Thrombosis In Cancer Patients Research Articles

O14-5 Anticoagulation for distal deep venous thrombosis in cancer patients; a post-hoc analysis from PROVE-emboli study

O14-5 Anticoagulation for distal deep venous thrombosis in cancer patients; a post-hoc analysis from PROVE-emboli study

Catheter – related thrombosis in cancer patients: Data from the registry of thrombosis and nEoplasia of SEOM (TESEO)

BackgroundCatheter related thrombosis (CRT) is the most frequent non-infectious complication associated with central venous access devices (CVAD), with a reported incidence between 13 % and 66 % in symptomatic and asymptomatic patients, respectively, with several factors influencing its development. MethodsCRT events recorded in TESEO, an international, multicentric, and prospective cancer-associated thrombosis registry were assessed. Descriptive analyses were conducted. ResultsBetween July 2018 and December 2023, 2,567 patients were included in TESEO. Of these, 245 patients developed CRT and were included in this analysis. Mean age was 60.5 years (SD 12.3). Peripherally inserted central catheters (PICC) were present in 42.1%, totally implanted ports (PORT) in 40.9% while 17% had missing data. The most common reported comorbidities were arterial hypertension (28.6%) and dyslipidemia (28.2%). Other thromboembolism associated risk factors were present in ≤10% of patients.Venous thromboembolism (VTE) related symptoms occurred in 70.2% of cases at presentation. Pulmonary embolism (PE) was present in 6.5%, being clinically suspected in 56.2% of cases. The diagnosis was mainly unilateral (81.3%) and 50% were central. Arterial and venous rethrombosis was present in 0.8% and 4.9% of cases respectively. Minor bleeding episodes occurred in 2.5% of cases, while major/clinically relevant episodes were present in 3.6%. ConclusionsUsual VTE associated risk factors were infrequent in the TESEO registry population. CRT was symptomatic in most cases, with reduced complication rates after treatment.

Cancer progression and tumor hypercoagulability: a platelet perspective.

Venous thromboembolism, which is common in cancer patients and accompanies or even precedes malignant tumors, is known as cancer-related thrombosis and is an important cause of cancer- associated death. At present, the exact etiology of the elevated incidence of venous thrombosis in cancer patients remains elusive. Platelets play a crucial role in blood coagulation, which is intimately linked to the development of arterial thrombosis. Additionally, platelets contribute to tumor progression and facilitate immune evasion by tumors. Tumor cells can interact with the coagulation system through various mechanisms, such as producing hemostatic proteins, activating platelets, and directly adhering to normal cells. The relationship between platelets and malignant tumors is also significant. In this review article, we will explore these connections.

The Role of Platelet Activation in the Development and Metastasis of Solid Tumors

The blood coagulation system is actively involved in the development of cancer. It is known that many solid tumors express tissue factor, a “trigger” of the cascade of plasma coagulation reactions, which leads to an increased risk of cancer-associated thrombosis and venous thrombosis in cancer patients. It has also long been known that platelets - small cellular fragments that are the basis of blood clots - play a critical role in metastasis by binding to the tumor cell after it enters the blood vessel, “shielding” it from the immune system and promoting the adhesion and extravasation of the tumor cell into tissues and the formation metastasis. In addition, platelets, being mobile “storehouses” of growth factors, are actively attracted and, in some cases, consumed by the tumor, which contributes to its development and vascularization. Platelet attraction occurs both through activation of the blood coagulation system in the tumor area and through exposure of the adhesive surface by the tumor. Activated in the tumor vicinity, platelets attract and induce neutrophil activation and the formation of neutrophil extracellular traps (NETs), thereby modulating the tumor microenvironment. When activated, platelets are known to secrete a variety of growth factors that promote both tumor development and vascularization. In addition to direct interaction, platelets and tumor cells exchange mRNA, micro-RNA and other regulatory molecules through microvesicles, while platelets are containers for the spread of tumor genetic material (circulating nucleic acids) throughout the body. In this review, we consider the molecular mechanisms of platelet participation in the development and metastasis of solid tumors, and also discuss possible options for pharmacological interruption of this interaction.

