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Vedovati MC, Muñoz Martín AJ, Giustozzi M, Jimenez-Fonseca P, Becattini C, Martínez Del Prado MP, Dentali F, Huisman MV, Cohen AT, Bauersachs R, Carmona-Bayonas A, Agnelli G. Derivation and validation of the Caravaggio score for the risk stratification for recurrence in patients with cancer-associated venous thromboembolism. Eur J Intern Med 2025:S0953-6205(25)00149-9. [PMID: 40253230 DOI: 10.1016/j.ejim.2025.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 03/31/2025] [Accepted: 04/13/2025] [Indexed: 04/21/2025]
Abstract
BACKGROUND In patients with cancer associated venous thromboembolism (CAT), risk factor-based scores for recurrence could drive clinical management. The aim of this study in patients with CAT was to develop and validate a risk score for recurrent venous thromboembolism (VTE) during anticoagulation: the Caravaggio score. METHODS The Caravaggio score was developed in patients included in the Caravaggio trial and then externally validated in patients included in the TESEO registry. Potential predictors (univariate p-value ≤ 0.1) for recurrence were evaluated in a multivariable Cox regression model with death unrelated to VTE as competing event. Candidate predictors were identified and scored based on clinical relevance and β-coefficient. Patients were then categorized in three risk classes. The performance of the Caravaggio score was assessed by discrimination (c-statistics), sensitivity, specificity, positive and negative predictive value (NPV). RESULTS Symptomatic VTE, ovarian and/or uterine cancer, pancreatic cancer, metastatic cancer, adenocarcinoma histological subtype, and pharmacological anticancer treatment were included in the score. In the derivation cohort, the incidence of recurrent VTE in the high, intermediate and low-risk groups was 11.6, 7.7 and 2.5 %, respectively. Incidences in the validation cohort were 8.0, 3.5 and 1.7 %, respectively. c-statistics in derivation and validation cohorts were 0.641 (95 % CI 0.584-0.698) and 0.606, (95 % CI 0.557-0.653), respectively. The NPV for low vs. intermediate/high-risk group was 98 % (95 % CI 95-99) in the derivation and 98 % (95 % CI 97-99) in the validation cohort. CONCLUSIONS The Caravaggio score is simple and able to stratify patients with CAT for the risk for VTE recurrence.
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Affiliation(s)
- Maria Cristina Vedovati
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
| | - Andrés J Muñoz Martín
- Cancer and Thrombosis Section, Spanish Society of Medical Oncology (SEOM), Spain; Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Michela Giustozzi
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Paula Jimenez-Fonseca
- Cancer and Thrombosis Section, Spanish Society of Medical Oncology (SEOM), Spain; Medical Oncology Service, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Cecilia Becattini
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Maria Purificación Martínez Del Prado
- Cancer and Thrombosis Section, Spanish Society of Medical Oncology (SEOM), Spain; Medical Oncology Service, Hospital Universitario Basurto, Basque Country University-UPV/EHU, Bilbao Bizkaia, Spain
| | | | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexander T Cohen
- Department of Haematology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, King's College London, United Kingdom
| | | | - Alberto Carmona-Bayonas
- Cancer and Thrombosis Section, Spanish Society of Medical Oncology (SEOM), Spain; Medical Oncology Service, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Giancarlo Agnelli
- Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy
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Riva N, Muscat-Baron L, Vassallo C, Ageno W, Rottenstreich A, Sauvé N, Wysokinski WE, Goldberg GL, Salomon O, Labropoulos N, Foulon A, AlSheef M, Gatt A, Calleja-Agius J. Safety and efficacy of anticoagulant treatment in patients with ovarian vein thrombosis: a systematic review and meta-analysis of observational studies. Res Pract Thromb Haemost 2024; 8:102501. [PMID: 39175528 PMCID: PMC11339252 DOI: 10.1016/j.rpth.2024.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/24/2024] [Accepted: 06/14/2024] [Indexed: 08/24/2024] Open
Abstract
Background The role of anticoagulation in ovarian vein thrombosis (OVT) is uncertain. Objectives We aimed to evaluate safety and efficacy of anticoagulant treatment in OVT patients. Methods A systematic search was conducted in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases up to April 2024. Eligible studies included randomized controlled trials and observational studies enrolling at least 10 adult patients with objectively diagnosed OVT and treated with any anticoagulants. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42021270883). Results We included 17 observational studies (621 anticoagulated and 376 nonanticoagulated OVT patients); 9 studies enrolled mainly pregnancy/puerperium-related OVT. Most patients received heparins alone (45.7%) or proceeded to vitamin K antagonists (39.2%). The average treatment duration was ≤3 months in 8 studies (47.1%), >3 to ≤6 months in 6 studies (35.3%), and >6 months in 3 studies (17.6%). In treated patients, mortality rate was 2.43% (95% CI, 0.54%-5.41%; I2 = 53.8%; 12/406 patients; 13 studies), major bleeding was 1.27% (95% CI, 0.48%-2.38%; I2 = 2.5%; 7/583 patients; 15 studies), recurrent venous thromboembolism (VTE) was 3.49% (95% CI, 1.12%-6.95%; I2 = 63.5%; 22/482 patients; 15 studies), and vessel recanalization was 89.4% (95% CI, 74.6%-98.6%; I2 = 80.6%; 163/184 patients; 8 studies). The rate of recurrent VTE in untreated patients was 8.65% (95% CI, 2.61%-17.35%); however, the difference compared with treated patients was not statistically significant (risk ratio, 0.70; 95% CI, 0.36-1.37). At subgroup analyses, the rates of major bleeding and recurrent VTE were 0.80% (95% CI, 0.0-2%.17%) and 3.81% (95% CI, 0.42%-9.63%) in pregnancy/puerperium-related OVT, respectively, and 1.12% (95% CI, 0.32%-2.34%) and 1.78% (95% CI, 0.62%-3.46%), respectively, when analyzing only full-text studies. Conclusion There is paucity of literature regarding OVT. Our results suggest that anticoagulation is associated with low rates of major bleeding and recurrent VTE.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Lorna Muscat-Baron
