Current state of non-hematologic cancer-associated thrombosis at a tertiary care hospital in India

Abstract Introduction Cancer-associated thrombosis is a leading cause of morbidity and mortality in malignancy patients. Prophylactic anticoagulation is under-utilized and the cost of low-molecular-weight heparin (LMWH) and direct oral anticoagulants is a major barrier in developing countries. Material and methods A retrospective analysis was performed of all cancer-associated thrombosis patients attending the thrombosis clinic at a tertiary-level referral hospital based in North India between 2011 and 2015. Patient demographics and disease-related parameters were collected and analyzed. Results A total of 771 patients attended the thrombosis clinic during study period, of which 64 cases were malignancy-associated. Of these, 56% of the patients were female and 20% were bedridden. The median age was 48.5 years, adenocarcinoma (48%) being the most common histological subtype. Gynecological malignancies (30%) were the most common malignancies, followed by genitourinary (11%) malignancies. Most of the cases occurred during first year of diagnosis (51%), and only 14% occurred after 3 years. Most of the patients were on combined treatment. Almost 40% of the patients developed thrombosis within 30 days of surgical treatment. Lower limb thrombosis was the most commonly seen type (56%), while abdominal and pulmonary thrombosis were both seen in 5%. Patients were managed with LMWH and vitamin K antagonists (84.3%) and only 6.25% with LMWH alone. Direct oral anticoagulants were not commonly used during the study period. Discussion At the hospital studied, most of the cases occurred early in the disease course. Postoperative prophylaxis could have contributed towards reducing thrombosis in the peri-operative period. Early suspicion and prompt treatment can improve quality of life in such patients.

Advances in the study of new oral anticoagulants in cancer-associated venous thromboembolism / 中国临床药理学与治疗学

Venous thromboembolism (VTE) is one of the common complications of cancer and the second cause of death in cancer patients. Low molecular weight heparin(LMWH) is the standard of care but the high cost and the inconvenience of daily injections have led to low persistence with therapy. New oral anticoagulants (NOACs) have recently emerged as a new therapeutic option due to the ease of administration, especially compared to warfarin. The patients do not have to do laboratory monitoring for NOACs and there is less food or drug interactions. Several large randomized clinical trials have been performed and indicated that specific NOACs are more effective in the treatment of cancer-associated VTE compared with LMWH, but might increase the risk of bleeding. In some kinds of tumors, NOACs will be the reasonable alternative agents in the management of cancer-associated VTE. This review summarizes the current evidences for NOACs in the prevention and treatment of CAT, and there are ongoing studies providing more evidences for NOACs in CAT as well.