Page 2529 - Hematology_ Basic Principles and Practice ( PDFDrive )

2252 Part XIII Consultative Hematology

showed an approximately 50% reduction of combined outcome of with pulmonary embolism: a comparison with symptomatic patients.
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compared with warfarin (10.5% versus 21.1%). Based on a number Font C, Farrus B, Vidal L, et al: Incidental versus symptomatic venous
of similar studies, and reflected in a number of current treatment thrombosis in cancer: a prospective observational study of 340 consecu-
guidelines, LMWH is generally preferred for cancer patients with tive patients. Ann Oncol 22(9):2101–2106, 2011.
VTE who do not have other contraindications. Grisariu S, Spectre G, Kalish Y, et al: Increased risk of central venous
Oral anticoagulation agents that directly inhibit factor Xa or catheter-associated thrombosis in acute promyelocytic leukemia: a single-
thrombin are increasingly used in the treatment of VTE. The anti-Xa institution experience. Eur J Haematol 90(5):397–403, 2013.
agents rivaroxaban and apixaban along with the direct thrombin Im JH, Fu W, Wang H, et al: Coagulation facilitates tumor cell spreading
inhibitor dabigatran have been shown to be effective in VTE prophy- in the pulmonary vasculature during early metastatic colony formation.
laxis after major hip and knee surgeries, as well as in stroke prevention Cancer Res 64(23):8613–8619, 2004.
in patients with atrial fibrillation. However, few patients with cancer Lee AY, Levine MN, Baker RI, et al: Low-molecular-weight heparin versus
have been evaluated in these trials, and no studies have specifically a coumarin for the prevention of recurrent venous thromboembolism in
considered the treatment of malignancy associated VTE using these patients with cancer. N Engl J Med 349(2):146–153, 2003.
inhibitors. A small phase II study evaluating the safety and tolerability Levine MN, Gu C, Liebman HA, et al: A randomized phase II trial of apixa-
of apixaban found a low risk of major bleeding (2.2%) during 12 ban for the prevention of thromboembolism in patients with metastatic
weeks of therapy in 125 patients with metastatic or advanced cancer cancer. J Thromb Haemost 10(5):807–814, 2012.
without thrombosis. Safety concerns regarding these agents include the Ludwig H, Van Belle S, Barrett-Lee P, et al: The European Cancer Anaemia
possible interactions with chemotherapeutic agents as well as the Survey (ECAS): a large, multinational, prospective survey defining the
inability to reverse them quickly in a population that has potential prevalence, incidence, and treatment of anaemia in cancer patients. Eur
to rapidly develop cytopenias and bleeding. While these agents are J Cancer 40(15):2293–2306, 2004.
not currently recommended for malignancy-associated VTE, future Lyman GH, Dale DC, Wolff DA, et al: Acute myeloid leukemia or myelo-
study may further clarify the feasibility and efficacy of these agents dysplastic syndrome in randomized controlled clinical trials of cancer
in patients with malignancy and thrombosis. chemotherapy with granulocyte colony-stimulating factor: a systematic
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Meyer G, Marjanovic Z, Valcke J, et al: Comparison of low-molecular-weight
FUTURE DIRECTIONS heparin and warfarin for the secondary prevention of venous thrombo-
embolism in patients with cancer: a randomized controlled study. Arch
Future studies on hematopoiesis and coagulation in cancer patients Intern Med 162(15):1729–1735, 2002.
have the potential to provide insight into new treatment strategies for Nash GF, Turner LF, Scully MF, et al: Platelets and cancer. Lancet Oncol
the many hematologic manifestations of cancer, as well as the treat- 3(7):425–430, 2002.
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hematologic manifestations of malignancy have centered on sup- and angiogenesis: Evidence for a thrombin-regulated dormant tumor
portive care; however, these may also play a role in tumor survival phenotype. Cancer Cell 10(5):355–362, 2006.
and growth. For example, a deeper understanding of how growth Piran S, Ngo V, McDiarmid S, et al: Incidence and risk factors of symp-
factors may play a role in mediating tumor growth could identify new tomatic venous thromboembolism related to implanted ports in cancer
therapeutic targets and strategies. Platelets appear to play increasingly patients. Thromb Res 133(1):30–33, 2014.
intricate roles in tumor metastasis and survival. Given the prevalence Prandoni P, Lensing AW, Piccioli A, et al: Recurrent venous thromboembolism
of thrombosis in cancer patients, new anticoagulation strategies will and bleeding complications during anticoagulant treatment in patients
also prove increasingly important in the management of this unique with cancer and venous thrombosis. Blood 100(10):3484–3488, 2002.
population. Sallah S, Wan JY, Nguyen NP, et al: Disseminated intravascular coagula-
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