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Carine Vassallo
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Amihai Rottenstreich
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
- Laboratory of Blood and Vascular Biology, Rockefeller University, New York, New York, USA
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nadine Sauvé
- Division of Internal Medicine, Department of Medicine, University of Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Gary L. Goldberg
- Department of Obstetrics and Gynecology, Gynecologic Oncology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health Cancer Institute, New Hyde Park, New York, USA
| | - Ophira Salomon
- Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Arthur Foulon
- Obstetrics and Gynecology Department, Amiens University Center, Picardie Jules Verne University, Amiens, France
| | - Mohammed AlSheef
- Internal Medicine and Thrombosis, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alex Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Maciel CB, Busl KM. Neuro-oncologic Emergencies. Continuum (Minneap Minn) 2024; 30:845-877. [PMID: 38830073 DOI: 10.1212/con.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Neuro-oncologic emergencies have become more frequent as cancer remains one of the leading causes of death in the United States, second only to heart disease. This article highlights key aspects of epidemiology, diagnosis, and management of acute neurologic complications in primary central nervous system malignancies and systemic cancer, following three thematic classifications: (1) complications that are anatomically or intrinsically tumor-related, (2) complications that are tumor-mediated, and (3) complications that are treatment-related. LATEST DEVELOPMENTS The main driver of mortality in patients with brain metastasis is systemic disease progression; however, intracranial hypertension, treatment-resistant seizures, and overall decline due to increased intracranial burden of disease are the main factors underlying neurologic-related deaths. Advances in the understanding of tumor-specific characteristics can better inform risk stratification of neurologic complications. Following standardized grading and management algorithms for neurotoxic syndromes related to newer immunologic therapies is paramount to achieving favorable outcomes. ESSENTIAL POINTS Neuro-oncologic emergencies span the boundaries of subspecialties in neurology and require a broad understanding of neuroimmunology, neuronal hyperexcitability, CSF flow dynamics, intracranial compliance, and neuroanatomy.
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McBane RD, Loprinzi CL, Zemla T, Tafur A, Sanfilippo K, Liu JJ, Garcia DA, Heun J, Gundabolu K, Onitilo AA, Perepu U, Drescher MR, Henkin S, Houghton D, Ashrani A, Billett H, McCue SA, Lee MK, Le-Rademacher JG, Wysokinski WE. Extending venous thromboembolism secondary prevention with apixaban in cancer patients. The EVE trial. J Thromb Haemost 2024; 22:1704-1714. [PMID: 38537780 DOI: 10.1016/j.jtha.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/05/2024] [Accepted: 03/09/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Cancer-associated venous thromboembolism (VTE) management guideline recommendations include continued therapeutic anticoagulation while active cancer persists. The Federal Drug Administration label for apixaban for secondary VTE prevention includes a dose reduction to 2.5 mg twice daily after 6 months of treatment. OBJECTIVES The study's purpose was to determine whether this dose reduction is advisable for cancer-associated VTE. METHODS A randomized, double-blind trial compared apixaban 2.5 mg with 5 mg twice daily for 12 months among cancer patients with VTE who had completed 6 to 12 months of anticoagulation therapy. The primary outcome was combined major bleeding plus clinically relevant nonmajor bleeding. RESULTS Of 370 patients recruited, 360 were included in the intention-to-treat analyses. Major plus clinically relevant nonmajor bleeding occurred in 16 of 179 patients (8.9%) in the apixaban 2.5 mg group compared with 22 of 181 patients (12.2%) in the 5 mg group (hazard ratio [HR], 0.72; 95% CI, 0.38-1.37; P = .39). Major bleeding occurred in 2.8% of the apixaban 2.5 mg group and in 2.2% of the 5 mg group (HR, 1.26; 95% CI, 0.34-4.66; P = .73). Recurrent VTE or arterial thrombosis occurred in 9 of 179 patients (5.0%) in the apixaban 2.5 mg group and 9 of 181 patients (5.0%) in the 5 mg group (HR, 1.0; 95% CI, 0.40-2.53; P = 1.00). All-cause mortality rates were similar between groups, 13% vs 12% (HR, 1.14; 95% CI, 0.63-2.04; P = .67). CONCLUSION For secondary prevention of cancer-associated VTE, apixaban 2.5 mg compared with 5 mg twice daily did not lower combined bleeding events (EVE trial NCT03080883).
