Page 9 - Vasoclick emagazine Issue2

Vasoclick, Edition 2
Conclusion
This review of updated CAT guidelines
effectively summarizes the treatment
recommendations for cancer-associated
VTE. 2
The majority of guidance points are in
agreement with each other and emphasize
on individualized treatment regimens after
shared decision-making between the
healthcare professionals (HCPs) and the
patients. 2
The latest guidelines by the ASCO, ISTH,
ITAC, and SEOM 3,5,6,8 recommend the use of
DOACs owing to the growing real-world
evidence of their safety and efficacy in the
treatment of CAT. 15
Despite the advantages of DOACs over
parenteral anticoagulants and a favorable
risk-benefit profile, careful patient selection
should be made to avoid bleeding risks, renal
complications, and drug-drug interactions 2,16,
17.
References:
1) Streiff MB. Thrombosis in the setting of cancer.
Hematology Am Soc Hematol Educ Program.
2016;2016(1):196-205.
doi:10.1182/asheducation-2016.1.196
2) Streiff MB, Abutalib SA, Farge D, Murphy M, Connors
JM, Piazza G. Update on Guidelines for the Management
of Cancer-Associated Thrombosis. Oncologist.
2021;26(1):e24-e40. doi:10.1002/onco.13596
3) Key NS, Khorana AA, Kuderer NM, et al. Venous
Thromboembolism Prophylaxis and Treatment in Patients
With Cancer: ASCO Clinical Practice Guideline Update. J
Clin Oncol. 2020;38(5):496-520.
doi:10.1200/JCO.19.01461
4) Carrier M, Khorana AA, Zwicker J, Noble S, Lee AY;
psoriasis, and outcomes of interest (VTE and
PVD). 2
The adjusted risk estimates, including hazard
ratios (HRs), risk ratios (RRs), and
standardized incidence ratios (SIRs), with 95%
confidence intervals (CIs). 2
Data Synthesis:
The meta-analyses were conducted using
Review Manager version 5.4.1 (The Cochrane
Collaboration), and Stata, version 17
(StataCorp). A P value of <0.05 was defined as
statistically significant. 2
HRs and SIRs were used for meta-analysis to
analyse risk for the entire study period. The
adjusted risk estimates of subgroups were
pooled when overall effects were not
available. 2
Crude risk estimates with 95% CI were
calculated when not available in the studies. 2
I statistic was used to quantify between-study Risk for Incident VTE:
2
heterogeneity with I >50% indicating moderate
2
heterogeneity. 2
Results:
Study Selection and their characteris-
tics:
A total of 1836 records were retrieved from
the literature search, 13 cohort studies
(12,435,982 participants) out of which were
selected for qualitative review (Figure 1).
Out of the 13 studies selected, 9 (69.2%)
reported the risk estimates of incident VTE,
and 4 (30.8%) reported the risk estimates of
incident PVD (Figure 1).
08
Subcommittee on Haemostasis and Malignancy for the and safety of novel oral anticoagulants versus low
SSC of the ISTH. Management of challenging cases of molecular weight heparin in cancer patients with venous
patients with cancer-associated thrombosis including thromboembolism: A systematic review and
recurrent thrombosis and bleeding: guidance from the meta-analysis. Crit Rev Oncol Hematol. 2020;154:103074.
SSC of the ISTH. J Thromb Haemost.
doi:10.1016/j.critrevonc.2020.103074
2013;11(9):1760-1765. doi:10.1111/jth.12338
16) Short NJ, Connors JM. New oral anticoagulants and
5) Khorana AA, Noble S, Lee AYY, et al. Role of direct oral the cancer patient. Oncologist. 2014;19(1):82-93.
anticoagulants in the treatment of cancer-associated doi:10.1634/theoncologist.2013-0239
venous thromboembolism: guidance from the SSC of the
ISTH. J Thromb Haemost. 2018;16(9):1891-1894. 17) Mendoza-Sanchez J, Silva F, Rangel L, et al. Benefit,
doi:10.1111/jth.14219 risk and cost of new oral anticoagulants and warfarin in
atrial fibrillation; A multicriteria decision analysis. PLoS
6) Farge D, Frere C, Connors JM et al. 2019 international One. 2018;13(5):e0196361. Published 2018 May 3.
doi:10.1371/journal.pone.0196361
clinical practice guidelines for the treatment and
prophylaxis of venous thromboembolism in patients with
cancer. Lancet Oncol 2019;20:e566–e581.
