Venous Thromboembolism Risk in Patients With Locoregional Urothelial Tract Tumors

Ramos, Jorge; Wingate, Jonathan; Gulati, Roman; Plimack, Elizabeth R.; Harshman, Lauren C.; Powles, Thomas; Crabb, Simon J.; Niegisch, Günter; Bellmunt, Joaquim; Ladoire, Sylvain; Giorgi, Ugo De; Hussain, Syed A.; Alva, Ajjai; Baniel, Jack; Agarwal, Neeraj; Rosenberg, Jonathan E.; Vaishampayan, Ulka N.; Galsky, Matthew D.; Yu, Evan Y.

doi:10.1016/j.clgc.2017.08.001

Cited by 3 publications

(5 citation statements)

References 24 publications

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“…As previously demonstrated, history of VTE was strongly associated with development of a subsequent VTE [27]. Additionally, renal dysfunction was associated with a 47% greater odds of developing a VTE, consistent with our findings in analyses of patients with locoregional and metastatic urothelial tract tumours using the Retrospective International Study of Cancers of the Urothelial Tract (RISC) database [13,14]. Not surprisingly, the chemotherapy-alone group had a statistically significantly higher VTE rate than the preoperative group, as the chemotherapy group probably represents patients with metastatic disease and thus higher tumour burden, which has been previously shown to be associated with more thrombotic events [1,2].…”

Section: Discussionsupporting

confidence: 90%

“…In addition, platinum-based chemotherapy is a mainstay of treatment in bladder cancer in the peri-operative and first-line metastatic setting, further increasing a patient's thrombotic risk [11,12]. Our group and others have previously shown that VTEs are frequent both in locoregional and metastatic urothelial tract tumours and that experiencing a VTE has clinical impact with shorter survival in the metastatic setting [13,14]; however, in our previous analyses we were not able to show statistically significant differences in VTE rates between the three most frequently utilized chemotherapy regimens: gemcitabine/cisplatin (GC); methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) or similar regimens; and gemcitabine/carboplatin (CarboG). As there were numerical but not statistically significant differences between regimens, we hypothesize that our previous study may have lacked statistical power; therefore, we performed a retrospective cohort study using the larger Surveillance, Epidemiology and End Results (SEER) Medicare-linked database to assess whether particular chemotherapy combinations had an impact on VTE rates in patients with urothelial tract cancer.…”

Section: Introductionmentioning

confidence: 99%

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Chemotherapy regimen is associated with venous thromboembolism risk in patients with urothelial tract cancer

et al. 2019

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Objective To assess the association of venous thromboembolism (VTE) with different chemotherapy regimens in patients with urothelial tract cancer. Patients and Methods We identified patients aged ≥66 years, diagnosed with urothelial tract cancer in the period 1998 to 2011 in the Surveillance, Epidemiology, and End Results (SEER) Medicare‐linked database. The chemotherapy regimens analysed were gemcitabine/cisplatin (GC), methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), or gemcitabine/carboplatin (CarboG). Propensity scores for treatment regimen based on comorbidities, tumour characteristics, age, and year of diagnosis were calculated. VTE rates within 120 days of chemotherapy initiation were calculated. VTE risk stratified by chemotherapy regimen was modelled using multivariable logistic regression, adjusting for treatment propensity scores and additional demographic characteristics. Overall survival stratified by VTE and chemotherapy regimen was estimated using Kaplan–Meier methods and the log‐rank test. Results Of 5594 identified patients, a VTE occurred in 13.0%. The VTE rates within 120 days of chemotherapy initiation were 15.3% for GC, 8.7% for MVAC, and 12.0% for CarboG. On multivariable analysis, MVAC (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.39–0.94) and CarboG (OR 0.71, 95% CI: 0.59–0.85) were associated with lower VTE risk compared with GC. VTE was associated with worse overall survival (P < 0.001). Conclusions Compared with GC, MVAC and CarboG were associated with a lower rate of VTE. This finding suggests that gemcitabine may add to the increased thrombosis risk from cisplatin. Additionally, patients with a VTE had worse survival outcomes than those without a VTE. Analysis of the risk of blood clots with different chemotherapy regimens in patients with urothelial tract cancer showed that GC was associated with the highest rate. We also found that blood clots were associated with worse patient outcomes.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Chemotherapy regimen is associated with venous thromboembolism risk in patients with urothelial tract cancer

et al. 2019

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“…The results in the present and other series indicate that neoadjuvant or adjuvant chemotherapy might have a further prolonged effect on the occurrence of VTE [20][21][22][23][29][30][31], possibly due to cisplatin-induced apoptosis and vascular necrosis mediated by the cytotoxic effect of caspases and calpain or vascular damage from central venous catheters or other mechanisms of hypercoagulability [17,18]. Similar results have been found with carboplatin and gemcitabine [19].…”

