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Unprovoked venous thromboembolism in women over 40: is screening for occult malignancy with mammography and abdominopelvic CT of benefit? Clin Radiol 2020; 75:757-762. [PMID: 32646605 DOI: 10.1016/j.crad.2020.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/29/2020] [Indexed: 10/23/2022]
Abstract
AIM To determine imaging and pathological outcomes in cases of unprovoked venous thromboembolism (VTE) referred for mammogram. A secondary objective was to elucidate outcomes of abdominopelvic computed tomography (CT) imaging performed in this cohort. MATERIALS AND METHODS A retrospective review of mammograms performed in cases of unprovoked VTE was undertaken from January 2016 to September 2019. Patient notes and imaging were reviewed to establish patient demographics, additional imaging required, biopsies performed, pathology findings, and eventual outcomes. Cases were reviewed to determine if concurrent CT abdomen/pelvis was performed to screen for malignancy. Outcomes of CT were recorded. RESULTS One hundred and thirty-nine women attended for screening mammogram following unprovoked VTE during the study period. Mean patient age was 68 years (range 42-89 years). Fourteen women (10%) were recalled for further breast imaging, with two cases of confirmed malignancy (1.4%). Of the 139 women, 118 also underwent CT imaging, with 18 patients (15%) recalled for further investigations. Two (1.7%) cases of malignancy (lung and ovarian) were identified. CONCLUSION A low cancer detection rate was demonstrated in women undergoing mammography or CT following unprovoked VTE. In addition, the high number of false-positive findings and need for additional investigations questions the value of screening in this setting. Based on these findings, Cambridge Breast Unit has ceased mammographic and abdominopelvic CT imaging in women with unprovoked VTE, anticipating the newly updated National Institute for Health and Care Excellence (NICE) guidelines.
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Kalinin R, Suchkov I, Zemlyanukhin S. Idiopathic Deep Vein Thrombosis: Choosing a Screening Strategy for Detecting Occult Cancer. ACTA ACUST UNITED AC 2020. [DOI: 10.17116/flebo202014021142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Yannoutsos A, Lazareth I, Priollet P. Occult cancer screening and idiopathic venous thromboembolic disease: Where do we stand? JOURNAL DE MEDECINE VASCULAIRE 2018; 43:339-341. [PMID: 30522704 DOI: 10.1016/j.jdmv.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/10/2018] [Indexed: 06/09/2023]
Affiliation(s)
- A Yannoutsos
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - I Lazareth
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - P Priollet
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
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Šarinayová S. [Not Available]. PRAXIS 2018; 107:271-275. [PMID: 29486646 DOI: 10.1024/1661-8157/a002897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Zusammenfassung. Eine unprovozierte venöse Thromboembolie (VTE) kann das erste Zeichen einer Neoplasie sein. Bei 5–10 % der Patienten wird in den nachfolgenden zwölf Monaten eine Krebserkrankung diagnostiziert. Bei allen Patienten nach einer unprovozierten VTE sollte deshalb eine gründliche Anamnese, eine sorgfältige klinische Untersuchung, eine Blutanalyse (Blutbild mit Blutausstrich, Leberenzyme, Kalzium), der Urinstatus und ein Thorax-Röntgen durchgeführt werden. Zusätzlich sollten ergänzend, je nach Alter und Geschlecht, die spezifischen Vorsorgeuntersuchungen (Darm, Zervix, Mamma und Prostata) vorgenommen werden. Alle auffälligen Befunde sollten weiter abgeklärt werden. Für eine noch aggressivere Tumorsuche konnte bislang kein Vorteil in Hinsicht auf die Tumordetektionsrate oder auf die Senkung der krebsbedingten Mortalität gezeigt werden.
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Affiliation(s)
- Svetlana Šarinayová
- 1 Medizinische Universitätsklinik, Zentrum für Onkologie, Hämatologie und Transfusionsmedizin, Kantonsspital Aarau
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Khan F, Rahman A, Carrier M. Occult cancer detection in venous thromboembolism: the past, the present, and the future. Res Pract Thromb Haemost 2017; 1:9-13. [PMID: 30046669 PMCID: PMC6058204 DOI: 10.1002/rth2.12007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Unprovoked venous thromboembolism (VTE) can be the first manifestation of an undiagnosed cancer. Recently published studies have suggested that approximately 4-5% of patients with new unprovoked VTE will be diagnosed with cancer within 12 months of follow-up. Therefore, it is important for clinicians to keep a low threshold of suspicion for occult cancer in this patient population. After an unprovoked VTE diagnosis, patients should undergo a thorough medical history, physical examination, basic laboratory investigations (ie, complete blood count and liver function tests), chest X-ray, as well as age- and gender-specific cancer screening (breast, cervical, colon, and prostate). More intensive cancer screening including additional investigations (eg, computed tomography of the abdomen/pelvis) does not seem to increase the rate of occult cancer detection, decrease cancer-related morbidity, or increase survival or cost-effectiveness.