7) National Comprehensive Cancer Network. 2020. NCCN
guideline on cancer associated venous thromboembolic
disease. Version 1. 2020.
8) Muñoz Martín AJ, Gallardo Díaz E, García Escobar I, et
al. SEOM clinical guideline of venous thromboembolism
(VTE) and cancer (2019). Clin Transl Oncol.
2020;22(2):171-186. doi:10.1007/s12094-019-02263-z
9) Soff GA, Mones J, Wilkins C, et al. Rivaroxaban
treatment of cancer-associated venous
thromboembolism: Memorial Sloan Kettering Cancer
Center institutional experience. Res Pract Thromb
Haemost. 2019;3(3):349-356. doi:10.1002/rth2.12215
Methods: associations of psoriasis with VTE or PVD.
10) Investigators E, Bauersachs R, Berkowitz SD, Brenner This review and meta-analysis followed the Had an exposure group that had patients with
B, Buller HR, Decousus H, et al. Oral rivaroxaban for
symptomatic venous thromboembolism. N Engl J Med. Meta-analysis of Observational Studies in psoriasis and a non-exposure group that had
2010;363:2499–510.
Epidemiology (MOOSE) reporting guideline patients without psoriasis.
4
11) Investigators E P, Buller HR, Prins MH, Lensin AW, group19 and the Preferred Reporting Items for Reported the risk estimates of VTE and/or
Decousus H, Jacobson BF, et al. Oral rivaroxaban for the
treatment of symptomatic pulmonary embolism. N Engl J PVD.
Med. 2012;366:1287–97. Systematic Reviews and Meta-analyses
(PRISMA) reporting 2020 guideline. Studies with confirmed clinical diagnoses of
5
12) Young AM, Marshall A, Thirlwall J, et al. Comparison psoriasis, VTE, and PVD.
of an Oral Factor Xa Inhibitor With Low Molecular Weight
Heparin in Patients With Cancer With Venous
Thromboembolism: Results of a Randomized Trial Data Sources:
(SELECT-D). J Clin Oncol. 2018;36(20):2017-2023. Studies excluded:
doi:10.1200/JCO.2018.78.8034 MEDLINE, Embase, Cochrane Library, Web of
Science, and the Cumulative Index to Nursing Cross-sectional studies, case-control studies,
13) Khorana AA, Soff GA, Kakkar AK, et al. Rivaroxaban for
Thromboprophylaxis in High-Risk Ambulatory Patients and Allied Health Literature were searched for case reports, editorials, review articles, and
with Cancer. N Engl J Med. 2019;380(8):720-728. nonhuman studies were excluded. 2
doi:10.1056/NEJMoa1814630 publications that studied the associations of
psoriasis with VTE or PVD from their
14) Cohen AT, Maraveyas A, Beyer-Westendorf J, et al.
Patient-reported outcomes associated with changing to respective inception to May 21, 2021. 2 Data Extraction:
rivaroxaban for the treatment of cancer-associated First author, year of publication, country,
venous thromboembolism - The COSIMO study. Thromb
Res. 2021;206:1-4. doi:10.1016/j.thromres.2021.06.021 Study Selection Criteria: database, study period, patient characteristics
15) Camilli M, Lombardi M, Vescovo GM, et al. Efficacy Cohort studies that examined the (sample size, mean age, and sex), definition of
There were 9 (69.2%) studies that reported The pooled risk estimates differed with incident VTE in patients with psoriasis but
HR or SIR and were selected for quantitative geographic locations, with studies done in not in the US (Table 1).
2
meta-analysis (Figure 1). Asia and Europe showing an increased risk of
Based on the 9 studies (12,052,781
participants) examined, patients with
psoriasis had a 1.26-fold increased risk for
incident VTE than those without psoriasis
(pooled HR, 1.26; 95%, CI 1.08-1.48; I = 93%)
2
(Figure 2). 2
The association remained significant in
patients with psoriatic arthritis but did not
increase significantly in patients with
psoriasis alone (Table 1). 2
The studies done on women showed an
increased risk for VTE as opposed to those
done on men(Table 1). 2