Arterial Thromboembolism in Patients With Advanced Lung Cancer: Secondary Analyses of the Rising-VTE/NEJ037 Study.

Arterial and Venous Thromboembolism in Critically Ill, COVID-19 Positive Patients Admitted to Intensive Care Unit

Arterial Thrombosis and Cancer: Implications for Screening and Risk Modification

Incidence of arterial thromboembolism in patients with myeloproliferative neoplasms treated with anticoagulation for venous thromboembolism

Comparison of Anticoagulants in the Prevention of Arterial Thromboembolism in Patients with Cancer and Venous Thromboembolism: A Population-Based Cohort Study

Arterial Thromboembolism in Cancer Patients Treated with Apixaban

1552P Patterns of venous and arterial thromboembolism in patients with advanced pancreatic cancer treated with palliative first line chemotherapy of gemcitabine/nab-paclitxel or FOLFIRINOX

Venous and Arterial Thromboembolism in Patients With Cancer: JACC: CardioOncology State-of-the-Art Review

Lung cancer is the leading cause of cancer-related mortality worldwide with anincreasing incidence in many countries. There were few studies on arterial andvenous thromboembolism (ATE/VTE) in patients with metastatic lung cancer. Ourstudy focused on the clinical characteristics of stage IV lung cancer patientswith ATE or VTE to further explore the risk factors and prognosis. Patientsdiagnosed with metastatic lung cancer were enrolled from January 2011 to June2019 at a tertiary hospital in Jiangyin, China. Log-rank test was used to revealthe survival for patients with ATE or VTE. Univariable analysis andmultivariable logistic regression were used to study the risk factors for ATE. Atotal of 587 patients were enrolled in our study, including 52 patients with VTEand 48 with ATE. ATE occurred earlier than VTE. Patients with ATE had a worseprognosis. Multivariable logistic regression revealed that older age and ahistory of hypertension were independent risk factors for ATE. Patients withmetastatic lung cancer were at high risk of VTE and ATE. ATE occurred earlierand was associated with a worse prognosis. Attention should be paid tometastatic lung cancer patients who may develop thromboembolism, especiallyATE.

Effect of dexamethasone on direct Xa-inhibitor oral anticoagulant plasma levels in patients with COVID-19

In contrast to venous thromboembolism, little is known about arterial thromboembolism in patients with cancer. The aim of this study was to quantify the risk and explore clinical risk factors of arterial thromboembolism in patients with cancer, and investigate its potential impact on mortality. Patients with newly-diagnosed cancer or progression of disease after remission were included in a prospective observational cohort study and followed for two years. Between October 2003 and October 2013, 1880 patients (54.3% male; median age 61 years) were included. During a median follow up of 723 days, 48 (2.6%) patients developed arterial thromboembolism [20 (41.7%) myocardial infarction, 16 (33.3%) stroke and 12 (25.0%) peripheral arterial events], 157 (8.4%) developed venous thromboembolism, and 754 (40.1%) patients died. The cumulative 3-, 6-, 12-, and 24-month risks of arterial thromboembolism were 0.9%, 1.1%, 1.7%, and 2.6%, respectively. Male sex (subdistribution hazard ratio=2.9, 95%CI: 1.5-5.6; P=0.002), age (subdistribution hazard ratio per 10 year increase=1.5, 1.2-1.7; P<0.001), hypertension (3.1, 1.7-5.5; P<0.001), smoking (2.0, 1.1-3.7; P=0.022), lung cancer (2.3, 1.2-4.2; P=0.009), and kidney cancer (3.8, 1.4-10.5; P=0.012) were associated with a higher arterial thromboembolism risk. Furthermore, the occurrence of arterial thromboembolism was associated with a 3.2-fold increased risk of all-cause mortality (hazard ratio=3.2, 95%CI: 2.2-4.8; P<0.001). Arterial thromboembolism is a less common complication in patients with cancer than venous thromboembolism. The risk of arterial thromboembolism is high in patients with lung and kidney cancer. Patients with cancer who develop arterial thromboembolism are at a 3-fold increased risk of mortality.