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Affiliation(s)
- Faizan Khan
- School of Epidemiology, Public Health & Preventive MedicineUniversity of OttawaOttawaONCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaONCanada
| | - Alvi Rahman
- School of Epidemiology, Public Health & Preventive MedicineUniversity of OttawaOttawaONCanada
| | - Marc Carrier
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaONCanada
- Department of MedicineOttawa Blood Disease CentreUniversity of Ottawa and The Ottawa HospitalOttawaONCanada
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6
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Husseinzadeh H, Carrier M. Occult cancer detection in patients with hemostatic disorder and venous thromboembolism. Thromb Res 2017; 163:242-245. [PMID: 28587726 DOI: 10.1016/j.thromres.2017.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/21/2017] [Accepted: 05/31/2017] [Indexed: 11/28/2022]
Abstract
There are physiologic ties between Von Willebrand Factor (VWF) and circulating tumor cells. VWF appears to play a role in tumor biology, but it is unclear whether cancer behavior differs in Von Willebrand Disease. In patients presenting with venous thromboembolism (VTE), occult cancer is frequently considered as an underlying cause. The prevalence of occult cancer after provoked VTE is low (3%); therefore, cancer screening in these patients is not routinely recommended. In those with unprovoked VTE, occult cancer is more prevalent, estimated between 4 and 10%. Due to this elevated risk, occult cancer screening is recommended in this population. Multiple studies have investigated whether a "limited" approach (including history and physical exam, basic labs, and chest X-ray) versus "extensive" approach (addition of advanced imaging, such as computer tomography) is more effective. Current data fails to demonstrate extensive screening strategies diagnose more occult cancer, miss fewer cancers during follow up, or improve cancer-related mortality. Furthermore, many patients may be needlessly exposed to unnecessary diagnostic procedures with their associated complications and costs, as well as significant anxiety. Therefore, the decision to perform additional testing should be made on a case-by-case basis. Additional studies are needed to identify subgroups of patients with unprovoked VTE at highest risk for occult cancer.
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Affiliation(s)
- Holleh Husseinzadeh
- Department of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Marc Carrier
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
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7
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Búsqueda de cáncer oculto en pacientes con tromboembolismo venoso: un dilema por resolver. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Jara-Palomares L, Otero R, Jimenez D, Carrier M, Tzoran I, Brenner B, Margeli M, Praena-Fernandez JM, Grandone E, Monreal M. Development of a Risk Prediction Score for Occult Cancer in Patients With VTE. Chest 2016; 151:564-571. [PMID: 27815153 DOI: 10.1016/j.chest.2016.10.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The benefits of a diagnostic workup for occult cancer in patients with VTE are controversial. Our aim was to provide and validate a risk score for occult cancer in patients with VTE. METHODS We designed a nested case-control study in a cohort of patients with VTE included in the RIETE (Registro Informatizado Enfermedad TromboEmbólica) registry from 2001 to 2014. Cases included cancer detected beyond the first 30 days and up to 24 months after VTE. Control subjects were defined as patients with VTE with no cancer in the same period. RESULTS Of 5,863 eligible patients, 444 (7.6%; 95% CI, 6.8%-8.2%) were diagnosed with occult cancer. On multivariable analysis, variables selected were male sex, age > 70 years, chronic lung disease, anemia, elevated platelet count, prior VTE, and recent surgery. We built a risk score assigning points to each variable. Internal validity was confirmed using bootstrap analysis. The proportion of patients with cancer who scored ≤ 2 points was 5.8% (241 of 4,150) and that proportion in those who scored ≥ 3 points was 12% (203 of 1,713). We also identified scores divided by sex and age subgroups. CONCLUSIONS This is the first risk score that has identified patients with VTE who are at increased risk for occult cancer. Our score needs to be externally validated.
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Affiliation(s)
- Luis Jara-Palomares
- Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Seville, Spain.
| | - Remedios Otero
- Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Seville, Spain
| | - David Jimenez
- Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
| | - Marc Carrier
- Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Inna Tzoran
- Thrombosis and Hemostasis Unit, Department of Hematology and Bone Marrow Transplantation Rambam Medical Center, Haifa, Israel
| | - Benjamin Brenner
- Thrombosis and Hemostasis Unit, Department of Hematology and Bone Marrow Transplantation Rambam Medical Center, Haifa, Israel
| | - Mireia Margeli
- Department of Medical Oncology, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, Spain
| | - Juan Manuel Praena-Fernandez
- Statistics, Methodology and Research Evaluation Unit, Andalusian Public Foundation for Health Research Management, Hospital Virgen del Rocío, Seville, Spain
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, Casa Sollievo della Sofferenza, Foggia, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol de Badalona, Barcelona, Universidad Católica de Murcia, Guadalupe, Spain
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Abstract
Venous thromboembolism (VTE) is a highly prevalent complication of malignancy with emerging changes in incidence, diagnosis and treatment paradigms. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. We address a) the appropriate workup to search for occult malignancy in patients with idiopathic VTE, b) identification of high-risk cancer patients for primary thromboprophylaxis, c) the appropriate immediate and long-term treatment for people with cancer diagnosed with acute thromboembolism, d) the appropriate duration of anticoagulation and e) the appropriate treatment strategy in patients with recurrent VTE on anticoagulation. Areas of controversy and future directions in this field are highlighted.