Mechanical Venous Thrombectomy for Deep Venous Thrombosis in Cancer Patients: A Single-Center Retrospective Study

PurposeVenous thromboembolism (VTE) is a major contributor to the mortality of cancer patients. Mechanical thrombectomy (MT) is an endovascular technique that physically removes a thrombus without thrombolytics. The purpose of this study was to evaluate safety, efficacy, and clinical outcomes following MT for lower extremity DVT in cancer patients.MethodsThis single-center, retrospective study evaluated outcomes following MT of lower extremity DVT in cancer patients from November 2019 to May 2023. The primary outcome measure was clinical success, defined as a decrease in Villalta score by at least 2 points following the intervention. Secondary outcomes included repeat intervention-free survival and overall survival. Technical success was defined as restoring venous flow with mild (< 10%) or no residual filling defect.ResultsIn total, 90 patients and 113 procedures were included. Technical and clinical success was achieved in 81% and 87% of procedures performed. Repeat intervention-free survival at 1 month, 3 months, and 6 months post-procedure was 92%, 82%, and 77%, respectively. The complication rate was 2.7%. Pathologic analysis of the extracted thrombus revealed tumor thrombus in 18.4% (18/98) samples. Overall survival for the study cohort was 87% at 1 month, 74% at 3 months, and 62% at 6 months. Patients who were found to have tumor thrombi were noted to have a decreased overall survival compared to patients with non-tumor thrombi (P = 0.012).ConclusionMT is safe and efficacious in reducing cancer patients’ VTE-related symptoms. The high rate of tumor thrombus in thrombectomy specimens suggests this phenomenon is more common than suspected.Graphical

The role of neutrophil extracellular traps in cancer progression and thrombosis development

Introduction. Initially discovered as a mechanism to protect host neutrophils from pathogens and prevent spread of infection outside inflammatory site, neutrophil extracellular traps (NETs) have been implicated in progression of other diseases associated with sterile inflammation such as autoimmune diseases, diabetes, and cancer. NETs components (myeloperoxidase, citrullinated histones, cell-free DNA) exhibit manifold effects on tumor cells, thereby emphasizing a need to be aware of the features of biological functions related to their constituents and their place in carcinogenesis to identify major molecular targets for targeted therapy of gynecologic cancers in the future.Aim: to determine an impact of NETs on tumor progression/metastasis and thrombosis risk in gynecologic cancer.Materials and Methods. A single-center interventional study was conducted: 70 women with uterine, ovarian and cervical cancer were examined; 60 age-matched apparently healthy women without thrombotic complications were selected as controls. All study participants were examined for myeloperoxidase (MРO), citrullinated histone (сitH3), proinflammatory cytokine interleukin-1β (IL-1β), and neutrophil/lymphocyte ratio (NLR).Results. Laboratory biomarkers such as MPO (p &lt; 0.001), IL-1β (p &lt; 0.001) and NLR (p = 0.003) were significantly more often elevated in patients with oncological pathology compared to group of healthy women. 32 (45.7 %) of the 70 women with cancer of the reproductive system had metastases. Metastases-related analysis in patients showed significant differences in MPO level (p = 0.002), but not in level of citH3, IL-1β and NLR (p = 0.441, p = 0.159, and p = 0.739, respectively). Elevated citH3 vs. MPO, IL-1β and NLR level was significantly more often associated with developing thrombosis in study patients (p &lt; 0.001).Conclusion. The results of our study demonstrate that inflammation and NETs components such as MPO and citH3 may be potentially implicated in many aspects of carcinogenesis including tumor metastasis and the risk of developing thrombosis in cancer patients.

