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Clinical guidelines indicate that in patients with cancer-associated thrombosis (CAT), anticoagulant treatment should be continued beyond 6 months as long as the cancer is active. We aimed to analyse the safety of low-molecular-weight heparin (LMWH) beyond 12 months in patients with CAT.We performed a post hoc analysis of consecutive CAT patients from October 2008 to December 2019. The primary outcome was the rate of clinically relevant bleeding (CRB), and we compared two periods (1-12 vs. 12-24 months). Hazard ratio (HR), competing risk analysis and sensitivity analyses were performed.Of the 588 patients included, 30.1% (n = 177) received LMWH beyond 12 months. The rate of CRB in the first 12 months compared to the 12-24 month period was 3.2 per 100 patients/month (95% CI 2.5-4.1) vs. 0.9 per 100 patients/month (95% CI 0.4-1.5), (P 0.0001). The competing risk analysis of CRB comparing both periods showed a lower sub-distribution hazard ratio (SHR) during the period 12-24 months (SHR: 0.5, 95% CI: 0.3-0.8, P 0.001).In patients with cancer-associated thrombosis under anticoagulant treatment with LMWH, the rate of clinically relevant bleeding and major bleeding were lower beyond 12 months.

BACKGROUND: Clinical guidelines suggest continuing anticoagulation therapy for >6 months for patients with active cancer and venous thromboembolism (VTE). However, data regarding the safety of its discontinuation are scarce. OBJECTIVES: To valuate the risk factors and the incidence of recurrent VTE 6 months after the discontinuation of anticoagulation therapy in patients with cancer-associated thrombosis (CAT). METHODS: We performed a retrospective study on consecutive patients with CAT recruited between 2008 and 2019. The primary and secondary outcomes were recurrent VTE at 6 and 12 months, respectively. Sensitivity analyses were conducted to investigate the possible heterogeneity of these effects. RESULTS: A total of 311 patients were included, among whom 33.4% had metastases and 30.8% were still receiving oncological treatment after 6 months of anticoagulant therapy. At 6 and 12 months, the incidences of recurrent VTE were 6.1% (95% CI, 3.5–9.4%) and 8.7% (95% CI, 5.8–12.4%), respectively. Recurrent VTE was more frequent in patients with metastases at 6 (sub-distribution hazard ratio [SHR] 3.83; 95% CI, 1.54–9.52) and 12 months (SHR 5; 95% CI, 2.2–11.5). Patients with incidental VTE had fewer recurrent events at 6 (SHR 0.3; 95% CI, 0.1–0.8) and 12 months (SHR 0.3; 95% CI, 0.1–0.6) after discontinuing the anticoagulant therapy. CONCLUSION: The incidence of recurrent VTE at 6 and 12 months following the discontinuation of anticoagulant therapy is higher in patients with CAT. Patients with metastases were at an increased risk of recurrent VTE, whereas patients with incidental VTE were at a lower risk.

Anemia is a common condition in cancer patients and is associated with a wide variety of symptoms that impair quality of life (QoL). However, exactly how anemia affects QoL in cancer patients is unclear because of the inconsistencies in its definition in previous reports. We aimed to examine the clinical impact of anemia on the QoL of cancer patients using specific questionnaires. We performed a post-hoc analysis of a multicenter, prospective, case-control study. We included patients with cancer with (cases) or without (controls) anemia. Participants completed the European Organization for Research and Treatment of Cancer Quality of Life questionnaire version 3.0 (EORTC QLQ-C30) and Euro QoL 5-dimension 3-level (EQ−5D−3L) questionnaire. Statistically significant and clinically relevant differences in the global health status were examined. From 2015 to 2018, 365 patients were included (90 cases and 275 controls). We found minimally important differences in global health status according to the EORTC QLQ-C30 questionnaire (case vs. controls: 45.6 vs. 58%, respectively, mean difference: −12.4, p &lt, 0.001). Regarding symptoms, cancer patients with anemia had more pronounced symptoms in six out of nine scales in comparison with those without anemia. In conclusion, cancer patients with anemia had a worse QoL both clinically and statistically.

Secondary brain tumours, also known as brain metastasis, are a group of neoplasias which constitute the most frequent type of brain tumour in adults. Up to 20% patients with brain metastasis present venous thromboembolism (VTE). The management of VTE in these patients is complicated by multiple factors including intracranial haemorrhage, among others. We evaluated the case fatality rate (the proportion of patients who die due to a particular condition) of haemorrhage and recurrent VTE in patients with deep vein thrombosis (DVT) and brain metastasis to compare the risk/benefits of anticoagulant treatment. We also describe a clinical case and a systematic review of the literature on the management of anticoagulant treatment in patients with brain metastases and DVT. The principal objective of this review was to clarify the main questions about the management of this type of patient based on a clinical case.

