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The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy. [ABSTRACT FROM AUTHOR]

The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Thromboembolism is common in lung cancer. Current thromboprophylaxis guidelines lack specific recommendations for appropriate strategies in this high thrombotic risk patient cohort. We profiled lung cancer patients receiving anti-cancer therapy. Thromboembolism incidence and thromboembolism-related mortality rates are reported and we explored patient, disease, and treatment-related risk factors associated with higher thrombotic rates. Methods: Retrospective review of lung cancer patients referred to a Comprehensive Cancer Centre between 01/07/2011 and 30/06/2012 for anti-cancer therapy. Data were collected from medical, pharmacy, pathology and diagnostic imaging electronic records. Results: After a median follow up of 10 months (range: 0.03–32 months), 24/222 patients (10.8%) had developed radiologically confirmed thromboembolism; 131 events per 1000 person-years (95%CI 87–195). Thromboembolism occurred equally in patients with non-small cell and small cell lung cancer (10.8% and 10.5% respectively), and more frequently among patients with adenocarcinoma compared to squamous cell carcinoma (14.7% and 5.3% respectively). Chemotherapy-treated patients experienced thromboembolism more often than patients who did not receive chemotherapy (HR 5.7 95%CI 2.2–14.8). Radiotherapy was also associated with more frequent thromboembolism (HR 5.2 95%CI 2.0–13.2). New lung cancer diagnosis, presence of metastatic disease, second primary malignancy and Charlson Index ≥5 were also associated with higher rates of thromboembolism. Importantly, pharmacological thromboprophylaxis (P-TP) was not routinely or systematically prescribed for ambulant lung cancer patients during any treatment phase, at this institution. The majority (83%) of thromboembolic events occurred in the ambulatory care setting. Conclusion: Morbidity and mortality from thromboembolism occurs frequently in lung cancer. Thromboprophylaxis guidelines should be developed for the ambulatory care setting. [Copyright &y& Elsevier]

Introduction Cancer associated thromboembolism (TE) is common however the risk is heterogeneous and dynamic. Aim To assess the TE risk profile of patients with Non-Small Cell Lung Cancer (NSCLC), though treatment phases, and generate a risk-stratified decision algorithm for appropriate thromboprophylaxis. Materials and Methods Single centre, prospective observational study, profiling NSCLC patients using clinical-, tumour- and treatment-related risk factors, in conjunction with an extensive thrombogenic biomarker panel, during treatment (surgery, chemotherapy, targeted therapy and/ or radiotherapy) and disease phases. Biomarkers include: FBC, APTT, PT, D-dimer, fibrinogen, FVIIIc, TM, TAT, vWF, prothrombin fragments 1 + 2, fibrin monomers, TEG, microparticles, OHP. Cancer management is per clinician discretion and/or concurrent interventional study protocol. Biomarkers are assessed at baseline; weeks 1, 4 and 12 after commencing cancer treatment; 3 monthly until 12 months. Results The interim cohort for analysis included 68 patients, 43 (63%) males, median age 67 years (range 43-67) and with median follow-up 5 months (range 0.2-11). Importantly, 21 patients (15% of patients screened) were ineligible for this study, having presented with TE at diagnosis of NSCLC, while a further 15 patients (15% of study cohort) developed TE while on study. Median time to TE on study was 2.4 months (range 0.1-7). Patients who developed TE demonstrated a biomarker profile indicative of a hypercoagulable state. Khorana score did not adequately stratify or predict TE in this cohort (PPV 20%, NPV 80%), with more than half of patients classified as low or intermediate risk (score 1 (44%), 2 (29%). However, D-dimer ≥ 1.44mg/L + Fibrinogen ≥ 4g/L + TEG-MA ≥ 69mm, as a single measurement at baseline, predicted TE (OR 4.2, p = 0.005) and at 4-weeks after commencing cancer treatment (OR 6.7, p = 0.005). Predictive power increased further, when considering longitudinal measurements from baseline to 12-weeks after commencing cancer treatment, with OR 14.0 (p < 0.001) and PPV 40%, NPV 95%. Inclusion of other Khorana parameters in this model, did not improve predictive performance. Conclusions Interim study results reveal a high TE risk among patients with NSCLC. Simple, routine, algorithmic thrombogenic biomarkers demonstrate the capacity to stratify risk and predict TE. Ongoing analyses with the planned larger cohort, expanded biomarker panel and longer follow-up, with longitudinal assessments, are likely to provide greater insight and enhance predicative power. The results will contribute to the development of a simple clinical and biomarker risk stratification tool, to facilitate real-time and dynamic decision-making for appropriate thromboprophylaxis strategies. [ABSTRACT FROM AUTHOR]