Venous Thromboembolism Pulmonary Embolism Research Articles

P380 ORAL ANTICOAGULATION THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION AND CANCER: A LITERATURE REVIEW

Abstract Introduction Cancer and atrial fibrillation (AF) are two very frequent conditions that share common pathophysiological and epidemiological features. Spontaneous coagulation is associated with malignant neoplasia as well as prothrombotic potential due to the overexpression of procoagulants. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult. The use of direct oral anticoagulants (DOACs) is now first line anticoagulation in common clinical practice, but no specific study addressing the use of DOACs in cancer patients has been published to date. In this review we aimed to retrieve all studies comparing the use of DOACs to warfarin. Methods We searched for all relevant articles published in English. Articles included RCTs sub–studies and observational trials comparing the use of DOACs therapy to warfarin in cancer patients with AF. Efficacy outcomes comprised three efficacy endpoints: ischemic stroke (IS), systemic embolism (SE) and venous thromboembolism/pulmonary embolism (VTE/PE) and five safety endpoints: cerebral bleedings (CB), minor bleedings (mB), gastrointestinal bleedings (GI–B) major bleedings (MB) and overall mortality (OM). Not all endpoints were available for all the retrieved articles. Results We retrieved 3 RCTs sub–studies and 7 observational studies for a total of 219952 patients. DOACs patients have lower risk of ischemic stroke; Odds Ratio (OR) 0.65 (95%IC 0.48–0.98). Both SE and VTE/PE did not significantly differ between the two groups OR 0.61 (95%IC 0.26–1.42) OR 0.49 (95%IC 0.22–1.07), respectively. All safety endpoints except for overall mortality were significantly lower in the DOACs group: CB OR 0.42 (95%IC 0.27–0.66), mB OR 0.62 (95%IC 0.45–0.87), GI–B OR 0.65 (95%IC 0.45–0.95), MB OR 0.55 (95%IC 0.45–0.95). Overall mortality did not statistically differ between the two anticoagulation strategies OR 0.75 (95%IC 0.46–1.22). Discussion Overall DOACs may be an effective and safe option for cancer patients suffering from atrial fibrillation.

Rivaroxaban: Drug review

Cancer-associated thrombosis is a challenging problem when treating patients with cancer. It is recurrent and difficult to treat because of the increased risk of bleeding. Low-molecular-weight heparin is the standard of care for treating cancer-associated venous thromboembolism/pulmonary embolism (VTE/PE). Recently, there have been emerging data favoring the use of direct oral anticoagulants (DOACs) for treating cancer-associated VTE/PE. They are well tolerated because of oral administration and favorable side effect profile. Rivaroxaban was the first DOAC to be approved by the US Food and Drug Administration in 2012. In this comprehensive review, we discuss the history, chemistry, mechanism of action, indications, dose modifications, and drug–drug interactions of rivaroxaban. We also discuss briefly the results of various clinical trials related to DOACs.

Infection, thrombosis, and oncologic outcome after interval debulking surgery: Does perioperative blood transfusion matter?

ObjectivesTo determine whether perioperative red blood cell transfusion (PRBCT) affects infection, thrombosis, or survival rates in epithelial ovarian cancer (EOC) patients undergoing neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS). MethodsDemographics, operative characteristics, and outcome data were abstracted from records of stage IIIC-IV EOC patients managed with NACT-IDS from 01/2010–07/2015. Associations of PRBCT with morbidity and oncologic outcomes were evaluated. ResultsOf 270 patients, 136 (50.4%) received PRBCT. Patients with preoperative anemia and higher estimated blood loss (EBL) were more likely to undergo PRBCT (OR,95%CI 1.80, 1.02–3.17) and (OR,95%CI 1.00, 1.002–1.004), respectively. There were no significant differences in PRBCT based on patient age, Charlson Comorbidity Index, or stage. When compared to low complexity operations, patients with moderate and high complexity surgeries were more likely to receive PRBCT (OR,95%CI 1.81, 1.05–3.09) and (OR,95%CI 2.25, 1.13–4.50), respectively. On univariate analysis, PRBCT was associated with intraabdominal infection (OR,95%CI 8.31, 1.03–67.41), but not wound complications (OR,95%CI 1.57, 0.76–3.23) or venous thromboembolism/pulmonary embolism (VTE/PE) (OR,95%CI 2.02, 0.49–8.23). After adjusting for surgical complexity and preoperative anemia, PRBCT was not independently associated with intraabdominal infection (OR,95%CI 7.66, 0.92–63.66), wound complications (OR,95%CI 1.70, 0.80–3.64), or VTE/PE (OR,95%CI 2.15, 0.51–9.09). When comparing patients undergoing PRBCT versus those who did not, there were no significant differences in median progression-free survival (PFS) or median overall survival (OS) on univariate analysis after adjusting for age, stage and residual disease. ConclusionsAmong patients undergoing NACT-IDS, intraabdominal infection, wound complication and VTE/PE rates are similar, regardless of PRBCT. PRBCT does not impact PFS or OS.