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Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis.

Identifieur interne : 002D29 ( PubMed/Corpus ); précédent : 002D28; suivant : 002D30

Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis.

Auteurs : S. Schulman ; M. Zondag ; L. Linkins ; S. Pasca ; Y W Cheung ; M. De Sancho ; A. Gallus ; R. Lecumberri ; S. Molnar ; W. Ageno ; G. Le Gal ; A. Falanga ; E. Huleg Rdh ; S. Ranta ; P. Kamphuisen ; P. Debourdeau ; V. Rigamonti ; T L Ortel ; A. Lee

Source :

RBID : pubmed:25851122

English descriptors

Abstract

Recommendations for management of cancer-related venous thromboembolism (VTE) in patients already receiving anticoagulant therapy are based on low-quality evidence. This international registry sought to provide more information on outcomes after a breakthrough VTE in relation to anticoagulation strategies.

DOI: 10.1111/jth.12955
PubMed: 25851122

Links to Exploration step

pubmed:25851122

Le document en format XML

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<name sortKey="Falanga, A" sort="Falanga, A" uniqKey="Falanga A" first="A" last="Falanga">A. Falanga</name>
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<term>Aged</term>
<term>Anticoagulants (administration & dosage)</term>
<term>Anticoagulants (adverse effects)</term>
<term>Chi-Square Distribution</term>
<term>Drug Substitution</term>
<term>Female</term>
<term>Hemorrhage (chemically induced)</term>
<term>Heparin, Low-Molecular-Weight (administration & dosage)</term>
<term>Heparin, Low-Molecular-Weight (adverse effects)</term>
<term>Humans</term>
<term>Kaplan-Meier Estimate</term>
<term>Male</term>
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<term>Neoplasms (blood)</term>
<term>Neoplasms (complications)</term>
<term>Neoplasms (mortality)</term>
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<term>Proportional Hazards Models</term>
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<term>Recurrence</term>
<term>Registries</term>
<term>Retrospective Studies</term>
<term>Risk Factors</term>
<term>Time Factors</term>
<term>Treatment Outcome</term>
<term>Venous Thromboembolism (blood)</term>
<term>Venous Thromboembolism (diagnosis)</term>
<term>Venous Thromboembolism (drug therapy)</term>
<term>Venous Thromboembolism (etiology)</term>
<term>Venous Thromboembolism (mortality)</term>
<term>Vitamin K (antagonists & inhibitors)</term>
<term>Warfarin (administration & dosage)</term>
<term>Warfarin (adverse effects)</term>
</keywords>
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<term>Anticoagulants</term>
<term>Heparin, Low-Molecular-Weight</term>
<term>Warfarin</term>
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<term>Vitamin K</term>
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<term>Neoplasms</term>
<term>Venous Thromboembolism</term>
</keywords>
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<term>Hemorrhage</term>
</keywords>
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<term>Neoplasms</term>
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<term>Venous Thromboembolism</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en">
<term>Venous Thromboembolism</term>
</keywords>
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<term>Venous Thromboembolism</term>
</keywords>
<keywords scheme="MESH" qualifier="mortality" xml:lang="en">
<term>Neoplasms</term>
<term>Venous Thromboembolism</term>
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<term>Neoplasms</term>
</keywords>
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<term>Aged</term>
<term>Chi-Square Distribution</term>
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<term>Prospective Studies</term>
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<front>
<div type="abstract" xml:lang="en">Recommendations for management of cancer-related venous thromboembolism (VTE) in patients already receiving anticoagulant therapy are based on low-quality evidence. This international registry sought to provide more information on outcomes after a breakthrough VTE in relation to anticoagulation strategies.</div>
</front>
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<PMID Version="1">25851122</PMID>
<DateCreated>
<Year>2015</Year>
<Month>06</Month>
<Day>02</Day>
</DateCreated>
<DateCompleted>
<Year>2016</Year>
<Month>02</Month>
<Day>25</Day>
</DateCompleted>
<DateRevised>
<Year>2015</Year>
<Month>06</Month>
<Day>02</Day>
</DateRevised>
<Article PubModel="Print-Electronic">
<Journal>
<ISSN IssnType="Electronic">1538-7836</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>13</Volume>
<Issue>6</Issue>
<PubDate>
<Year>2015</Year>
<Month>Jun</Month>
</PubDate>
</JournalIssue>
<Title>Journal of thrombosis and haemostasis : JTH</Title>
<ISOAbbreviation>J. Thromb. Haemost.</ISOAbbreviation>
</Journal>
<ArticleTitle>Recurrent venous thromboembolism in anticoagulated patients with cancer: management and short-term prognosis.</ArticleTitle>
<Pagination>