Disclosure: M. Botros: None. N. Mazzaferro: None. P. Greenberg: None. D.A. Cohen: None. Introduction: Current literature describes the strong association between thrombosis risk and cancer. Multiple studies have shown a relationship between cancer and venous thromboembolism (VTE), a condition that occurs when a blood clot forms in a vein and includes deep vein thrombosis (DVT) and pulmonary embolism (PE) (1). Few European studies have shown an association between VTE and thyroid cancer (2). However, research studying the association of thyroid cancer with VTE in the United States or on a large scale is lacking. The discovery of thyroid cancer as a risk factor in the development of VTE may improve the detection of thyroid cancer and prevent future morbidity and mortality from thyroid cancer and VTE. Objectives: Using the National (Nationwide) Inpatient Sample (NIS) database, this study reports VTE incidence in various cancer types to determine if the association between VTE prevalence is higher in thyroid cancer than in other cancer types. The study also compared the coexistence of VTE and thyroid cancer in hospitalized patients to the prevalence in the general population. Methods: NIS uses ICD 9 and 10 diagnosis codes for extracting data. For this study, we obtained data for the years 2015-2017. In this analysis, we reviewed the number of patients over 18 admitted with ICD 10 codes with any of sixteen different cancer types and the diagnosis of VTE. We reviewed the literature comprehensively and selected sixteen types of cancer most commonly associated with VTE. Patients with coagulation disorders and pregnant patients with ICD-10-related codes were excluded. Other variables included smoking status, obesity, and gender. Results: Data from 3,471,240 hospitalized patients were collected. 1,662,710 (48%) were females. The cancers most commonly associated with VTE were lymphoid leukemia (22.3%), non-Hodgkin’s lymphoma (14.6 %), Hodgkin’s lymphoma (13%), pancreatic cancer (11.3%), and lung cancer (10%). The cancers with the lowest cancers VTE co-diagnosis were gall bladder (9.8%), urinary bladder (9%), stomach (9%), ovarian (8.7%), melanoma (7.7%), breast (7.2%), prostate (6.8%), uterine (6%), kidney (5.7%), colon (5.4%), and thyroid (3.3%). Conclusion: In this analysis, 3.3% of all patients with thyroid cancer carried a diagnosis of VTE. Although this suggests a relatively low risk, it is still higher than VTE incidence in the general population (0.001%) (3). The increased frequency of thyroid cancer in patients with VTE may warrant further screening for underlying thyroid cancer in patients with unprovoked PE. 1.Gervaso L, et al. Venous and Arterial Thromboembolism in Patients with Cancer. J Am Coll CardiolCardioOnc. 2021. 2.Walker AJ, et al. Incidence of venous thromboembolism in patients with cancer - A cohort study using linked United Kingdom databases. European Journal of Cancer. 3.Kearon C. Epidemiology of venous thromboembolism. Semin Vasc Med. 2001. Presentation Date: Saturday, June 17, 2023

Arterial Thromboembolism in Patients With AF and CHA2DS2-VASc Score 0-2 With and Without Cancer

The risk of thromboembolism (TE) is increased in patients with inflammatory bowel disease (IBD), mainly due to an increased risk of venous TE (VTE). The risk of arterial TE (ATE) is less pronounced, but an increased risk of cardiovascular diseases needs to be addressed in IBD patients. IBD predisposes to arterial and venous thrombosis through similar prothrombotic mechanisms, including triggering activation of coagulation, in part mediated by impairment of the intestinal barrier and released bacterial components. VTE in IBD has clinical specificities, i.e., an earlier first episode in life, high rates during both active and remission stages, higher recurrence rates, and poor prognosis. The increased likelihood of VTE in IBD patients may be related to surgery, the use of medications such as corticosteroids or tofacitinib, whereas infliximab is antithrombotic. Long-term complications of VTE can include post-thrombotic syndrome and high recurrence rate during post-hospital discharge. A global clot lysis assay may be useful in identifying patients with IBD who are at risk for TE. Many VTEs occur in IBD outpatients; therefore, outpatient prophylaxis in high-risk patients is recommended. It is crucial to continue focusing on prevention and adequate treatment of VTE in patients with IBD.

The burden of thromboembolism (TE) in severe sepsis is largely unknown. We assessed the prevalence of venous and arterial TE in patients with severe sepsis over a four-week period. We performed a retrospective analysis of a pooled database of three randomized, placebo-controlled trials of two novel pharmacological agents for the treatment of severe sepsis, drotrecogin alfa (activated) (DrotAA) and secretory phospholipase A2 inhibitor (sPLA(2)I). The study was conducted at intensive care units of the participating institutions. A total of 2,649 patients with known or suspected infection and sepsis-associated acute organ dysfunction were enrolled in the three trials and were assigned to treatment groups (DrotAA=850; sPLA2I=578; placebo=1221). The database was queried for venous and arterial TE, using investigator reports of serious adverse events. Eighty-four of 2,649 patients (3.2%; 95% confidence interval, 2.5% to 3.9%) developed at least one thromboembolic event over 28 days. Nearly three-quarters of episodes were atheroembolic (n=62); 25% involved the deep venous system (n=25). Ischemic stroke (n=30) and venous thromboembolism (n=25) each occurred in about 1% of patients. Ischemic stroke and acute coronary syndrome had a higher peak incidence during the first five days compared to venous TE onset, which was more constant over the 28-day period. Subgroup analysis by pooled treatment groups yielded TE rates of 2.0% (DrotAA), 3.5% (placebo), and 4.0% (sPLA2I), respectively. Clinically manifest TE occurred in about 3% of severe sepsis patients treated in the intensive care unit over a 28-day period. Arterial TE may be more common than previously recognized. More accurate estimates of TE prevalence and relationship to sepsis await future studies.

Direct Oral Anticoagulant Vs Vitamin K Antagonist As Anticoagulant Therapy in Patients with Inherited and Acquired Thrombophilia