Thromboprophylaxis in surgically treated colorectal cancer patients with tinzaparin: Intermediate results from the Onco-CAST trial

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Background: The incidence of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) after colorectal surgery is approximately 29% and 1.6% respectively. The incidence of asymptomatic postoperative DVT in colorectal cancer (CRC) patients has been reported as high as 20%, even under thromboprophylaxis. Thus, thromboprophylaxis after surgical treatment for CRC is crucial. Latest guidelines from International Initiative on Thrombosis and Cancer (ITAC 2019) recommend use of highest prophylactic dose of Low Molecular Weight Heparin (LMWH). Methods: Onco-CAST is a prospective, phase IV, observational, non-interventional cohort study evaluating a) current management approach for CRC surgical prophylaxis and b) efficacy and safety of tinzaparin at 8.000 Anti-Xa IU, once daily (OD), for at least one month post hospital discharge. Patients enrolled after signing informed consent. Onco-CAST was conducted by the Hellenic Society of Coloproctology. Results: Results from 175 CRC patients from 9 Onco Surgical Clinics are reported. Participation completed 79% of patients at report time: 66% males, 67±12 years, BMI: 27.4±5.5. Histology: adenocarcinomas NOS 81%, mucinous adenocarcinomas 9%, small cell neuroendocrine carcinomas 2%, and others. High grade differentiation indicated: 26% and 5% metastatic. 32% treated with right hemicolectomy, 20% with low anterior resection, 12% with sigmoid colectomy, 9% with abdominal-perineal resection, 9% with left hemicolectomy and other methods. 67% treated open and 33% laparoscopic while the median number of lymph nodes dissected for left and right hemicolectomy was 32.5 (Q1-Q3:26-38) and 24 (Q1-Q3: 14.5-32), p = 0.0253. Factors related to thrombosis risk are presented in table, notably, 95% of patients accumulated ≥3 risk factors. Median thromboprophylaxis duration with tinzaparin 8.000 Anti-Xa IU, OD, was: 37 days (1st-3rd quartile: 33-45 days). Three thrombotic events occurred (efficacy 98.3%, 95% CI: 95.1-99.4%), one DVT+PE, one DVT and one due to Central Venous Catheter (CVC). Eight patients experienced bleeding events (4.6%, 95%CI: 2.3-8.8%), 3 minor, 3 major and 2 CNMB, 2 had a possible relation to thromboprophylaxis (1.1%, 95%CI: 0.3-4.1%). Conclusions: Thromboprophylaxis in Surgically Treated Colorectal Cancer Patients with Tinzaparin intermediate dose seems safe and efficient approach.[Table: see text]

Effect of dietary saffron (Crocus sativusL.) on the oxidative stability of egg yolk

1. The effects of dietary inclusion of red stigmas of Greek saffron (Crocus sativus L.) on the oxidative stability of shell eggs and liquid yolks were investigated and compared with those of dietary a-tocopherol. 2. Ninety-six Lohmann laying hens, 38 weeks old, distributed into 4 groups with 4 replicates each, were given either a control diet, diets enriched with 10 (SAF10) or 20 (SAF20) mg/kg saffron, or a diet enriched with 200 mg/kg a-tocopheryl acetate (VE200). 3. Following 6 weeks of feeding, eggs were collected and the rate of lipid oxidation was determined in refrigerated stored shell eggs, as well as in yolks adjusted to a pH of 6.2 or 4.2 and stored in the presence of light. 4. The results showed that the extent of lipid oxidation in shell eggs, as measured by malondialdehyde (MDA) formation, differed between dietary treatments, but did not change with storage time. In stored shell eggs, MDA levels differed between dietary treatments at all time points. 5. Yolks from the control group adjusted to pH 6.2 gave MDA values higher than those of the SAF10 group, which in turn were higher than those of the SAF20 group, a finding suggesting that saffron exerted a dose-dependent antioxidative activity. The VE200 group gave lower MDA values than the other groups at all time points. The oxidation profile of yolks at pH 4.2 showed a similar pattern but the rate of oxidation was greater.