Antiphospholipid antibodies as a potential factor of tumor progression

Introduction. Current generally accepted clinical and laboratory criteria for antiphospholipid syndrome (APS) have been clearly determined, which include vascular thrombosis and pregnancy complications in patients with circulating antiphospholipid antibodies (aPLs). However, in the last several years, aPLs have become a common finding in patients with malignancies. Accumulating data provide strong evidence for such association and suggests that thrombosis in cancer patients may be related to aPLs activity. According to global publications, aPLs circulation in cancer patients varies from 15 to 74 %, which may be due to differences in clinical characteristics of cancer patients examined as well as distinct interpretations on aPLs diagnostic tests.Aim: to determine aPLs profile in patients with malignant neoplasms of the female reproductive system, identify an association between aPLs and thrombosis as well as degree of disease progression and outcome.Materials and Methods. A single-center observational study was conducted with 130 women, among which 70 subjects had adenocarcinoma of the uterine body, cervix and ovaries. 60 age-matched apparently healthy women lacking thrombotic complications were included into control group. All study participants were examined for circulating lupus anticoagulantas well as anti-cardiolipin antibodies (aCLs), anti-β2-glycoprotein 1 antibodies (anti-β2-GР1), annexin V antibodies, and anti-phosphatidylserine-prothrombin complex antibodies (anti-PS-PT) IgG and IgM by using enzyme-linked immunosorbent assay.Results. Moderate or low aPLs titers were found in 34.2 % of patients with uterine, cervical and ovarian cancer. Ten (14.2 %) of 70 women in main study group had thrombosis so that aPLs were detected only in 5 of 10 women with thrombosis. No significant differences between patients with thrombosis and without thrombotic complications in gynecological cancer were observed. In addition, assessed parameters had no impact on relapse-free survival in cancer patients. However, a significant relation was found between circulating aCLs (IgG, IgM) and anti-PS-PT (IgG, IgM) as well as degree of oncological process. In addition, a significant association was found between aCLs isotype IgG (p = 0.017) and disease relapse.Conclusion. Although thrombosis along with acute thrombosis is a hallmark of APS patients, they demonstrate other non-thrombotic manifestations, one of which is the impact on tumor growth invasion and progression.

Anticoagulation in cancer patients with atrial fibrillation and grade 3–4 thrombocytopenia

IntroductionAtrial fibrillation or flutter (AF) is prevalent in cancer patients. Many of these patients have an indication for anticoagulation (AC) but are also at risk for developing chemotherapy-induced thrombocytopenia. There are scarce data regarding management of AC and risk of bleeding and thrombosis in cancer patients with AF and thrombocytopenia. AimTo assess anticoagulation management and incidence of bleeding and arterial thromboembolism (ATE) in cancer patients with AF and grade 3–4 thrombocytopenia (platelets <50 × 109/L). MethodsA retrospective cohort study included adults with active cancer, grade 3–4 thrombocytopenia and AF with CHA2DS2-VASc score ≥ 1. Patients were stratified according to AC discontinuation (No-AC) or continuation (Continue-AC) when platelets dropped below 50 × 109/L and followed for 30 days. The study outcomes were ATE (ischemic stroke, transient ischemic attack or systemic emboli) and major bleeding. Cox proportional hazards model was used to calculate hazard ratios (HR) with death as a competing risk (Fine and Gray model). ResultsThe cohort included 131 patients; 90 in the No-AC group and 41 in the Continue-AC group. Patient characteristics were balanced between the groups. The 30-day cumulative incidence of ATE was 2 % [95 % CI 0.4 %–7 %] in the No-AC group and 2 % [0.2 %–11 %] in the Continue-AC group (HR 0.92 [95 % CI 0.09–9.88]). The 30-day cumulative incidence of major bleeding was 7.8 % [95 % CI 3.40 %–14.52 %] and 2.44 % [95 % CI 0.18 %–11.22 %] in the No-AC and Continue-AC groups, respectively (HR 3.29 [95 % CI 0.42–26.04]). ConclusionsThe high rate of bleeding and low rate of ATE in thrombocytopenic cancer patients with AF suggests that holding AC during time-limited periods may be a reasonable approach.

A change of rhodocytin's suprastructure turns the agonist into an antagonist of tumor cell induced platelet aggregation.

Cancer cells circulating in the blood attach to platelets by direct cell-cell interactions via several receptor-counterreceptor contacts and indirectly by fibrin bridges which connect the two cell types by distinct integrin receptors. In the microenvironment of these tumor cell platelet aggregates (TCPAs), the tumor cells are shielded from the shear stress of the blood flow and from attack by the immune system. This supports hematogenous metastasis and tumor cell induced thrombosis. Platelet activation is triggered by binding of podoplanin on cancer cells to the platelet receptor Clec-2. Therefore, we hypothesize that targeting this initial step will prevent the entire cascade leading to the formation of TCPAs. Rhodocytin, a heterodimeric (αβ)2 C-type lectin from the Malayan pit viper Calloselasma rhodostoma, binds to Clec-2 and thereby induces TCPA formation. Remarkably, mutations in rhodocytin that disturbed formation of oligomers, blocked the podoplanin-Clec-2 axis and prevented platelet activation. Therefore, we used lysine reactive chemicals to modify rhodocytin isolated from the crude snake venom. Blue native gel electrophoresis and far western blotting showed a change of rhodocytin's suprastructure triggered by acetylation and PEGylation. Mass spectrometry analysis of altered lysines suggested that their modifications interfered with the formation of rhodocytin tetramers. When tested in assays for tumor cell induced platelet aggregation, we found that derivatization turned rhodocytin from an agonist into an antagonist. This observation indicates that Clec-2 is a valid target receptor molecule to curb TCPA formation and to prevent hematogenous metastasis and tumor cell induced thrombosis in cancer patients.