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Affiliation(s)
- Robert D McBane
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA.
| | | | - Tyler Zemla
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Alfonso Tafur
- Cardiovascular Division, North Shore University Health System, Evanston, Illinois, USA
| | - Kristen Sanfilippo
- Hematology and Medical Oncology, Siteman Cancer Center, Washington University, St. Louis, Missouri, USA
| | - Jane Jijun Liu
- Hematology and Medical Oncology, Illinois Cancer Care, Peoria, Illinois, USA
| | - David A Garcia
- Hematology Division, University of Washington, Seattle, Washington, USA
| | - James Heun
- Dean Hematology and Medical Oncology Group, Madison, Wisconsin, USA
| | - Krishna Gundabolu
- Hematology and Medical Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Adedayo A Onitilo
- Hematology and Medical Oncology, Cancer Care & Research Center, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Usha Perepu
- Hematology and Medical Oncology, University of Iowa/Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
| | - Monic R Drescher
- Cardiovascular Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Stanislav Henkin
- Cardiovascular Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Damon Houghton
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Aneel Ashrani
- Hematology Division, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shaylene A McCue
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Minji K Lee
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Waldemar E Wysokinski
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
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Fujisaki T, Sueta D, Yamamoto E, Buckley C, Sacchi de Camargo Correia G, Aronson J, Tallón de Lara P, Fujisue K, Usuku H, Matsushita K, Mehran R, Dangas GD, Tsujita K. Comparing Anticoagulation Strategies for Venous Thromboembolism Associated With Active Cancer: A Systematic Review and Meta-Analysis. JACC CardioOncol 2024; 6:99-113. [PMID: 38510285 PMCID: PMC10950435 DOI: 10.1016/j.jaccao.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 03/22/2024] Open
Abstract
Background Current guidelines recommend several direct oral anticoagulant agents (DOACs) equally for managing cancer-associated venous thromboembolism (VTE). Objectives The aim of this study was to assess the efficacy and safety of DOACs in patients with active cancer. Methods Literature searches were conducted in PubMed, Embase, and Cochrane Central in November 2022. Randomized controlled trials investigating anticoagulation strategies (vitamin K antagonists, parenteral anticoagulation [eg, low-molecular weight heparin], and DOACs) for VTE in patients with active cancer were identified for network meta-analysis. The outcomes included recurrent VTE, recurrent pulmonary embolism, recurrent deep venous thrombosis, major bleeding, clinically relevant nonmajor bleeding (CRNMB), and a composite outcome of major bleeding or CRNMB. Pooled HRs and 95% CIs were estimated using either the HR or relative risk provided from each study. Random-effects models were used for all the analyses. Results Seventeen randomized controlled trials involving 6,623 patients with active cancer were included. No significant differences were found among the DOACs for efficacy outcomes (recurrent VTE, pulmonary embolism, and deep venous thrombosis). In terms of major bleeding, apixaban was similarly safe compared with dabigatran and rivaroxaban but was associated with a decreased risk compared with edoxaban (HR: 0.38; 95% CI: 0.15-0.93). Regarding CRNMB, edoxaban was similarly safe compared with apixaban but was associated with a decreased risk compared with rivaroxaban (HR: 0.31; 95% CI: 0.10-0.91). Compared with parenteral anticoagulation, apixaban was associated with a reduced risk for recurrent VTE (HR: 0.60; 95% CI: 0.38-0.93) without increasing bleeding, edoxaban was associated with an increased risk for major bleeding or CRNMB (HR: 1.35; 95% CI: 1.02-1.79), and rivaroxaban was associated with an increased risk for CRNMB (HR: 3.76; 95% CI: 1.43-9.88). Conclusions DOACs demonstrate comparable efficacy but exhibit different safety profiles. Apixaban may confer an antithrombotic benefit without an increased risk for bleeding, distinguishing it from other contemporary anticoagulation strategies in patients with active cancer and VTE.
