Thromboembolic Events During Chemotherapy for Germ Cell Cancer: A Cohort Study and Review of the Literature

Weijl, N.I.; Rutten, Marc F. J.; Zwinderman, Aeilko H.; Keizer, H. J.; Nooy, M. A.; Rosendaal, Frits R.; Cleton, F. J.; Osanto, Susanne

doi:10.1200/jco.2000.18.10.2169

Cited by 208 publications

(146 citation statements)

References 50 publications

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“…We found no association between the risk for thrombosis and known risk factors for venous thrombosis, nor with elevated levels of factor VIII, IX or XI. This is consistent with our previous data [17] and data from Ramacciotti and colleagues [18], who also did not find an association between gene polymorphisms tested, i.e., Factor V Leiden, factor II G20210A, factor XIII val 34leu and Methylene tetrahydrofolate reductase (MTHFR) C677T, and the risk of venous thrombosis in cancer patients. In agreement with these findings, Riordan and colleagues [19] found a low prevalence of factor V Leiden gene mutation in 28 cancer patients with catheter-related venous thrombosis.…”

Section: Discussionsupporting

confidence: 82%

Risk factors for catheter-related thrombosis in cancer patients

Tesselaar¹,

Ouwerkerk²,

Nooy³

et al. 2004

European Journal of Cancer

108

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We investigated the risk factors for venous thrombosis in cancer patients with implantable ports undergoing chemotherapy. One hundred and seventy one ports were placed in a central (''chest ports'') and 84 in a peripheral vein (''arm ports''), 181 received prophylactic nadroparin and 10 coumarin. Clinically overt thrombosis was confirmed by ultrasound or angiography. Catheter-related thrombosis incidence without anticoagulants was 28% in arm and 33% in chest ports, but with anticoagulants this was 32% in arm and only 1% in chest ports (odds ratio (OR) 34.8 95% confidence interval (CI) 7.3-165). Left-sided placement compared with rightsided and catheter tip position in the superior vena cava compared with right atrium were associated with a 3.5 respectively 2.6-fold increased risk. Thrombosis was associated with elevated homocysteine levels (OR = 3.8, 95% CI 1.3-11.3), but not with factor V Leiden or prothrombin 20210A gene mutations, or high concentration of factor VIII, IX or XI. Prophylaxis with anticoagulants is recommended for chest, but not for arm ports. Determination of plasma homocysteine levels may identify patients at an increased risk for thrombosis.

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Section: Discussionsupporting

confidence: 82%

Risk factors for catheter-related thrombosis in cancer patients

Tesselaar¹,

Ouwerkerk²,

Nooy³

et al. 2004

European Journal of Cancer

108

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“…chemotherapy regimens) may be associated with increased risk of both thrombotic and some peripheral arterial diseases. [13][14][15][16][17] The current algorithm can be used to identify PAD patients in any high-risk population (e.g. cancer patients undergoing chemotherapy) from claims data to enable the analysis of the impact of related medical interventions on PAD incidence or outcomes.…”

Section: Identification Of Pad Casesmentioning

confidence: 99%

National health care costs of peripheral arterial disease in the Medicare population

et al. 2008

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Lower extremity peripheral arterial disease (PAD) is prevalent in the Medicare population and is associated with high rates of myocardial infarction, stroke, amputation, and death. Nevertheless, national health expenditures for PAD are not known. We hypothesized that PAD-related costs are high, increase with age, and that treatment rates would be less than known PAD prevalence. The objective was to determine national health care expenditures for PAD in the United States. PADrelated treatment costs were calculated in the elderly, non-disabled Medicare population. The cost analysis relied on the 5% control population for the linked SEERMedicare data and Medicare claims for the calendar year 2001, identifying PAD cases based on diagnosis and procedure codes. Costs were aggregated separately for inpatient and outpatient treatment and estimates adjusted to reflect the Medicare population. A total of $4.37 billion was spent on PAD-related treatment and 88% of expenditures were for inpatient care. Medicare program outlays totaled $3.87 billion, while enrollees (or their supplemental insurance) spent the remaining $500 million. In total, 6.8% of the elderly Medicare population received treatment for PAD. Treatment increased with age at rates of 4.5%, 7.5%, and 11.8% for individuals aged 65-74, 75-84, and >85 years, respectively. PAD-related costs accounted for approximately 13% of all Medicare Part A and B expenditures for the PAD-treated cohort, and 2.3% of total Medicare Part A and B expenditures. In conclusion, US national PAD-related costs are high, associated with inpatient care, and increase with age. PAD is treated at rates lower than the known PAD prevalence as only approximately one-third of the population with known PAD had detectable PAD-related health care costs in our analysis. The potential impact of earlier PAD detection and use of outpatient preventive strategies on total national PAD health care costs is unknown.

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“…18 Therefore, the majority of patients do not require long-term corticosteroids or chemotherapy, treatments that have been associated with increased VTE rates. 3,19 In addition, fewer than 10% of meningiomas feature brain invasion, which in glioma patients is thought responsible for initiating and maintaining low-grade disseminated intravascular coagulation by releasing brainderived tissue factor into the systemic circulation. 5 Whereas prolonged operative times (due to the technical challenges of excising these often highly vascular tumors) have been cited as a possible reason for elevated VTE rates in patients with meningiomas, 8 the median operative time of 300 minutes in this study is identical to that reported in a series of glioma patients at the same institution, 22% of whom developed VTE.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism occurs infrequently in meningioma patients receiving combined modality prophylaxis

Gerber

Segal

Salhotra

et al. 2007

Cancer

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The long‐term disease‐free survival in patients with metastatic transitional cell carcinoma (TCC) is still considerably low. Novel chemotherapeutic agents are needed to decrease the morbidity and mortality of TCC. In this study, we have evaluated several epigenetic modifiers for their therapeutic application in bladder cancer. Both histone deacetylase inhibitors (FK228, TSA) and DNA hypomethylating agent (5‐Azacytidine) were tested using in vitro assays such as cell viability, cell cycle analysis and western blot to determine their mechanisms of action. Drug combination experiments were also designed to study any additive or synergistic effects of these agents. In addition, two bladder cancer xenograft models (one subcutaneous and one orthotopic) were employed to assess the therapeutic efficacy of these agents in vivo. Three agents exhibited various growth inhibitory effects on 5 different TCC cell lines in a dose‐ and time‐dependent manner. In addition to G2/M cell cycle arrest, FK228 is more potent in inducting apoptosis than the two other single agents, and combination of both FK228 and 5‐Aza further enhances this effect. p21 induction is closely associated with FK228 or TSA but not 5‐Aza, which is mediated via p53‐independent pathway. Consistent with in vitro results, FK228 exhibited a significant in vivo growth inhibition of TCC tumor in both subcutaneous and orthotopic xenograft models. FK228 is a potent chemotherapeutic agent for TCC in vivo with minimal undesirable side effects. The elevated p21 level mediated via p53 independent pathway is a hallmark of FK228 mechanism of action. © 2007 Wiley‐Liss, Inc.

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Thromboembolic Events During Chemotherapy for Germ Cell Cancer: A Cohort Study and Review of the Literature

Abstract: Germ cell cancer patients who receive chemotherapy, in particular those who have liver metastases or receive high doses of corticosteroids, are at considerable risk of developing thromboembolic complications.

Cited by 208 publications

References 50 publications

Risk factors for catheter-related thrombosis in cancer patients

Risk factors for catheter-related thrombosis in cancer patients

National health care costs of peripheral arterial disease in the Medicare population

Venous thromboembolism occurs infrequently in meningioma patients receiving combined modality prophylaxis

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