Establishment and validation of a predictive nomogram for central venous catheter-related thrombosis in cancer patients: a retrospective nested case-control study.

Catheter-related thrombosis (CRT) is a common complication for patients who receive central venous catheter (CVC) placement. This study investigated the risk factors for CRT and developed a nomogram for CRT prediction among cancer patients. This nested case-control study was conducted in the Third Affiliated Hospital of Kunming Medical University between January 2019 and February 2021. Univariable and multivariable logistic regression analyses were used to identify the risk factors for CRT. A nomogram was developed to predict CRT. Receiver operating curves (ROC), calibration curves, and decision curves were used to evaluate the performance of the nomogram in the training and validation sets. A total of 4,691 cancer patients were included in this study. Among them, 355 (7.57%) had CRT, and 70% of CRTs occurred in the first week of insertion. Among the 3,284 patients in the training set, the multivariable analysis showed that nine characteristics were independently associated with CRT, and a nomogram was constructed based on the multivariable analysis. The ROC analysis indicated good discrimination in the training set (area under the curve [AUC] = 0.832, 95% CI: 0.802-0.862) and the testing set (AUC = 0.827, 95% CI: 0.783-0.871) for the CRT nomogram. The calibration curves showed good calibration abilities, and the decision curves indicated the clinical usefulness of the prediction nomograms. The validated nomogram accurately predicts CRT occurrence in cancer patients. This model may assist clinicians in developing treatment plans for each patient.

Port-Associated Thrombosis in Cancer Patients. Case Series

На базе отделения онкологии ФГБУ «НМИЦ им. ак. Е.Н. Мешалкина» Минздрава России проведен анализ по наблюдению за пациентами, которым были установлены венозные порт-системы с целью оценки возникших венозных тромбоэмболических осложнений и коррекции антикоагулянтной терапии для их предотвращения. Проанализировано 76 операций, связанных с порт-системами (73 установки и 3 удаления). Частота зафиксированных тромбозов, связанных с установленной венозной порт-системой, составила 5,3 %. Представлены 4 клинических случая ведения пациентов, у которых были диагностированы венозные тромбоэмболические осложнения на фоне установленных порт-систем. Трём пациентам порт-системы были удалены ввиду наличия прямых показаний, во избежание развития дальнейших осложнений. Одному пациенту после обнаруженного тромба верхней полой вены, флотирующего в полость правого предсердия, проводилась антикоагулянтная терапия в лечебных дозах, в связи с чем удалось как избежать развития дальнейших осложнений, так и сохранить функционирующую венозную порт-систему с целью продолжения лекарственного противоопухолевого лечения. Установка венозных порт-систем может сопровождаться тромбоэмболическими осложнениями и требует контроля за пациентами. Обеспечение постоянного венозного доступа у пациентов, подлежащих длительной лекарственной противоопухолевой терапии, диктует необходимость сохранения порт-систем, даже в случае развития осложнений при условии эффективности консервативной терапии и надлежащем функционировании. Существующие на данный момент клинические рекомендации по профилактике венозных тромбоэмболических осложнений не решают в полном объеме проблему с порт-ассоциированными тромбозами, что требует индивидуального подхода к пациентам и дальнейшему изучению проблемы.

Use of direct oral anticoagulants in hematologic malignancies

Thrombosis is a common and serious event in cancer patients. While risk factors are well established in solid tumors and have lead to guidance regarding prophylaxis, similar data and recommendations are lacking for patients with hematologic malignancies. Likewise treatment for established venous thrombosis in cancer patients has shifted from low molecular weight heparin to direct oral anticoagulants (DOACs) based on favorable outcomes with the latter drugs in most tumor types while hematologic malignancies remain understudied and the appropriateness of DOAC use in these patients is less certain. Reasons for the knowledge gaps that have developed regarding management of thrombosis in hematologic malignancies include their relative rarity compared to solid organ cancer making large scale trials difficult to complete, and the particular nature of blood cancers and their treatment giving rise frequently to severe thrombocytopenia which is typically regarded as an exclusion from clinical trials.In this review we discuss landmark studies and other available literature regarding management of thromboembolism in hematologic malignancies and highlight unique features of these diseases and their treatment in this context.

