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1.
HemaSphere ; 6:3200-3201, 2022.
Article in English | EMBASE | ID: covidwho-2032144

ABSTRACT

Background: Arterial thrombotic events (ATE) are important cause of noncancer-related deaths among patients with cancer. It is estimated that the prevalence of ATE among those patients is between 2-5%. However, data regarding acute myeloid leukemia (AML) related ATE are scarce and far less available than those related to venous thrombotic events. Aims: To determine the incidence of ATE in nonM3-AML patients and to underline the potential risk factors for ATE development. Methods: The single center, retrospective, cohort study was carried out in University Clinical Center of Serbia. Adult patients, who were diagnosed with nonM3-AML between January 2009. and December 2021. were included. In all patients the occurrence of ATE (e.g. a heart attack, a stroke, critical limb ischemia) was assessed during the active treatment and the three months following the last chemotherapy session. Diagnosis of ATE was established using clinical, laboratory and radiological methods. Patients who experienced venous thromboembolism during the treatment period were excluded. Demographic data, presence of obesity, smoking status, history of thrombosis, baseline laboratory findings (complete blood count, fibrinogen, D-dimer, PT, aPTT, LDH), leukemia-related parameters (cytogenetics (including ELN risk stratification), flow cytometry), Khorana score, ECOG PS, HCT CI score, concurrent COVID-19 were collected from patients' health records. The methods of descriptive (mean ± standard deviation, median (range), frequency (%)) and analytic statistics (Student's t-test, chi-squared test) were used. Results: A total of 545 patients (293 males (53.8%)) were included in the study. Median age of the study population was 58 (range: 18-81) years. ATE was noted in 18/545 (3.3%) subjects with following distribution: ischemic stroke 12/18 (66.7%), myocardial infarction 5/18 (27.8%), and acute lower extremity arterial thrombosis 1/18 (5.5%). ATE was diagnosed most commonly during the induction (8 (44.4%) patients), reinduction (3 (16.7%) patients) and consolidation (4 (22.2%) patients) cycles. However, cases of ATE were noted at diagnosis (1 (5.6%) patient), after transplantation (1 (5.6%) patient) or at relapse (1 (5.6%) patient) as well. ATE were significantly more frequent among patients with previous history of thromboembolic events (p = 0.016). Moreover, ATE were more common in patients with adverse cytogenetic abnormalities (p < 0.001). Other examined parameters did not significantly differ between those with and without ATE. Summary/Conclusion: The incidence of arterial thrombosis in our group was 3.3% which is in accordance with the previously published studies. Since the great number of already known risk factors for the arterial thrombosis are modifiable (e.g. smoking, diet, physical activity, excessive drinking?) it is important to actively work on the reduction on those risk factors, especially if the patient has the history of previous thromboembolic event and/or suffer from high risk AML. Prophylactic therapy with antiplatelet agents is aggravated due to the lack of firmer evidences and the presence of thrombocytopenia. Therefore further studies regarding this issue are needed.

3.
Lancet Oncology ; 23(7):E334-E347, 2022.
Article in English | Web of Science | ID: covidwho-1980468

ABSTRACT

The International Initiative on Thrombosis and Cancer is an independent academic working group of experts aimed at establishing global consensus for the treatment and prophylaxis of cancer-associated thrombosis. The 2013, 2016, and 2019 International Initiative on Thrombosis and Cancer clinical practice guidelines have been made available through a free, web-based mobile phone application. The 2022 clinical practice guidelines, which are based on a literature review up to Jan 1, 2022, include guidance for patients with cancer and with COVID-19. Key recommendations (grade 1A or 1B) include: (1) low-molecular-weight heparins (LMWHs) for the initial (first 10 days) treatment and maintenance treatment of cancer-associated thrombosis;(2) direct oral anticoagulants for the initial treatment and maintenance treatment of cancer-associated thrombosis in patients who are not at high risk of gastrointestinal or genitourinary bleeding, in the absence of strong drug-drug interactions or of gastrointestinal absorption impairment;(3) LMWHs or direct oral anticoagulants for a minimum of 6 months to treat cancer-associated thrombosis;(4) extended prophylaxis (4 weeks) with LMWHs to prevent postoperative venous thromboembolism after major abdominopelvic surgery in patients not at high risk of bleeding;and (5) primary prophylaxis of venous thromboembolism with LMWHs or direct oral anticoagulants (rivaroxaban or apixaban) in ambulatory patients with locally advanced or metastatic pancreatic cancer who are treated with anticancer therapy and have a low risk of bleeding.