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10
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Arnoult AC, Pernod G, Genty C, Galanaud JP, Colonna M, Sevestre MA, Bosson JL. Low incidence of cancer after venous thromboembolism: An update from the French OPTIMEV Cohort. ACTA ACUST UNITED AC 2016; 41:169-75. [PMID: 27080824 DOI: 10.1016/j.jmv.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/22/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies have shown lower rates of cancer following venous thromboembolism (VTE) than previously described. OBJECTIVES To reassess the risk of cancer in patients with clinical symptoms of VTE with or without confirmed VTE. PATIENTS We used data from OPTIMEV, a French prospective multicenter observational study of patients presenting to hospital and community vascular medicine specialists with suspected VTE. Patients with confirmed VTE (1565) and matched controls without VTE (1847) were followed for 3 years (2006-2009). The main outcome was occurrence of cancer at 3 years, and death was a censoring event. RESULTS A total of 5.0% [4.0-6.3] of patients with VTE and 3.8% [3.0-4.9] without VTE developed cancer during follow-up. The adjusted hazard ratio (HR) was 1.2 [0.9-1.8] for patients with confirmed VTE (P=0.22). The overall standardized incidence ratio (SIR) was 1.4 [1.1-1.6] for our population, VTE+ and VTE-, compared with the general population, statistically significant (P<0.05). CONCLUSIONS We found a lower occurrence of cancer after VTE than previously described, with no significant difference between patients whether VTE was confirmed or not. Our results (low incidence and no difference between patients VTE+ or VTE-) provide no argument in favor of an extensive screening for cancer in case of VTE.
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Affiliation(s)
- A-C Arnoult
- Grenoble Alpes University, TIMC-IMAG, UMR 5525, 38043 Grenoble, France; Geneva University Hospital, Division of Angiology and Hemostasis, CH-1211 Geneva 14, Switzerland
| | - G Pernod
- Grenoble Alpes University, TIMC-IMAG, UMR 5525, 38043 Grenoble, France; Grenoble University Hospital, Department of Vascular Medicine, 38043 Grenoble, France
| | - C Genty
- Grenoble Alpes University, TIMC-IMAG, UMR 5525, 38043 Grenoble, France; Grenoble University Hospital, Clinical Research Center, 38043 Grenoble, France
| | - J-P Galanaud
- Montpellier University Hospital, Clinical Research Center, Department of Internal Medicine, 34090 Montpellier, France
| | - M Colonna
- Grenoble University Hospital, Isère Cancer Registry, 38043 Grenoble, France
| | - M-A Sevestre
- Grenoble Alpes University, TIMC-IMAG, UMR 5525, 38043 Grenoble, France; Amiens University Hospital, Department of Vascular Medicine, 80000 Amiens, France
| | - J-L Bosson
- Grenoble Alpes University, TIMC-IMAG, UMR 5525, 38043 Grenoble, France; Grenoble University Hospital, Clinical Research Center, 38043 Grenoble, France.
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11
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Gheshmy A, Carrier M. Venous thromboembolism and occult cancer: impact on clinical practice. Thromb Res 2016; 140 Suppl 1:S8-11. [DOI: 10.1016/s0049-3848(16)30091-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Watson HG, Keeling DM, Laffan M, Tait RC, Makris M. Guideline on aspects of cancer-related venous thrombosis. Br J Haematol 2015; 170:640-8. [PMID: 26114207 DOI: 10.1111/bjh.13556] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The guideline was drafted by a writing group identified by the Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology (BCSH). All the authors are consultants in haematology in the UK. A search was performed of PubMed and Embase using the term 'cancer' combined with 'thrombosis', 'treatment', 'prophylaxis' and 'clinical presentation'. The search covered articles published up until December 2014. Only human studies were included and articles not written in English were excluded. References in recent reviews were also examined. The writing group produced the draft guideline, which was subsequently revised by consensus by members of the Haemostasis and Thrombosis Task Force of the BCSH and the BCSH executive. The guideline was then reviewed by the sounding board of the British Society for Haematology (BSH). This comprises 50 or more members of the BSH who have reviewed the guidance and commented on the content and application to the UK setting. The 'GRADE' system was used to quote levels and grades of evidence, details of which can be found at: http://www.bcshguidelines.com/BCSH_PROCESS/EVIDENCE_LEVELS_AND_GRADES_OF_RECOMMENDATION/43_GRADE.html. The objective of this guideline is to provide healthcare professionals with clear guidance on the prevention and management of venous thromboembolism (VTE) in patients with cancer and to advise on an approach to screening for cancer in patients with unprovoked VTE in whom cancer was not initially suspected based on clinical grounds.