The Risk of Venous Thrombosis for Erythropoiesis Stimulating Agents and Blood Transfusions in Cancer Patients: A Nationwide Population-Based Study in Korea

Introduction: Several previous studies have indicated that both erythropoiesis-stimulating agents (ESAs) and blood transfusions elevate the risk of venous thrombosis in cancer patients. Nevertheless, there has been inconsistency in the evidence regarding whether ESAs or blood transfusions are more closely linked to thrombotic complications. To address this, nationwide population data was analyzed to explore the association between the use of ESAs, blood transfusions, and the risk of venous thrombosis in cancer patients. Methods: This study utilized a case-crossover design and analyzed the National Health Insurance Database of Korea. A total of 710,910 patients diagnosed cancer (ICD-10 code: C00.x-C26.x, C30.x-C34.x, C37.x-C41.x, C45.x-C58.x, C60.x-C76.x, C81.x-C85.x, C88.3, C88.7, C88.9, C90.0, C90.1, C91.x-C93.x, C94.0-C94.3, C94.5, C94.7, C95.x, C96.x) between January 1, 2011, and December 31, 2020 were included. Of these, 57,256 (8.03%) identified with venous thrombosis (ICD-10 code: I80.x). The hazard period, starting from the week of thrombosis and going back 12 weeks, was compared to an earlier 12-week control period separated by a 24-week gap. Secondary analyses were conducted with different durations for the hazard/control periods (8 and 4 weeks) to assess the robustness of the results. Patients served as their own controls, and time-dependent covariates such as granulocyte colony-stimulating factor and chemotherapy were evaluated for their association with thrombotic risk. Patients were categorized based on occurrences of inpatient hospitalization, red blood cell transfusion, platelet transfusion, central venous catheter placement, and major surgery during hazard and control periods, and these variables were compared using χ2 tests. Finally, conditional logistical regression was employed to compare the odds of exposure to ESAs, blood transfusions, and other thrombosis risk factors during the hazard period to the exposure odds during the control period. Results: There were similar rates of ESA use during the hazard period and the control period (0.88% vs. 0.28%; P = 0.477). However, red blood cell transfusions (6.85% vs. 1.79%; P &amp;lt;0.001), platelet transfusions (1.92% vs. 0.48%; P = 0.003), insertion of a central venous catheter (3.34% vs. 0.74%; P &amp;lt;0.001), hospitalizations (11.79% vs. 2.77%; P &amp;lt;0.001), and major surgery (5.70% vs. 2.00%; P &amp;lt;0.001) differed significantly between the two exposure periods. All of these factors were more frequent during the hazard period compared to the control period. In the crude conditional logistical regression model, the odds ratio (OR) for ESA use was significantly increased (OR = 3.14; 95% CI: 2.63, 7.75). However, after controlling for other covariates including red blood cell transfusions, platelet transfusions, central venous catheter insertion, hospitalization, and major surgery in an adjusted model, ESA use was found to be non-significant (OR = 1.12; 95% CI: 0.93, 1.36). In contrast to ESA use, red blood cell transfusion was associated with an increased risk of thrombosis in both the crude model (OR = 3.83; 95% CI: 3.58, 4.11) and the adjusted model (OR = 1.44; 95% CI: 1.32, 1.58). This study also investigated whether varying the lengths of the hazard and control periods (8 and 4 weeks) would affect the association between ESA use, red blood cell transfusions, and thrombotic events. The results showed that the association remained consistent regardless of the duration of the periods. Overall, these findings suggest that while there was an increased risk of thrombosis associated with red blood cell transfusions, the use of ESAs did not show a significant association with thrombotic events after adjusting for other relevant factors. Conclusions: This study revealed a stronger association between red blood cell transfusions and thrombotic complications in cancer patients. These findings suggest that red blood cell transfusions may have a higher thrombotic risk compared to ESAs in this particular patient population. Furthermore, the results indicate that the use of ESAs in cancer patients might not increase the risk of thrombotic complications depending on the exposure duration. Further studies are needed to assess the impact of ESAs and blood transfusions on thrombotic risk in different populations.

