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Advances in managing and preventing thromboembolic disease in cancer patients
- Source :
- Current Opinion in Supportive & Palliative Care. 11:347-354
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- Purpose of review To update on new data for low-molecular weight heparins (LMWHs) and the direct oral anticoagulants (DOACs) for the treatment and prevention of cancer-associated thrombosis (CAT), to discuss progress with the risk-adaptive management scores (RAMS) and update on increased dose primary thromboprophylaxis (IDPTP). Recent findings In a pooled meta-analysis of 1132 cancer patients who received DOACs vs. vitamin K analogues (VKAs), recurrence of venous thromboembolism (VTE) was reduced from 6.0% on VKA schedules to 3.9% on DOACs. In a randomized trial of warfarin vs. once daily sc. tinzaparin (175 IU/kg), cumulative 6-month VTE incidence reduced from 10.5 to 7.2% [hazard ratio, 0.65 (95% confidence interval, 0.41-1.03); P = 0.07]. Despite early suggestions that DOACs may have a role in CAT, 3-6 months of LMWH remain the standard for initial treatment of CAT. A prospective comparison of RAMS found the Vienna CATS or the PROTECHT scores superior to the Khorana score but concluded that RAMS did not perform well enough to be used in the clinic. An efficacy scale of LMWHs in pancreatic cancer facilitates IDPTP. Practical implementation of IDPTP was needed to control the 40% VTE incidence of the HALO-109-202 study in metastatic pancreatic cancer. Summary DOACs have some encouraging data, but LMWHs remain the standard for CAT treatment. RAMS generated to predict VTE occurrence or recurrence are still of unproven significance and IDPTP for advanced pancreatic cancer has tools and guidance for implementation.
- Subjects :
- medicine.medical_specialty
Vitamin K
030204 cardiovascular system & hematology
Critical Care and Intensive Care Medicine
Risk Assessment
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Neoplasms
Pancreatic cancer
Internal medicine
Humans
Medicine
Oncology (nursing)
business.industry
Incidence (epidemiology)
Hazard ratio
Warfarin
Anticoagulants
Cancer
Venous Thromboembolism
General Medicine
Tinzaparin
Heparin, Low-Molecular-Weight
medicine.disease
Confidence interval
Oncology
030220 oncology & carcinogenesis
Practice Guidelines as Topic
business
Factor Xa Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 17514266 and 17514258
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- Current Opinion in Supportive & Palliative Care
- Accession number :
- edsair.doi.dedup.....17d959c630623ff1bf369760fb9507ad