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Affiliation(s)
- Henry G Watson
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - David M Keeling
- Oxford Haemophilia & Thrombosis Centre, Churchill Hospital, Oxford, UK
| | - Mike Laffan
- Centre for Haematology, Imperial College, Hammersmith Hospital, London, UK
| | | | - Mike Makris
- Sheffield Haemophilia and Thrombosis Centre, University of Sheffield, Sheffield, UK
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
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13
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Matzdorff A, Riess H, Bergmann F, Bisping G, Koschmieder S, Parmentier S, Petrides PE, Sosada M. Cancer Screening in Patients with Idiopathic Venous Thromboembolism - a Position Paper of the German Society of Hematology and Oncology Working Group on Hemostasis. Oncol Res Treat 2015; 38:454-8. [DOI: 10.1159/000437451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/25/2015] [Indexed: 11/19/2022]
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Lensing A, Prins M, Villalta S, Negri S, Piccioli A, Noventa F, Prandoni P. Venous thrombotic burden and the risk of subsequent overt cancer. Thromb Haemost 2015; 114:864-5. [DOI: 10.1160/th15-02-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/08/2015] [Indexed: 11/05/2022]
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Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, Gibbs JSR, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35:3033-69, 3069a-3069k. [PMID: 25173341 DOI: 10.1093/eurheartj/ehu283] [Citation(s) in RCA: 1850] [Impact Index Per Article: 185.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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16
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Semb VB, Tveit A. Limited malignancy screening of patients with idiopathic venous thromboembolism. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:407-11. [PMID: 24569739 DOI: 10.4045/tidsskr.13.0310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND There is a known relationship between venous thromboembolism and cancer, but there is no consensus as to how extensive screening for occult cancer should be in cases of venous thromboembolism with no apparent risk factor (idiopathic venous thromboembolism). The aim of this study was to investigate the extent to which limited screening of patients with idiopathic venous thromboembolism reveals occult cancer. MATERIAL AND METHOD The incidence of cancer during the first year after thrombosis was surveyed retrospectively for all patients with idiopathic venous thromboembolism at Bærum Hospital in the period 1.1. 2003-31.12. 2008. During this period, limited malignancy screening was performed routinely in cases of idiopathic venous thromboembolism, and we investigated the degree to which limited screening had indicated the possible presence of cancer. RESULTS Of 974 patients with venous thromboembolism, 499 had idiopathic venous thromboembolism. Malignancy was detected in 47 of these (9.4%; 95% CI 7.1-12.3) during the first year after the thrombosis. Limited screening detected 44 of these 47 cases (94%) and had a negative predictive value of 99%. Limited screening found anomalies in 98 patients (20%) in whom malignancy was not detected. INTERPRETATION Malignancy was detected in almost 10% of the patients with idiopathic venous thromboembolism in the course of the first year. Limited screening for occult malignancy identified the great majority of cases.
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Hairy cell leukaemia and venous thromboembolism: a case report and review of the literature. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 12:276-9. [PMID: 24931845 DOI: 10.2450/2014.0248-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/20/2013] [Indexed: 11/21/2022]
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Yuri T, Kato K, Hirohara Y, Kinoshita Y, Emoto Y, Yuki M, Yoshizawa K, Tsubura A. Trousseau's Syndrome Caused by Intrahepatic Cholangiocarcinoma: An Autopsy Case Report and Literature Review. Case Rep Oncol 2014; 7:376-82. [PMID: 24987359 PMCID: PMC4067732 DOI: 10.1159/000363689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
An autopsy case report of Trousseau's syndrome caused by intrahepatic cholangiocarcinoma is presented, and seven previously reported cases are reviewed. A 73-year-old woman experiencing light-headedness and dementia of unknown cause for 6 months developed severe hypotonia. A hypointense lesion compatible with acute cerebral infarction was detected by magnetic resonance imaging. Abdominal computed tomography revealed an ill-defined large liver mass in the right lobe. The mass was not further investigated because of the patient's poor condition. She died of multiple organ failure, and an autopsy was conducted. Postmortem examination revealed intrahepatic cholangiocarcinoma, fibrous vegetations on the mitral valves and multiple thromboemboli in the cerebrum, spleen and rectum. Trousseau's syndrome is defined as an idiopathic thromboembolism in patients with undiagnosed or concomitantly diagnosed malignancy. This syndrome is encountered frequently in patients with mucin-producing carcinomas, while the incidence in patients with intrahepatic cholangiocarcinoma is uncommon. We found that tissue factor and mucin tumor marker (CA19-9, CA15-3 and CA-125) expression in cancer cells may be involved in the pathogenesis of thromboembolism. A patient with unexplained thromboembolism may have occult visceral malignancy; thus, mucin tumor markers may indicate the origin of a mucin-producing carcinoma, and postmortem examination may play an important role in revealing the hidden malignancy.
