Thromboembolic events in patients with urothelial carcinoma undergoing neoadjuvant chemotherapy and radical cystectomy

Zareba, Piotr; Patterson, Laurel M.; Pandya, Rishikesh; Margel, David; Hotte, Sébastien J.; Mukherjee, Som D.; Elavathil, Leela; Daya, Dean; Shayegan, Bobby; Pinthus, Jehonathan H.

doi:10.1016/j.urolonc.2014.03.025

Cited by 27 publications

(32 citation statements)

References 26 publications

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“…Within the present study, we included abstracted data on pathological stage, including nodal status and presence of lymphovascular invasion into the analysis, in addition to other patient‐ and provider‐related factors. Perhaps contrary to expectations, pathological stage was not associated with VTE events after RC, which is consistent with a recent institutional series .…”

Section: Discussionsupporting

confidence: 83%

“…Previous studies have identified surrogates of operative time as independent risk factors for VTE . We had hypothesised that a more extensive PLND may be associated with higher rates of VTE based on increased operative time, as well as increased manipulation of pelvic vasculature or lymphocele rate.…”

Section: Discussionmentioning

confidence: 99%

“…Amongst major cancer surgeries, the incidence of VTE in radical cystectomy (RC) is exceedingly high with reported rates of 3–24% . Furthermore, there is now increased understanding that the risk of VTE in RC extends beyond discharge from hospital . However, reported risk factors from these observational studies are inconsistent and their data often lacks robust perioperative chemotherapy information and infrequently report on follow‐up beyond 30 days.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors and timing of venous thromboembolism after radical cystectomy in routine clinical practice: a population‐based study

2016

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors and timing of venous thromboembolism after radical cystectomy in routine clinical practice: a population‐based study

2016

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“…In their study the VTE incidence rate was 11%; half of these events occurred before surgery which is very comparable to our study which reported a 4% VTE rate before cystectomy [9]. A retrospective chart review study of 202 patients treated with cystectomy at two centres in Canada reported an overall arterial/venous thrombosis rate of 8%; higher rates were observed with NACT(19%) [12]. …”

Section: Discussionsupporting

confidence: 82%

Venous Thromboembolism and Peri-Operative Chemotherapy for Muscle-Invasive Bladder Cancer: A Population-based Study

Brennan

Karim

d’Oiron

et al. 2018

BLC

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Background:Chemotherapy and major pelvic surgery are established risk factors for venous thromboembolism (VTE). We evaluate the incidence rate, timing, and factors associated with VTE in patients with bladder cancer who underwent radical cystectomy and peri-operative chemotherapy in routine clinical practice.Methods:Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients who underwent cystectomy for bladder cancer in Ontario 1994–2013. VTE events within 6 months of before or after cystectomy were identified using diagnostic codes recorded on hospital admissions and emergency department visits. Multivariable logistic regression was used to analyze factors associated with VTE prior to surgery, within 90-days of cystectomy, and 120-days after the start of adjuvant chemotherapy.Results:4205 patients had cystectomy and 26% (1084/4205) received peri-operative chemotherapy. The overall incidence rate of VTE within 6 months of cystectomy was 9% (363/4205). VTE rate was highest among those patients treated with neoadjuvant chemotherapy (NACT) compared to patients treated with no chemotherapy or only adjuvant chemotherapy (ACT) (12% vs 8% vs 9%, p = 0.002). Among all VTE events, 10%, 28%, and 61% occurred before, during, and after hospitalization for cystectomy. Pre-operative VTE rate was highest among cases treated with NACT (4%) compared to patients with no chemotherapy (<1%) or ACT (<1%) (p < 0.001). VTE within 90 days of surgery was associated with greater length of hospital admission (p < 0.001) across all treatment groups.Conclusions:A substantial proportion of patients treated with peri-operative chemotherapy will develop VTE. The majority of these occur after discharge from hospital following cystectomy. Extended thromboprophylaxis treatment in high-risk patients including those who receive peri-operative chemotherapy should be considered.

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“…2,6,10,19 A smaller study suggested that neoadjuvant chemotherapy may be associated with an increased short-term risk of thromboembolic events from 8.4% to 19.1%. 20 Thus, patients with bladder cancer need to be closely monitored for thromboembolism and additional studies evaluating the role of thromboprophylaxis are needed.…”

Section: Discussionmentioning

confidence: 99%

Risk of Vascular Toxicity with Platinum Based Chemotherapy in Elderly Patients with Bladder Cancer

et al. 2016

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Thromboembolic events in patients with urothelial carcinoma undergoing neoadjuvant chemotherapy and radical cystectomy

Cited by 27 publications

References 26 publications

Risk factors and timing of venous thromboembolism after radical cystectomy in routine clinical practice: a population‐based study

Risk factors and timing of venous thromboembolism after radical cystectomy in routine clinical practice: a population‐based study

Venous Thromboembolism and Peri-Operative Chemotherapy for Muscle-Invasive Bladder Cancer: A Population-based Study

Risk of Vascular Toxicity with Platinum Based Chemotherapy in Elderly Patients with Bladder Cancer

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