Thromboembolic events during neoadjuvant chemotherapy in muscle invasive bladder cancer – any correlation to the central venous access? A clinical practice article

Victoria Eriksson,Elisabeth Eriksson,Amir Sherif

doi:10.12688/f1000research.75922.1

Victoria Eriksson, Elisabeth Eriksson + Show 1 more

Open Access

https://doi.org/10.12688/f1000research.75922.1

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Journal: F1000Research	Publication Date: Jan 13, 2022
Citations: 1	License type: CC BY 4.0

Affiliation: Umeå University

Abstract

Patients with muscle invasive bladder cancer have a generally known 5-year overall survival of approximately 58% with neoadjuvant chemotherapy (NAC). During the last decades, addition of Cisplatinum-based NAC in fit patients prior to radical cystectomy (RC), has significantly improved OS, compared to RC only. However, some published studies following NAC addition, describe an intermediate risk increase of thromboembolic events (TEEs). Placement of central venous access (CVA) before NAC has also been suggested as being a potential risk factor for thrombosis. We present a combination of images and cases from the Northern Swedish health region where three patients developed venous TEE after CVA placement for NAC-administration and found that the time until curable RC was prolonged circa one month each, with an addition of one RC cancelled. These are serious events and to our knowledge, there are no current guidelines on prevention of TEE before RC. The aim with this report was to provide examples of these events and conclude that further prospective trials are warranted on prevention and future guidelines regarding venous anticoagulant treatment for TEE that occur pre-RC in NAC-patients.

Highlights

Muscle invasive bladder cancer (MIBC) accounts for circa 25% of all urinary bladder cancer
We report on three male patients with MIBC from the Swedish Northern health region, who all developed venous thromboembolic events (TEEs) after central venous access (CVA) placement, during neoadjuvant chemotherapy (NAC)
In a recent randomized controlled trial, it is suggested that a smaller caliber vein, where peripherally inserted central catheter-line (PICC)-line is inserted, could be related to a five times higher risk of having venous thrombosis from the device, compared to from a CVA of totally implanted (PORTs), which are directly inserted in larger vessel

Summary

Introduction

Muscle invasive bladder cancer (MIBC) accounts for circa 25% of all urinary bladder cancer. Physical examination showed no sign of swelling in upper or lower extremities and he remained respiratory and circulatory stable He received venous anticoagulant treatment with anti-Xa; Tinzaparin, with a daily dosage of 16000 IE (equivalent to 144 mg) for a predetermined period of six months. The patient had symptoms of fatigue and shortness of breath, but he was respiratory and circulatory stable and physical examinations showed no signs of swelling in upper or lower extremities He received treatment with anti-Xa; Tinzaparin at the dosage of 16000 IE to be evaluated during a period of six months. Physical examination showed no sign of swelling in upper or lower extremities and besides symptoms such as fever, fatigue and pain, he was respiratory and circulatory stable He received treatment with anti-Xa; Tinzaparin with the dosage of 12000 IE (equivalent to 192 mg) for a predetermined. According to the most recent follow-up the patient remains in remission (Table 1)

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Discussion

Conclusion