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Affiliation(s)
- Takashi Yuri
- Department of Pathology II, Kansai Medical University, Hirakata, Neyagawa, Japan
| | - Kouta Kato
- Division of Internal Medicine, Kansai Medical University Kori Hospital, Neyagawa, Japan
| | - Y Hirohara
- Division of Internal Medicine, Kansai Medical University Kori Hospital, Neyagawa, Japan
| | - Yuichi Kinoshita
- Department of Pathology II, Kansai Medical University, Hirakata, Neyagawa, Japan
| | - Yuko Emoto
- Department of Pathology II, Kansai Medical University, Hirakata, Neyagawa, Japan
| | - Michiko Yuki
- Department of Pathology II, Kansai Medical University, Hirakata, Neyagawa, Japan
| | - Katsuhiko Yoshizawa
- Department of Pathology II, Kansai Medical University, Hirakata, Neyagawa, Japan
| | - Airo Tsubura
- Department of Pathology II, Kansai Medical University, Hirakata, Neyagawa, Japan
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Predictive score for estimating cancer after venous thromboembolism: a cohort study. BMC Cancer 2013; 13:352. [PMID: 23875619 PMCID: PMC3723428 DOI: 10.1186/1471-2407-13-352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 07/04/2013] [Indexed: 11/17/2022] Open
Abstract
Background Venous thromboembolism (VTE) has been associated with a higher risk of developing malignancy and mortality, and patients with VTE may therefore benefit from increased surveillance. We aimed to construct a clinical predictive score that could classify patients with VTE according to their risk for developing these outcomes. Methods Observational cohort study using an existing clinical registry in a tertiary academic teaching hospital in Buenos Aires, Argentina. 1264 adult patients greater than 17 years of age presented new VTE between June 2006 and December 2011 and were included in the registry. We excluded patients with previous or incident cancer, those who died during the first month, and those with less than one year of follow up (< 5%). 540 patients were included. Primary outcome was new cancer diagnosis during one year of follow-up, secondary composite outcome was any new cancer diagnosis or death. The score was developed using a multivariable logistic regression model to predict cancer or death. Results During follow-up, one-quarter (26.4%) of patients developed cancer (9.2%) or died (23.7%). Patients with the primary outcome had more comorbidities, were more likely to have previous thromboembolism and less likely to have recent surgery. The final score developed for predicting cancer alone included previous episode of VTE, recent surgery and comorbidity (Charlson comorbidity score), [AUC of 0.75 (95% CI 0.66-0.84) and 0.79 (95% CI 0.63-0.95) in the derivation and validation cohorts, respectively]. The version of this score developed to predict cancer or death included age, albumin level, comorbidity, previous episode of VTE, and recent surgery [AUC = 0.72 (95% CI 0.66-0.78) and 0.71 (95% CI 0.63-0.79) in the derivation and validation cohorts, respectively]. Conclusions A simple clinical predictive score accurately estimates patients’ risk of developing cancer or death following newly diagnosed VTE. This tool could be used to help reassure low risk patients, or to identify high-risk patients that might benefit from closer surveillance and additional investigations. Trial registration ClinicalTrials.gov: NCT01372514.
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Alfonso A, Redondo M, Rubio T, Del Olmo B, Rodríguez-Wilhelmi P, García-Velloso MJ, Richter JA, Páramo JA, Lecumberri R. Screening for occult malignancy with FDG-PET/CT in patients with unprovoked venous thromboembolism. Int J Cancer 2013; 133:2157-64. [DOI: 10.1002/ijc.28229] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/09/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Ana Alfonso
- Hematology Service, Clínica Universidad de Navarra; Pamplona; Spain
| | - Margarita Redondo
- Hematology Service, Complejo Hospitalario de Navarra; Pamplona; Spain
| | - Tomás Rubio
- Internal Medicine Department; Complejo Hospitalario de Navarra; Pamplona; Spain
| | - Beatriz Del Olmo
- Internal Medicine Department; Hospital San Juan de Dios; Pamplona; Spain
| | | | | | - José A. Richter
- Nuclear Medicine Service, Clínica Universidad de Navarra; Pamplona; Spain
| | - José A. Páramo
- Hematology Service, Clínica Universidad de Navarra; Pamplona; Spain
| | - Ramón Lecumberri
- Hematology Service, Clínica Universidad de Navarra; Pamplona; Spain
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21
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Chevallier-Grenot M, Bulabois B, Seinturier C, Genty C, Bosson JL, Pernod G. [Identification of patients at high risk of cancer after a venous thromboembolic disease]. ACTA ACUST UNITED AC 2013; 38:172-7. [PMID: 23540920 DOI: 10.1016/j.jmv.2013.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 02/04/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Assessment of cancer screening in the context of venous thromboembolic disease (VTE) remains controversial. We tried to characterize a population at high risk of developing cancer among patients suffering from VTE. METHOD We conducted a retrospective ancillary case-control study among patients with VTE who later had a positive diagnosis of cancer. We assessed the association of cancer with characteristic features of VTE and with the results for four biological markers. RESULTS Our population included 142 patients (53% men, median age 71 years). Two years after VTE, 24 patients (17%) had cancer. Median values for D-dimers, fibrin monomers and SP-selectin were significantly higher among patients who developed cancer. Logistic regression enabled us to identify two parameters targeting patients with a high risk of cancer: bilateral venous thrombosis (OR: 4.41, 95%CI: 1.41-13.78, P=0.01) and D-dimers superior to 3.8 μg/mL (OR: 3.68, 95%CI: 1.36-9.94, P=0.01). The information provided by these two characteristics was additive; 58% of patients in our population who had both factors developed cancer. CONCLUSION Bilateral venous thrombosis and D-dimers superior to 3.8 μg/mL are highly associated with carcinoma. This result requires a prospective validation. It could be useful in limiting the screening process to the population most at risk.
