carefully considering the risks and benefits for acute SVT with the goals of preventing the development and sequelae of portal hypertension and reducing the risk of recurrent VTE.…”

Section: Splanchnic Vein Thrombosismentioning

confidence: 99%

“…55,94 Furthermore, multiple retrospective studies have established that the presence of SVT in patients with pancreatic and HCC is associated with worse OS in multivariate analysis. 55,92,93,95,96 Decisions regarding management of SVT in patients with GI malignancy are based on the acuity of SVT. 54 Factors suggesting acute thrombosis include symptoms less than 8 weeks, lack of cavernous transformation of the portal vein, lack of collateral vein development, and lack of evidence of portal hypertension.…”

Section: Splanchnic Vein Thrombosismentioning

confidence: 99%

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Epidemiology, Prevention, Diagnosis, and Management of Venous Thromboembolism in Gastrointestinal Cancers

Chapin

Sudheendra

Goity

et al. 2020

Digestive Disease Interventions

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Venous thromboembolism (VTE) is a leading cause of cardiovascular death and is associated with significant morbidity. Patients with cancer, and gastrointestinal (GI) malignancies in particular, are at increased risk of VTE, increased risk of bleeding with VTE treatment, and increased risk of recurrent VTE compared with the general population. VTE has been shown to be a leading cause of death among patients with cancer. This review will discuss special considerations in the prevention, diagnosis, and management of VTE in patients with GI malignancies. Given the increased risk of VTE observed in ambulatory patients with GI malignancies, multiple trials have examined and demonstrated the efficacy of prophylactic anticoagulation in high-risk patients with cancer undergoing chemotherapy, particularly in patients with gastric and pancreatic cancers. Patients with GI malignancies have also played a central role in discussions of the risks and benefits of the use of direct oral anticoagulants in patients with cancers, with first-line anticoagulation options expanding to include low-molecular-weight heparin, rivaroxaban, edoxaban, and apixaban. However, there continue to be concerns regarding an increased risk of bleeding with edoxaban and rivaroxaban in patients with GI malignancies. In addition to anticoagulation, individualized risk and benefit analysis should be undertaken for interventions including inferior vena cava (IVC) filter placement and catheter-directed thrombolysis in the setting of increased risk of bleeding and recurrent VTE for patients with GI malignancies. Several unique scenarios that may be seen with GI malignancies, including incidental VTE, splanchnic vein thrombosis, IVC thrombosis, and iliac vein compression, require individualized decision making.

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“…[31] Of note, anticoagulant therapy improved survival in those patients with VTE (HR 0.30, 95% CI 0.12-0.74, p = 0.009) [31]. Two retrospective studies focusing on the association of VVT with survival also found an association between the onset of VVT and increased mortality [44,48]. Few studies have investigated the association between early VTE (defined by a VTE at diagnosis or within 30 days after the beginning of palliative chemotherapy) and survival.…”

Section: Association Of Vte With Progression Free Survival and Overalmentioning

confidence: 99%

Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented

Farge

Bournet

Conroy

et al. 2020

Cancers

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Exocrine pancreatic ductal adenocarcinoma, simply referred to as pancreatic cancer (PC) has the worst prognosis of any malignancy. Despite recent advances in the use of adjuvant chemotherapy in PC, the prognosis remains poor, with fewer than 8% of patients being alive at 5 years after diagnosis. The prevalence of PC has steadily increased over the past decades, and it is projected to become the second-leading cause of cancer-related death by 2030. In this context, optimizing and integrating supportive care is important to improve quality of life and survival. Venous thromboembolism (VTE) is a common but preventable complication in PC patients. VTE occurs in one out of five PC patients and is associated with significantly reduced progression-free survival and overall survival. The appropriate use of primary thromboprophylaxis can drastically and safely reduce the rates of VTE in PC patients as shown from subgroup analysis of non-PC targeted placebo-controlled randomized trials of cancer patients and from two dedicated controlled randomized trials in locally advanced PC patients receiving chemotherapy. Therefore, primary thromboprophylaxis with a Grade 1B evidence level is recommended in locally advanced PC patients receiving chemotherapy by the International Initiative on Cancer and Thrombosis clinical practice guidelines since 2013. However, its use and potential significant clinical benefit continues to be underrecognized worldwide. This narrative review aims to summarize the main recent advances in the field including on the use of individualized risk assessment models to stratify the risk of VTE in each patient with individual available treatment options.

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Splanchnic vein thrombosis predicts worse survival in patients with advanced pancreatic cancer

Cited by 20 publications

References 35 publications

Trends and In-Hospital Outcomes of Splanchnic Vein Thrombosis Associated with Gastrointestinal Malignancies: A Nationwide Analysis

Trends and In-Hospital Outcomes of Splanchnic Vein Thrombosis Associated with Gastrointestinal Malignancies: A Nationwide Analysis

Epidemiology, Prevention, Diagnosis, and Management of Venous Thromboembolism in Gastrointestinal Cancers

Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented

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