Incidence and Risk Factors for Thrombosis in Cancer Patients with COVID-19

Introduction: Cancer is a leading cause of morbidity and mortality in the United States, and cancer patients infected with COVID-19 are at increased risk of death. Given that cancer and COVID-19 are both risk factors for thrombosis, it has been hypothesized that cancer patients with COVID-19 may be at greater risk for thromboembolic events than patients with COVID-19 alone. This risk could necessitate the need for more vigilant thrombosis prophylaxis. However, studies investigating risk factors for thromboembolic events in this population are limited with mixed results. We aimed to determine the incidence and risk factors for thromboembolic events in patients with cancer and COVID-19. Methods: We performed a retrospective cohort review of all cancer patients hospitalized with COVID-19 at our institution between January 1, 2021 and April 1, 2023. Patients over the age of 18 who had previously been diagnosed with cancer, received treatment within the prior 6 months, and had been hospitalized due to COVID-19 were included in the study. We assessed whether patients had experienced a thromboembolic event during their hospital stay, which included thrombosis of the extracorporeal circuit, distal or proximal lower extremity deep venous thrombosis (DVT), upper extremity DVT, pulmonary embolism, superficial thrombophlebitis, ischemic stroke, or other arterial event. Information regarding comorbidities and clinical course was extracted from the patient's record. Descriptive analysis was performed, and association between qualitative variables was studied with the Chi-squared test and the Fisher Exact test, when appropriate. For quantitative variables, the t-test or the Mann-Whitney U test was performed. Multivariate logistic regression was used to assess variables predictive of thromboembolic events. Results: 456 patients with cancer and COVID-19 were included in the study. The median age was 69 years (IQR 62 - 78) and 55% of patients were male. The majority (85%) of patients were White. Most patients had either lung (19%) or bone marrow (17%) cancer, and 196 (43%) had received chemotherapy in the 6 months prior to hospitalization. 37 patients (8.1%) had thromboembolic events during their hospital stay. Age, race, receipt of chemotherapy, and history of hypertension, heart disease, obesity, and stroke were not predictive of thromboembolic events. Patients with thromboembolic events experienced significantly longer lengths of hospital stay than those without thromboembolic events (9 days vs 12 days, p&amp;lt;0.05). Conclusion: Thromboembolic events affect many cancer patients with COVID-19 and may complicate their treatment course during hospitalization. Patients who experienced a thromboembolic event had prolonged hospital stays, which may lead to increased financial and emotional burden in this patient population. Evidence-based strategies for preventing thrombosis, including pharmacologic and mechanical methods, should be emphasized in hospitalized cancer patients with COVID-19, which may decrease thrombotic complications. Further, methods of secondary thrombosis prophylaxis, such as early detection with screening methods or treatment of subclinical methods, should be encouraged. Future studies should promote risk classification in this patient population and optimal prophylaxis paradigms.