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Affiliation(s)
- M Chevallier-Grenot
- Clinique Universitaire de Médecine Vasculaire, CHU de Grenoble, 38043 Grenoble cedex 9, France
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Keeling D, Alikhan R. Management of venous thromboembolism--controversies and the future. Br J Haematol 2013; 161:755-63. [PMID: 23531017 DOI: 10.1111/bjh.12306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/18/2013] [Indexed: 11/30/2022]
Abstract
Despite the availability of comprehensive evidence-based guidelines there are difficult and controversial areas in the management of venous thromboembolism. Institutions and even countries disagree on the importance of calf vein thrombosis, with some rigorously detecting and treating it and others deliberately not looking for it. The need to treat proximal deep vein thrombosis and pulmonary embolism is accepted but which patients with an unprovoked first event should have long-term anticoagulation has become a difficult clinical decision. We are uncertain how to reduce the incidence of post-thrombotic syndrome seen in a substantial number of patients. How hard to look for an undiagnosed underlying cancer has become a contentious issue particularly in the United Kingdom following the recent publication of a guideline from the National Institute for Health and Clinical Excellence. Whilst we are wrestling with these dilemmas we are entering an era of new anticoagulants and have to solve the logistical problems of introducing them into clinical practice despite cost pressures. These issues will be explored in this review.
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Mukherjee SK, Panthagani A, Ramroop N, Al-Dujaily S. Pulmonary embolus as a first presentation of occult metastatic prostate cancer. BMJ Case Rep 2012; 2012:bcr.11.2011.5196. [PMID: 22962385 DOI: 10.1136/bcr.11.2011.5196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 65-year-old gentleman with a previous history of pulmonary embolus presented with a subacute onset of shortness of breath, haemoptysis and chest pain associated with a swollen left leg. Ultrasound Doppler scanning of the leg revealed no deep-vein thrombosis. Thereafter, a CT scan of the pulmonary vasculature revealed a large right-sided pulmonary embolus. CT scanning of the abdomen and pelvis was performed to look for evidence of an intra-abdominal source of thrombus and revealed evidence of a moderate sized pelvic mass causing obstructive uropathy. Urological review of the patient revealed a hard prostate and raised prostate specific antigen, consistent with a diagnosis of primary prostatic carcinoma, which after investigation with a radioisotope bone scan was found to have metastasised to the bony pelvis.
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Affiliation(s)
- S K Mukherjee
- Urology Department, Basildon & Thurrock University Hospital, Basildon, UK.
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de Oliveira ALC, Ribeiro A, Reis LF, Raymundo SRS, de Godoy JMP. Chest radiography as a method of screening for occult cancer in patients with idiopathic deep vein thrombosis. Angiology 2011; 63:378-9. [PMID: 22007027 DOI: 10.1177/0003319711421663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The occurrence of neoplasms in patients with idiopathic deep vein thrombosis (DVT) may result in a significant reduction in survival rates. The aim of our study was to assess the use of chest X-rays (CXRs) as a screening method of intrathoracic neoplasms in patients who with idiopathic DVT. In observational, cross-sectional study, the medical records of 99 patients with idiopathic DVT, who were submitted to CXR (during the hospital stay or within 30 days after discharge), were investigated. Of these patients, 15.1% had images suggestive of thoracic neoplasias (single or multiple pulmonary nodules and mediastinal widening). Neoplasms were diagnosed in 4 patients in the follow-up with CXR. The CXR is an option of early screening for thoracic neoplasms and other nonmalignant diseases in patients with idiopathic DVT.
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Affiliation(s)
- André Luís Cozetto de Oliveira
- Cardiology and Cardiovascular Surgery, Department of the Medicine School in São José do Rio Preto-FAMERP, Sao Paulo, Brazil
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A pilot study utilizing whole body 18 F-FDG-PET/CT as a comprehensive screening strategy for occult malignancy in patients with unprovoked venous thromboembolism. Thromb Res 2011; 129:22-7. [PMID: 21802118 DOI: 10.1016/j.thromres.2011.06.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/25/2011] [Accepted: 06/25/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Approximately 7-10% of patients with unprovoked VTE will be diagnosed with cancer within 12 months. Although cancer screening has been proposed in these patients, the optimal strategy remains unclear. In a pilot study, we prospectively investigated the use of FDG-PET/CT to screen for occult malignancy in 40 patients with unprovoked VTE. MATERIALS/METHODS Patients were initially screened for occult malignancy with a focused history, physical, and laboratory evaluation. Patients underwent whole body FDG-PET/CT and were followed for up to two years for a new diagnosis of cancer. The total costs of using FDG-PET/CT as a comprehensive screening strategy were determined using 2010 Medicare reimbursement rates. RESULTS Completion of FDG-PET/CT imaging was feasible and identified abnormal findings requiring additional evaluations in 62.5% of patients. Occult malignancy was evident in only one patient (cancer incidence 2.5%) and FDG-PET/CT imaging excluded malignancy in the remainder of patients. No patients with a negative FDG-PET/CT were diagnosed with malignancy during an average (±SD) follow-up of 449 (±311) days. The use of FDG-PET/CT to screen for occult malignancy added $59,151 in total costs ($1,479 per patient). The majority of these costs were due to the cost of the FDG-PET/CT ($1,162 per patient or 78.5% of total per-patient costs). CONCLUSIONS FDG-PET/CT may have utility for excluding occult malignancy in patients with unprovoked VTE. The costs of this comprehensive screening strategy were comparable to other screening approaches. Larger studies are needed to further evaluate the utility and cost-effectiveness of FDG-PET/CT as a cancer screening strategy in patients with unprovoked VTE.