<MedlinePgn>1010-8</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1111/jth.12955</ELocationID>
<Abstract>
<AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Recommendations for management of cancer-related venous thromboembolism (VTE) in patients already receiving anticoagulant therapy are based on low-quality evidence. This international registry sought to provide more information on outcomes after a breakthrough VTE in relation to anticoagulation strategies.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">Patients with cancer and VTE despite anticoagulant therapy were reported to the registry. Data on treatments, VTE events, major bleeding, residual thrombosis symptoms and death were collected for the following 3 months. Breakthrough VTE and subsequent recurrences were objectively verified. Outcomes with different treatment strategies were compared with Cox proportional hazards regression.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">We registered 212 patients with breakthrough VTE. Of those, 59% had adenocarcinoma and 73% had known metastases. At the time of the breakthrough event, 70% were on low-molecular-weight heparin (LMWH) and 27% on a vitamin K antagonist (VKA); 70% had a therapeutic or supratherapeutic dose. After breakthrough the regimen was: unchanged therapeutic dose in 33%, dose increased in 31%, switched to another drug in 24%; and other management in 11%. During the following 3 months 11% had another VTE, 8% had major bleeding and 27% died. Of the survivors, 74% had residual thrombosis symptoms. Additional VTE recurrence was less common with LMWH than with a VKA (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.11-0.70) but similar with unchanged or increased anticoagulant intensity (HR, 1.09; 95% CI, 0.45-2.63). The bleeding rate did not increase significantly with dose escalation.</AbstractText>
<AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">Morbidity and mortality are high after recurrence of cancer-related VTE despite anticoagulation. Further treatment appears to be more effective with LMWH than with a VKA.</AbstractText>
<CopyrightInformation>© 2015 International Society on Thrombosis and Haemostasis.</CopyrightInformation>
</Abstract>
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<LastName>Schulman</LastName>
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<Affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Karolinska Institutet, Stockholm, Sweden.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Zondag</LastName>
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<Initials>M</Initials>
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<Affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Linkins</LastName>
<ForeName>L</ForeName>
<Initials>L</Initials>
<AffiliationInfo>
<Affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Pasca</LastName>
<ForeName>S</ForeName>
<Initials>S</Initials>
<AffiliationInfo>
<Affiliation>Center for Hemorrhagic and Thrombotic Disease, University Hospital of Udine, Udine, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Cheung</LastName>
<ForeName>Y W</ForeName>
<Initials>YW</Initials>
<AffiliationInfo>
<Affiliation>Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>de Sancho</LastName>
<ForeName>M</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Weill Cornell Medical College, New York, NY, USA.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Gallus</LastName>
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<Initials>A</Initials>
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<Affiliation>Flinders University, Adelaide, SA, Australia.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Lecumberri</LastName>
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<Affiliation>Hematology Service, University Clinic of Navarra, Pamplona, Spain.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Molnar</LastName>
<ForeName>S</ForeName>
<Initials>S</Initials>
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<Affiliation>Oncology and Hematology Department, Sanatorio Allende, Cordoba, Argentina.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Ageno</LastName>
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<Affiliation>Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Le Gal</LastName>
<ForeName>G</ForeName>
<Initials>G</Initials>
<Identifier Source="ORCID">http://orcid.org/0000-0002-9253-248X</Identifier>
<AffiliationInfo>
<Affiliation>Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Falanga</LastName>
<ForeName>A</ForeName>
<Initials>A</Initials>
<AffiliationInfo>
<Affiliation>Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Hulegårdh</LastName>
<ForeName>E</ForeName>
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<Affiliation>Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Ranta</LastName>
<ForeName>S</ForeName>
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</AffiliationInfo>
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