Natural History of Isolated Splanchnic Vein Thrombosis in Cancer Patients

Introduction : Venous thromboembolism (VTE), especially pulmonary embolism (PE) and deep vein thrombosis (DVT), is associated with increased morbidity in cancer patients. However, the clinical course and optimal management of unusual and isolated splanchnic vein thrombosis (iSpVT) remain unclear. Past studies often excluded cancer patients or combined them in heterogeneous cohorts. We aimed to describe the natural history of cancer associated iSpVT. Methods : We queried a cancer registry linked database from a large safety-net hospital system from 2011-2020. Patients with incident cancer diagnosis and intra-abdominal venous thrombosis were identified by a combination of International Classification of Diseases (ICD) code and natural language processing (NLP) algorithm (Figure 1). iSpVT was defined as symptomatic or incidental portal, hepatic, splenic, mesenteric vein thrombosis without concurrent PE/DVT. Patients were excluded for remote SpVT &amp;gt;6 months (mo) before or &amp;gt;36 mo after cancer diagnosis, concurrent PE/DVT, existing anticoagulation (AC), or inadequate follow-up &amp;lt;3 mo (unless death). Thrombus type was classified as bland vs. tumor/mixed based on radiology impression. AC was defined by intention for extended therapeutic AC. Venous recanalization was defined as resolution or reduction in thrombus size in a subset of patients with repeat contrast radiology scans in 3-12 mo. VTE was defined as PE or DVT. Bleeding was defined as ISTH major (MB) or clinically relevant non-major (CRNMB). Cumulative incidence of VTE at 180 days (d) was estimated using competing risk method and overall mortality was assessed by Kaplan Meier estimator. Results : Figure 1 highlights the cohort selection where 298 of 15,342 patients (1.9%) met inclusion criteria for iSpVT. Median time from cancer diagnosis to iSpVT was 19d (IQR 0-138). Most occurred in upper gastrointestinal cancers; 54% were bland and 46% were tumor/mixed. Tumor (n=99) and bland (n-44) thrombi in hepatocellular carcinoma (HCC), along with bland thrombi in pancreatic ductal adenocarcinoma (PDCA) (n=24) comprised over half of iSpVT. AC rate differed by cancer and thrombus type. Most tumor thrombi regardless of cancer type did not receive AC (97%). Most HCC and PDCA regardless of thrombus type did not receive AC (96%). Among those with bland thrombi in other cancers, 39% received AC. Due to strong selection bias for AC, we analyzed future VTE, bleeding, recanalization, and mortality in different subgroups: 1) untreated iSpVT in HCC/PDCA (compare to similar patients without SpVT); 2) all other cancers with bland iSpVT (compare AC vs. no AC) (Table 2). Among 143 HCC patients with untreated iSpVT, 44 had bland thrombi. The 180d VTE incidence was 2.4% (95% CI 0.2-10.7), which was non-significantly lower than HCC patients without iSpVT at 4.7% (95% CI 3.2-6.7). In contrast, 99 HCC patients with tumor thrombi had twice the risk of VTE and mortality compared to bland thrombi. Among 32 PDCA patients with untreated iSpVT, 24 had bland splenic vein thrombi due to tumor encasement. The 180d VTE incidence was 13.5% (3.3-30.7), similar to PDCA patients without SpVT at 17.2% (13.2-21.7). Among 87 mixed cancer type patients with bland iSpVT, the overall 180d VTE incidence was 4.6% (1.5-10.6). Thirty-four received AC with a median duration of 81d (IQR 31-181). AC was associated with increased recanalization rate (46.7% vs. 21.7%); however, it was not associated with decreased VTE (12.1% vs. 0%) or mortality (42% vs. 42%) due to confounding by treatment indication. Notably, 3 of 4 VTE occurred &amp;lt; 2 weeks after stopping AC. Bleeding occurred in 26% (n=9) of patients on AC with 15% MB (n=5) and 12% CRNMB (n=4), at a median of 28d (IQR 7.5-115) after starting AC. Conclusion: iSpVT in cancer patients is not a singular entity but rather a heterogeneous disease based on cancer and thrombus type. Tumor thrombi are associated with higher risk of future VTE and mortality. Untreated iSpVT in HCC and PDCA appear to have similar risk of VTE as those without SpVT, which supports current practice of not anticoagulating these patients. Beyond these cancers, AC varies by perceived risk of thrombosis vs bleeding. Despite strong selection bias, AC is associated with higher recanalization rate but at a cost of high bleeding risk. Prospective studies in a cancer-specific context are needed to determine if iSpVT should be treated similarly as PE/DVT among cancer patients.

2149P Catheter-related thrombosis in cancer patients: Data from the registry of thrombosis and neoplasia of SEOM (TESEO)

2149P Catheter-related thrombosis in cancer patients: Data from the registry of thrombosis and neoplasia of SEOM (TESEO)

Effect of multidisciplinary team model on prevention of PICC-associated thrombosis in cancer patients

Effect of multidisciplinary team model on prevention of PICC-associated thrombosis in cancer patients

The clinical topography of peripherally inserted central catheter-related thrombosis in cancer patients: A prospective and longitudinal observational study based on ultrasound scans every two days