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Should we screen patients with unprovoked venous thromboembolism for occult cancers? A pilot study. Blood Coagul Fibrinolysis 2011; 21:709-10. [PMID: 20885135 DOI: 10.1097/mbc.0b013e32833c3714] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Van Doormaal FF, Terpstra W, Van Der Griend R, Prins MH, Nijziel MR, Van De Ree MA, Büller HR, Dutilh JC, ten Cate-Hoek A, Van Den Heiligenberg SM, Van Der Meer J, Otten JM. Is extensive screening for cancer in idiopathic venous thromboembolism warranted? J Thromb Haemost 2011; 9:79-84. [PMID: 20946181 DOI: 10.1111/j.1538-7836.2010.04101.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with a first episode of idiopathic venous thromboembolism (IVTE) have an estimated 10% incidence of cancer within 12 months after diagnosis. However, the utility of screening for cancer in this population is controversial. METHODS In this prospective concurrently controlled cohort study, limited and extensive cancer screening strategies were compared. All 630 patients underwent baseline screening consisting of history, physical examination, basic laboratory tests and chest X-ray. In the extensive screening group abdominal and chest CT scan and mammography were added. Outcomes were incidence and curability of cancer, and cancer-related and overall mortality. RESULTS In 12 of the 342 (3.5%) patients in the extensive screening group malignancy was diagnosed at baseline compared with 2.4% (seven of 288 patients) in the limited screening group. Extensive screening detected six additional cancers (2.0%; 95% CI, 0.74-4.3), of which three were potentially curable. During a median 2.5 years of follow-up, cancer was diagnosed in 3.7% and 5.0% in the extensive and limited screening groups, respectively. In the extensive screening group 26 patients (7.6%) died compared with 24 (8.3%) in the limited screening group; adjusted hazard ratio 1.22 (95% CI, 0.69-2.22). Of these deaths 17 (5.0%) in the extensive screening group and 8 (2.8%) in the limited screening group were cancer related; adjusted hazard ratio 1.79 (95% CI, 0.74-4.35). CONCLUSIONS The low yield of extensive screening and lack of survival benefit do not support routine screening for cancer with abdominal and chest CT scan and mammography in patients with a first episode of IVTE.
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Lekovic D, Miljic P, Mihaljevic B. Increased risk of venous thromboembolism in patients with primary mediastinal large B-cell lymphoma. Thromb Res 2010; 126:477-80. [DOI: 10.1016/j.thromres.2010.08.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 08/03/2010] [Accepted: 08/27/2010] [Indexed: 12/21/2022]
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Shimizu K, Itoh J. A possible link between Trousseau's syndrome and tissue factor producing plasma cells. Am J Hematol 2009; 84:382-5. [PMID: 19425064 DOI: 10.1002/ajh.21419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
OBJECTIVE To compare quality of life (QOL) of patients following iatrogenic bile duct injuries (BDI) to matched controls. SUMMARY BACKGROUND DATA BDI complicate approximately 0.3% of all cholecystectomy procedures. The literature regarding impact on quality of life is conflicted as assessment using clinical determinants alone is insufficient. METHODS The medical outcomes study short form 36 (SF-36), a sensitive tool for quantification of life quality outcome, was used. The study group of iatrogenic BDI was compared with an age- and sex-matched group who underwent uncomplicated cholecystectomy. Telephone questionnaire using the SF-36 quality of life tool was administered to both groups at a median postoperative time of 12 years 8 months (range, 2 months -20 years). RESULTS Seventy-eight patients were referred with BDI but due to mortality (n = 10) and unavailability (n = 6) 62 participated. The age- and sex-matched control cohort had undergone uncomplicated cholecystectomy (n = 62). Comparison between groups revealed that 7 of 8 variables examined were statistically similar to those of the control group (physical functioning, role physical, bodily pain, general health perceptions, vitality and social functioning, and mental health index). Mean role emotional scores were slightly worse in the BDI group (46 vs. 50) but the significance was borderline (P = 0.045). Subgroup analysis by method of intervention for BDI did not demonstrate significant differences. CONCLUSION Quality of life of surviving patients following BDI compares favorably to that after uncomplicated laparoscopic cholecystectomy.
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Sevestre MA, Roy PM, Morange PE, Quéré I, Pernod G. [Venous thromboembolic disease: questions and controversies. Teaching seminary in vascular medicine (November22, 2007)]. JOURNAL DES MALADIES VASCULAIRES 2009; 34:44-49. [PMID: 19147313 DOI: 10.1016/j.jmv.2008.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 10/28/2008] [Indexed: 05/27/2023]
Abstract
Rapid advances has been made in the diagnosis and treatment of venous thromboembolic disease, but many questions or controversies remain. In this review, we present a progress report on various concepts still open to discussion. New epidemiologic data from the French epidemiology study, Optimev, are presented. Widespread use of multidetector CT scan for the diagnostic work-up of pulmonary embolism has had considerable impact on clinical practices. We discuss indications and use of the various imaging methods. The review ends with a report on constitutional or acquired thrombophilia, particularly cancer-associated venous thromboembolic disease, which remains a daily preoccupation with various approaches still under debate. This review was the topic of the French vascular medicine teaching seminary in November2007.