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Affiliation(s)
- Tomohiro Fujisaki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Conor Buckley
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, New York, USA
| | | | - Julia Aronson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Paulino Tallón de Lara
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George D. Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Paffenholz P. [Venous thromboembolism: risk factors and prophylaxis]. Aktuelle Urol 2024; 55:44-49. [PMID: 37339669 DOI: 10.1055/a-2099-8233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Venous thromboembolism is an important complication in tumour patients as it occurs frequently in these patients and causes relevant morbidity. The risk of thromboembolic complications in tumour patients is 3-9 times higher than in non-tumour patients and is the second most common cause of death in tumour patients. The risk of thrombosis depends on tumour-induced coagulopathy and on individual factors, type and stage of cancer, time since cancer diagnosis as well as type of systemic cancer therapy. Thromboprophylaxis in tumour patients is effective but can be associated with increased bleeding. Even though there are currently no dedicated recommendations for individual tumour entities, international guidelines recommend prophylactic measures in high-risk patients. A thrombosis risk of >8-10% can be considered an indication for thromboprophylaxis, which is indicated by a Khorana score ≥2, and should be calculated individually using nomograms. In particular, patients with a low risk of bleeding should receive thromboprophylaxis. Risk factors and symptoms of a thromboembolic event should also be intensively discussed with the patient and materials for patient information should be handed out.
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Qin Q, Pan Y, Wang L. No evidence for a genetic causal effect of breast cancer on venous thromboembolism: a mendelian randomization study. J Thromb Thrombolysis 2024; 57:117-123. [PMID: 37615800 DOI: 10.1007/s11239-023-02871-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/25/2023]
Abstract
Active cancer is known to contribute to venous thromboembolism (VTE), but the cause-and-effect association of breast cancer on VTE is not yet clear. In order to investigate the possible causal relationships, we used a Mendelian randomization analysis. Data for generically predicted breast cancer were identified based on the BCAC consortium. A meta-analysis of genome-wide association study (GWAS) comprising 1,500,861 participants for VTE as well as data from the FinnGen study for VTE, DVT and PE was used for the causal-effect estimation. Our primary method was inverse-variance weighted (IVW), and our supplementary methods included weighted median and MR-Egger. We also carried out sensitivity analysis for the study. No evidence of causal-effect was detected of overall breast cancer on VTE in both the GWAS meta-analysis (OR=1.01, 95%CI:0.98-1.04, p = 0.495) and the FinnGen consortium (OR=1.00,95%CI:0.96-1.04, p = 0.945). In addition, the presence of ER-positive or ER-negative disease did not significantly influence the incidence of VTE and its subtypes. In conclusion, no genetic cause-and-effect of breast cancer on VTE risk was detected in the large MR analysis.
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Affiliation(s)
- Qindan Qin
- School of Nursing, Xinjiang Medical University, Urumqi, 830000, China.
| | - Yingying Pan
- School of Nursing, Wenzhou Medical University, Wenzhou, 325000, China
| | - Li Wang
- Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, 830000, China
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Muscat-Baron L, Borg AL, Attard LM, Gatt A, Riva N. Cancer-Associated Abdominal Vein Thrombosis. Cancers (Basel) 2023; 15:5293. [PMID: 37958466 PMCID: PMC10649304 DOI: 10.3390/cancers15215293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Cancer is associated with an increased risk of developing venous thromboembolism, due to its direct influence on the three pillars of Virchow's triad (e.g., compression on the blood vessels by the tumour, blood vessels invasion, and cytokine release), together with the effect of exogenous factors (such as chemotherapy, radiotherapy, surgery). In cancer patients, the risk of thrombosis at unusual sites, such as splanchnic, ovarian and renal vein thrombosis, is also increased. Abdominal vein thromboses are frequently incidental findings on abdominal imaging performed as part of the diagnostic/staging workup or the follow-up care of malignancies. There is little evidence on the management of unusual site venous thromboembolism in cancer patients since there are only a few specific recommendations; thus, the management follows the general principles of the treatment of cancer-associated deep vein thrombosis and pulmonary embolism. This narrative review summarises the latest evidence on cancer-associated abdominal vein thrombosis, i.e., thrombosis of the splanchnic, ovarian and renal veins.
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Affiliation(s)
- Lorna Muscat-Baron
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
| | - Amber Leigh Borg
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
| | - Laura Maria Attard
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
| | - Alex Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
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