AimsTo delineate the clinical topography of peripherally inserted central catheter (PICC)-related thrombosis in cancer patients. BackgroundMost of the clinical features of PICC-related thrombosis are based on a single follow-up, which is insufficient to reflect the full topography of a thrombosis. DesignThis is an observational study conducted at West China Hospital, according to the STROBE guidelines. MethodsCancer patients scheduled for PICC placement were potentially eligible; patients with contraindications to PICC placement or existing diseases affecting blood flow were excluded; and those who later withdrew or did not reply to our contact request during the follow-up period were eliminated from this study. Ultrasound was used to detect thrombosis from the insertion site, proximal insertion site, axillary vein to the subclavian vein once every two days for two weeks post insertion. The thrombosis and its involved venous segments, onset time and symptoms and signs were recorded. ResultsAmong the 173 included patients, 126 (72.8 %) were identified as having thrombosis. Specifically, 113 and 126 patients were identified as having thrombosis within the first three days and the first week post insertion, respectively. In the 126 patients, thrombosis occurred at the insertion site (72.8 %) concurrently with thrombosis at the proximal insertion site (n = 120, 69.4 %), thrombosis in the axillary vein (n = 94, 54.3 %), and/or thrombosis in the subclavian vein (n = 41, 23.7 %). The log-rank test demonstrated that thrombosis in these four venous segments decreased significantly from the distal to the proximal central vein (log-rank test = 117.128, P < .001). Of 31 patients (17.9 %) who presented symptomatic thrombosis, only five patients experienced obvious swelling in the upper arm, and the other 26 patients exhibited atypical symptoms, such as soreness, tightness, numbness, tingling, or other discomforts in the palm, arm, armpit, and/or shoulder. In some thrombotic cases, ultrasonic assessment of PICC-related thrombosis did not parallel clinical symptoms and signs. ConclusionPICC-related thrombosis is common and can occur very early post insertion in cancer patients, and most thromboses present atypical symptoms. More than half of the cases with thrombosis evaluated involve multiple venous segments, and the farther the venous segments are from the central vein, the higher the incidence of thrombosis tend to be and the earlier the onset time are. Relevance to clinical practiceThe results highlight the importance that medical staff pay particular attention to patients with catheters in the first week post insertion and be alert to thrombosis presenting atypical symptoms while keeping in mind that clinical symptoms and signs are not reliable for diagnosing thrombosis. Clinical regestrationClinical Trials ChiCTR1900024890.

Comparative Study of Catheter Structure Types on Venous Thrombosis in Cancer Patients with Peripherally Inserted Central Catheters

Background: Cancer patients with peripherally inserted central catheters (PICCs) are prone to venous thrombosis, occlusion, and other complications due to the disease itself, chemotherapy, age, and other factors. Objectives: The present study aimed to assess the effect of different catheter materials on thrombosis in cancer patients with PICCs. Methods: The clinical data of 110 cancer patients with PICCs implanted in an outpatient clinic of our hospital from January 2018 to June 2019 were collected. The valveless group comprised patients with catheter cancers without valvular structures and high-pressure resistant polyurethane material (n=58), and the valved group comprised patients with catheter cancers with valvular structures and high-pressure resistant polyurethane material (n=52). Results: In the valveless group, 25 (43.1%) patients had total venous thrombosis, which was significantly higher than that of the valved group (n=11 patients; 21.15%) (P=0.028). In 7 out of 11 (78.85%) patients with thrombosis in the valved group, the thrombosis initiation vein was the axillary vein/subclavian vein, while the basilica/brachial vein was the thrombosis initiation vein in 18 out of 25 patients (43.10%) in the valveless group (P=0.043). There was no statistical difference between the two groups in terms of underlying diseases, thrombosis time, and extension in patients with thrombosis(P&gt;0.05). Conclusion: As evidenced by the obtained results, the catheter-inverted cone structure may be a factor of venous thrombosis. Therefore, the structure of catheters before catheterization should be considered and evaluated.

Clinical factors of PICC-RVT in cancer patients: a meta-analysis.

There is a lack of studies that systematically evaluate the clinical factors of PICC-RVT such as treatment, tumor stage, metastasis, and chemotherapy drugs in cancer patients. This study, therefore, aims to evaluate the clinical factors of catheter-related venous thrombosis in cancer patients with indwelling PICC to provide a basis for the clinical prevention and reduction of thrombosis. Relevant studies were retrieved from major databases (PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Data, and China Biology Medicine disc (CMB)) and searched from their earliest available dates until July 2022. If two or more studies had the same outcome, a meta-analysis using RevMan 5.4.1 was performed. This systematic review was registered at PROSPERO (number CRD42022358426). A total of 19 articles involving 19,824 patients were included for quantitative analysis. Meta-analysis of these studies indicated that a history of chemotherapy, tumor type, tumor stage, presence or absence of metastasis, and use of fluorouracil, etoposide, platinum drugs, and taxane were all risk factors for PICC catheter thrombosis in cancer patients. In clinical PICC catheter thrombosis prevention, patients with the above characteristics should be watched more closely than other patients, as they have a higher risk for PICC catheter thrombosis. Based on the present evidence at hand, radiotherapy cannot be considered to be related to the formation of PICC-RVT in cancer patients.