Section: Results Of the Study In Relation To Previous Findingssupporting

confidence: 84%

“…We considered the time period for VTE after diagnosis up to 24 months after the start of first treatment, which is a longer period than in other series [19, 22-23, 29, 30]. In contrast to our findings of increased cumulative incidence during 24 months after treatment, others have found the incidence of VTE to decrease after six months [20,29,30], possibly due to differences in how VTE was reported. In our series the diagnosis of VTE came from all hospitalisations and most outpatient care services covering all hospital facilities in the country, while other studies may have reported only from to the institution providing the bladder cancer treatment.…”

Section: Results Of the Study In Relation To Previous Findingsmentioning

confidence: 84%

Thromboembolism in Muscle-Invasive Bladder Cancer. A Population-based Nationwide Study

et al. 2021

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BACKGROUND: Routine VTE prophylaxis within 30 days of radical cystectomy (RC) for urinary bladder cancer (UBC) is used to protect from venous thromboembolism (VTE). However, randomized studies and nationwide population-based studies are lacking. OBJECTIVE: To study VTE and risk factors for VTE in muscle-invasive UBC in a nationwide population-based series, with a focus on the association with RC with and without chemotherapy. MATERIALS AND METHODS: We studied all patients with clinical stage T2-T4 UBC diagnosed 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe). Previous VTE events and risk factors for VTE were registered from 1987. Cox regression analyses and Kaplan-Meier curves were performed to study risk factors for VTE and cumulative incidence of VTE. RESULTS: In 9720 patients (71%males) with a median age of 74 years 546 (5.6%) had VTE after diagnosis. In Cox analyses controlling for patient’s and tumour characteristics, and risk factors for VTE, VTE after diagnosis and first treatment date were associated with chemotherapy with or without RC. Cumulative incidence of VTE increased during 24 months after diagnosis and first treatment date. VTE were less common in patients with previous cardiovascular disease. CONCLUSIONS: VTE was commonly observed after 30 days from diagnosis and from first treatment date in patients with T2-T4 UBC, particularly after chemotherapy. The findings suggest that long-term intervention studies of benefit and possible harms of VTE prophylaxis after UBC should be undertaken.

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“…Most probably, it is caused by the delay of early diagnostics. Advanced cancers may bear a higher risk of thromboembolic complications, especially in the metastatic setting or after neoadjuvant therapy [ 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

Current thromboprophylaxis in urological cancer patients during COVID pandemic

Ostrowski

Skrudlik²,

Kowalski

et al. 2022

Cent european J Urol

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Introduction Venous thrombosis is a well-known complication of cancer disease, especially in Urology. However, even though proper antithrombotic prophylaxis is crucial in most urological procedures, we have insufficient high-quality studies on this topic. The European Association of Urology (EAU) Guidelines are outdated and lack data on COVID-19 increased risk of thrombosis. This review aimed to summarize data on thromboprophylaxis after radical prostatectomy, cystectomy, and nephrectomy during COVID-19 pandemic. Material and methods A thorough analysis of the EAU Guidelines of Thromboprophylaxis was performed and compared to PubMed search, considering updated literature on thromboprophylaxis of radical prostatectomy, cystectomy, nephrectomy, as well as COVID-19 influence on venous thrombosis and urological practice. Results Each patient should be evaluated individually to balance bleeding and venous thromboembolism (VTE) risk. There is still much uncertainty in low and medium-risk patients and all endoscopic procedures, where thromboprophylaxis could be omitted. Patients with COVID infection bear a significantly higher risk of VTE. All patients should be tested for COVID infection prior to a planned surgery during bursts of infections, undependably of vaccination status. Efforts to maintain early cancer diagnosis and treatment during the pandemic should be maintained. Conclusions The quality of evidence is inadequate, and when deciding on thromboprophylaxis, we need to base it on individual risk, cancer advancement, procedure type, and our own experience.

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Venous Thromboembolism Risk in Patients With Locoregional Urothelial Tract Tumors

Cited by 3 publications

References 24 publications

Chemotherapy regimen is associated with venous thromboembolism risk in patients with urothelial tract cancer

Chemotherapy regimen is associated with venous thromboembolism risk in patients with urothelial tract cancer

Thromboembolism in Muscle-Invasive Bladder Cancer. A Population-based Nationwide Study

Current thromboprophylaxis in urological cancer patients during COVID pandemic

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