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week 4.
follow-up. Anti-Clot Treatment Scale (ACTS)
treatment option for patients with CAT, because
9
The common reasons for shifting to rivaroxaban
questionnaires were performed at baseline, week
it can be administered to patients as a fixed oral
were mainly patient-related that were dependent
dose and without any requirement of routine
4, and months 3 and 6 for pairwise comparison
on their preferences and desires, as summarized
Following a shift to rivaroxaban, there was a
to mean scores at baseline (Figure 1).
anticoagulation monitoring.
8
in table 1.
significant improvement in patient treatment
8
Cancer-associated thrOmboSIs –
Study outcome:
satisfaction on the ACTS Burdens subscale at
patient-reported outcoMes with rivarOx-
week 4 and maintained at months 3 and 6.
1) Percentage of patients who switched to
aban (COSIMO) study:
The immediate increase in treatment
Rivaroxaban from other therapies
The COSIMO study was designed to evaluate
satisfaction at week 4 is strongly supportive
Majority of patients changed to Rivaroxaban
patient satisfaction after planned change from
of treatment dependent nature of the change
from LMWH therapy (96.65%), while few patients
traditional anticoagulant therapy to rivaroxaban
in satisfaction.
changed from VKA and Fondaparinux as well
therapy for cancer associated thrombosis
(Figure 2).
8
(CAT).
8, 9
treatment of CAT owing to superior efficacy and
Factors underlying cancer associated
The COSIMO study demonstrates that CAT
safety. The major drawbacks associated with
4, 5
thrombosis (CAT)
patients who changed their VTE treatment to
VKA include strict requirement of monitoring of
Study plan:
Cancer promotes hypercoagulability in patients
Rivaroxaban experienced :
8
international normalized ratio (INR) to track
A prospective, non-interventional, single-arm
improved
due to some or all of the following factors :
3
anticoagulation status and interactions with food
cohort study enrolled patients from 55 sites
everyday clinical practice.
Long-term chemotherapy
and drugs.
4,5
across Australia, Canada and Europe. 505
8,9
reduced anticoagulation burden (patient
Endothelial damage
cancer patients who received rivaroxaban were
reported).
However, patients’ adherence towards LMWH
included in the study. During analysis, ratings
6
Obstruction to blood flow by tumor masses
3) Patient-reported treatment satisfaction on
This can improve long term persistence and
over oral anticoagulants is low thereby affecting
were reverse coded; as a result, higher scores
Procoagulant microparticles released from
the ACTS Burdens subscale after switching to
clinical outcomes.
patient outcomes. Major reasons are as follows :
4
reflected greater patient treatment satisfaction.
8
cancer cells
Rivaroxaban :
8
Observations lasted for 6 months or until the
Comorbid conditions
References
Inconvenient intravenous infusion requires
participant withdrew consent, died, or was lost to
a) At Baseline:
Advanced age
recurrent hospital visits and clinical care
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Management of VTE in cancer patients
Recently the international guidelines have been
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Patients who remained in the study:
van der Meer FJ, Rosendaal FR. Incidence of venous
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4,5
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in
treatment
Significant
increase
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4,5
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The
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(LMWH).
low-molecular-weight heparin (LMWH) based
6
The ACTS Burden score was 56.2 and 56.5 out
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Endovascular repair versus open surgical repair of juxtarenal abdominal aortic aneurysms: short-term 8 2) Reasons for switching to rivaroxaban Conclusion 8 treatment satisfaction 8 in
postoperative outcomes and mortality 05
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Noble S. American Society of Hematology 2021 Endorsed by: Dr. Sunder Narasimhan, Senior Vascular Consultant, Bangalore
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prevention and treatment in patients with cancer. Blood Background
Adv. 2021; 5(4):927-974.
doi:10.1182/bloodadvances.2020003442 Endovascular aneurysm repair (EVAR) is a highly preferred and widely implemented method to treat
abdominal aortic aneurysms (AAAs) because it is minimally invasive and causes less mortality. 1
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Juxtarenal abdominal aortic aneurysm (JRAAA) extends up to the renal arteries but does not include
8) Cohen AT, Maraveyas A, Beyer-Westendorf J, Lee AY, them (i.e., a short infrarenal aortic neck <10 mm). JRAAAs therefore often require inter-renal,
Folkerts K, Abdelgawwad K, De Sanctis Y, Fatoba S,
Bamber L, Bach M, Mantovani LG. Patient-reported suprarenal below the superior mesentery artery, or infra- or supracoeliac clamping. 2,3
outcomes associated with changing to rivaroxaban for
the treatment of cancer-associated venous
thromboembolism–The COSIMO study. Thromb Res. In patients with elective infrarenal aneurysms, EVAR has been reported to confer a short-term survival
2021; 206; 1-4. doi: 10.1016/j.thromres.2021.06.021
advantage compared to open surgical repair (OSR). 4
9) Maraveyas A, Beyer-Westendorf J, Lee AY, et al.
Cancer-Associated ThrOmboSIs - Patient-Reported
OutcoMes With RivarOxaban (COSIMO) - Baseline However, the findings of infrarenal aneurysms cannot be directly extrapolated to JRAAAs repair as
characteristics and clinical outcomes. Res Pract Thromb
Haemost. 2021;5(8):e12604. doi:10.1002/rth2.12604 their surgery requires a distinct approach in OSR involving suprarenal clamping. When treated with
complex endovascular aneurysm repair (cEVAR), patients have to undergo branch inclusion during
reconstruction (chimney EVAR [CHEVAR] or fenestrated EVAR [FEVAR]. Thus, outcomes may be
different than those of the infrarenal aneurysms. 5, 6
JRAAAs account for roughly 15% of all AAAs, however limited clinical evidence is available regarding
outcomes of JRAAA repair. 5
Thus, this study evaluated the most recent short-term outcomes after elective juxtarenal aortic repair
in patients reflecting daily practice in The Netherlands. This was a multicenter retrospective study
6
analyzing prospectively collected data of the Dutch Surgical Aneurysm Audit (DSAA), a mandatory
nationwide audit for all patients treated for an aortic aneurysm in The Netherlands. (Figure 1)
7
Figure 1: Patient selection for multiple retrospective study of the Dutch Surgical Aneurysm Audit 6
OSR- 258 patients
455 electively and primarily
treated patients with JRAAAs
cEVAR- 197 patients