Introduction: Proper monitoring and treatment for asthma during pregnancy avoids important maternal-fetal consequences. Controversy about the influence of steroid therapy on fetal development has been a source of several studies. Objective: To analyze the influence of inhaled corticosteroids (ICS) during pregnancy in asthmatic patients on fetal biometry according to ultrasound scans. Material and Methods: A group of asthmatic pregnant women who attended a consultation on asthma and pregnancy in a tertiary center was included. We studied different factors, such as the adherence to treatment during pregnancy and fetal biometry data (biparietal diameter-BPD, abdominal circumference-AC and femur length-FL) measured by ultrasound scans at the end of pregnancy. Asthmatic women who had not required any treatment during pregnancy were included as a control group. A correlational analysis was performed to identify the relationship between two variables. Results: 43 patients with a mean age of 33.4 years (17-44) were included. The classification of asthma, according to severity, was: 47% intermittent, 25% mild persistent, 21% moderate persistent and 7% severe asthma. Mean gestational age of patients was 39 weeks. Fetal biometry measured in the third trimester showed mean FL, CA and BDP values of 68 mm, 320 mm and 88 mm respectively. Comparing these outcomes with the control group were not found statistically significant differences. Conclusions: In our study, the use of ICS in pregnancy is not related to alteration of fetal biometry. Although it must be confirmed with larger samples, our results support the safety of ICS in the management of bronchial asthma during pregnancy.

Introduction: Usefulness of PET-CT and EBUS-TBNA in the characterization of mediastinal adenopathies in lung cancer is well defined and protocolized, however, there is no consensus on the best diagnostic strategy for mediastinal adenopathies secondary to extrathoracic tumors (MAET). The aim of this study is to assess the usefulness of imaging tests and EBUS-TBNA in the diagnosis of MAET. Methods: Retrospective study of patients with MAET who underwent EBUS-TBNA from May 2016 to July 2019 for initial diagnosis, extension study or follow-up. Results: We analyzed 38 EBUS-TBNA belonging to 36 patients, who underwent the test due to findings of PET-CT and CT. 65 lymph nodes were sampled, being station 7 (38.5%) and 4R (29.2%) the most analyzed. Samples confirmed lymph node metastasis in 52.6% of cases. In 10.5% of cases EBUS-TBNA implied the diagnosis of an unknown extrathoracic tumor. Metastasis produced by breast, renal, hepatic, endometrial and urothelial cancer stood out. In 2 cases of breast cancer and 1 of liver cancer, mediastinoscopy and endoscopic ultrasonography (EUS) were needed to confirm the diagnosis. A second EBUS-TBNA was needed to confirm diagnosis in 22.2% of the benign cases. For the rest, a radiological follow-up was performed, with no reported cases of false negative. There was no statistically significant difference in the mean SUV between malignant (7.88 ± 1.55) and benign (8.48 ± 3.43) adenopathies. Conclusions: In our setting EBUS-TBNA has been effective and accurate in the diagnosis of MAET. In contrast to lung carcinoma, the predictive potential of SUV for malignancy in MAET is limited and the usefulness of PET-CT as a guide in mediastinal sampling is questionable.

In symptomatic acute pulmonary embolism (PE), the presence of deep vein thrombosis (DVT) is a risk factor for 30- and 90-day mortality. In patients with cancer and incidental PE, the prognostic effect of concomitant incidental DVT is unknown. In this retrospective study, we examined the effect of incidental DVT on all-cause mortality in such patients. Adjusted Cox multivariate regression analysis was used for relevant covariates. From January 2010 to March 2018, we included 200 patients (mean age, 65.3 &plusmn, 12.4 years) who were followed up for 12.5 months (interquartile range 7.4&ndash, 19.4 months). Of these patients, 62% had metastases, 31% had concomitant incidental DVT, and 40.1% (n = 81) died during follow-up. All-cause mortality did not increase in patients with DVT (hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.43&ndash, 2.75, p = 0.855). On multivariate analysis, weight (adjusted HR 0.96, 95% CI 0.92&ndash, 0.99, p = 0.032), and metastasis (adjusted HR 10.26, 95% CI 2.35&ndash, 44.9, p = 0.002) were predictors of all-cause mortality. In conclusion, low weight and presence of metastases were associated with all-cause mortality, while presence of concomitant DVT was unrelated to poorer survival.