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Affiliation(s)
- M-A Sevestre
- Service de médecine vasculaire, CHU d'Amiens, France
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Adcock DM, Fink LM, Marlar RA, Cavallo F, Zangari M. The Hemostatic System and Malignancy. ACTA ACUST UNITED AC 2008; 8:230-6. [DOI: 10.3816/clm.2008.n.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
In 1865, Armand Trousseau noted that unexpected or migratory thrombophlebitis could be a forewarning of an occult visceral malignancy. An analysis by Sack and colleagues in 1977 extended the term Trousseau's syndrome to include chronic disseminated intravascular coagulopathy associated with microangiopathy, verrucous endocarditis, and arterial emboli in patients with cancer, often occurring with mucin-positive carcinomas. In recent times the term has been ascribed to various clinical situations, ranging all the way from these classic descriptions to any kind of coagulopathy occurring in the setting of any kind of malignancy. These multiple definitions of Trousseau's syndrome are partly the consequence of multiple pathophysiologic mechanisms that apparently contribute to the hypercoagulability associated with cancer. Even the classic syndrome probably represents a spectrum of disorders, ranging from exaggerated fluid-phased thrombosis dependent on prothrombotic agents such as tissue factor to a platelet- and endotheliumum-based selectin-dependent microangiopathy associated with mucin-producing carcinomas, along with thrombin and fibrin production. Also considered here are recent hypotheses about genetic pathways within tumor cells that might trigger these thrombotic phenomena, and the reasons why therapy with heparins of various kinds remain the preferred treatment, probably because of their salutary actions on several of the proposed pathologic mechanisms.
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Affiliation(s)
- Ajit Varki
- University of California, San Diego, La Jolla CA 92093-0687, USA.
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Paz-Priel I, Long L, Helman LJ, Mackall CL, Wayne AS. Thromboembolic Events in Children and Young Adults With Pediatric Sarcoma. J Clin Oncol 2007; 25:1519-24. [PMID: 17442994 DOI: 10.1200/jco.2006.06.9930] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Adults with malignancy are at increased risk for venous thromboembolic events (TEs). However, data in children and young adults with cancer are limited. Patients and Methods To determine the risk and clinical features of TEs in children and young adults with sarcoma, we reviewed records on 122 consecutive patients with sarcoma treated from October 1980 to July 2002. Results Twenty-three TEs were diagnosed in 19 of 122 (16%; 95% CI, 10% to 23%) patients. Prevalence by diagnosis was Ewing sarcoma, eight of 61 (13%); osteosarcoma, two of 20 (10%); rhabdomyosarcoma, four of 26 (15%); and other sarcomas, five of 15 (33%). TEs developed in 23% of patients with metastases at presentation versus 10% with localized disease (odds ratio, 2.59; 95% CI, 0.9 to 7.1; P < .06). Fifty-three percent of patients with thrombosis had a clot at presentation. A lupus anticoagulant was detected in four of five evaluated patients. There was a single fatality due to pulmonary embolism. Patients who were diagnosed with cancer after 1993 had a higher rate of TE (7% v 23%; P < .015). Of the 23 events, 43% were asymptomatic. Main sites of thromboses were deep veins of the extremities (10 of 23; 43%), pulmonary embolism (five of 23; 22%), and the inferior vena cava (four of 23; 17%). TEs were associated with tumor compression in eight of 23 (35%) and with venous catheters in three of 23 (13%). Conclusion Thromboembolism is common in pediatric patients with sarcomas. Thromboses are detected frequently around the time of oncologic presentation, may be asymptomatic, and seem to be associated with a higher disease burden. Children and young adults with sarcoma should be monitored closely for thrombosis.
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Affiliation(s)
- Ido Paz-Priel
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, USA.
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Abstract
PURPOSE OF REVIEW The aim of this review is to explore the state of the art knowledge on the possible association between venous thromboembolism, especially idiopathic venous thromboembolism, and occult cancer, and to speculate on its implications. RECENT FINDINGS Venous thromboembolism, especially idiopathic venous thromboembolism, is sometimes associated with a subsequent increased risk of newly discovered cancers during the follow-up period. Its incidence approximates 10%. The performance of extensive screening procedures for cancer identification when venous thromboembolism is diagnosed appears advisable if it provides an impact on cancer-related mortality. Recent prospective trials have observed that, thanks to extensive screening procedures, most hidden cancers are detected at baseline or at an earlier stage. Data from these studies do not conclusively demonstrate that earlier diagnosis ultimately prolongs life, but the collective observation makes such a beneficial effect likely. SUMMARY Venous thromboembolism, especially in its idiopathic presentation, may sometimes be a marker for a hidden cancer. With extensive screening procedures, the earlier discovery of cancer, which might mean identification of the disease at an attachable stage, may be crucial, because innovations in treatment protocols provide increasing chances of success and the eradication of cancer.
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Affiliation(s)
- Paolo Prandoni
- Department of Medical and Surgical Sciences, University of Padua, Padua, Italy.
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Lévesque H. [Occult cancer and venous thromboembolism]. Rev Med Interne 2006; 27:273-5. [PMID: 16516354 DOI: 10.1016/j.revmed.2006.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 01/06/2006] [Indexed: 11/25/2022]
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Affiliation(s)
- M Monreal
- Servicio de Medicina Interna, Hospital Universitario Germans Trias i Pujol, Facultat de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain.
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