4.
Research and Practice in Thrombosis and Haemostasis ; 5(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1509073

ABSTRACT

Background : Administration of a standard-dose thromboprophylaxis in all hospitalized Coronavirus disease (COVID-19) patients is recommended. However, despite thromboprophylaxis, frequent thrombotic complications are diagnosed. Rotational thromboelastometry (ROTEM) is a method to access hypercoagulable state in whole blood from these patients. Aims : To analyze ROTEM parameters during the entire clinical COVID-19 stages including mild, moderate and critical phases and to assess the extent of hypercoagulablity by profiling ROTEM patterns. Methods : We evaluated coagulation abnormalities via traditional tests and ROTEM profile in a group of 94 patients with confirmed SARS-CoV-2 infection with different severity of pneumonia (34 moderate, 25 severe, 35 critical). Shorter than normal clotting time (CT) and higher than normal maximum clot firmness (MCF) in extrinsic rotational thromboelastometry (EXTEM) and fibrinogen rotational thromboelastometry (FIBTEM), shorter than normal EXTEM clot formation time (CFT), and higher than normal α-angle were identified as markers of hypercoagulable state. Results : At least one hypercoagulable ROTEM parameter had 62 (66%) patients. Increment in the number of patients with ≥ 2 hypercoagulable parameters, higher EXTEM ( P = .0001), FIBTEM MCF ( P = 0.0001) and maximum lysis decrement ( P = 0.002) with increment in disease severity was observed ( P = 0.0001). Significant positive correlations between IL6 and CT EXTEM ( P = 0.003), MCF EXTEM ( P = 0.033), MCF FIBTEM ( P = 0.01), and negative with ML EXTEM ( P = 0.006) were seen. Conclusions : These findings confirm that a hypercoagulable ROTEM profile characterized by clot formation acceleration, high clot strength, and reduced fibrinolysis was more frequent in advanced disease groups and patients with elevated IL6. These results underscore the need for different thromboprophylactic approaches for different severity groups.

5.
HemaSphere ; 5(SUPPL 2):641-642, 2021.
Article in English | EMBASE | ID: covidwho-1393455

ABSTRACT

Background: Thrombosis is frequently diagnosed in patients with Coronavirus disease (COVID - 19), despite the use of a standard-dose thromboprophylaxis in all hospitalized. Since conventional coagulation tests (CCTs) reflect only limited parts of the coagulation system and are insufficient to assess hypercoagulability, rotational thromboelastometry (ROTEM) could be more effective in identifying hypercoagulable pattern and patient in high-risk of thrombosis. Aims: 1. To analyze ROTEM parameters across the entire clinical COVID-19 pneumonia spectrum, from moderate to critical. 2. To determine the incidence of hypercoagulable ROTEM patterns and improve risk stratification. Methods: We evaluated coagulation abnormalities via CCTs and ROTEM in a group of 94 patients with confirmed SARS-CoV-2 infection and different severity of pneumonia (34 moderate, 25 severe, 35 critical). Shorter than normal clotting time (CT) and higher than normal maximum clot firmness (MCF) in both extrinsic pathway (EXTEM) and fibrinogen pathway (FIBTEM), as well as shorter than normal EXTEM clot formation time (CFT) and higher than normal α-angle were classified as markers of hypercoagulable state. Results: At least one hypercoagulable ROTEM parameter had 62 (66%) patients. Increment in the number of patients with ≥ 2 hypercoagulable parameters, higher EXTEM MCF (P = 0.0001), higher FIBTEM MCF (P = 0.0001) and decrement in maximum lysis (P = 0.002) were observedwith increment in disease severity (P = 0.0001). Significant positive correlations between interleukine - 6 (IL6) and CT EXTEM (P = 0.003), MCF EXTEM (P = 0.033), MCF FIBTEM (P = 0.01) as well as negative with ML EXTEM (P = 0.006) were seen. Contrary to hypercoagulable ROTEM pattern which was not predictive for death, hypocoagulability represented by prolonged EXTEM CT (P = 0.0001) and CFT (P = 0.0001), smaller α angle (P = 0.014) and a prolonged FIBTEM CT (P = .0001) was a predictor. Summary/Conclusion: Our findings confirmed that a hypercoagulable ROTEM pattern characterized by clot formation acceleration, high clot strength, and reduced fibrinolysis was more frequent in advanced disease groups and patients with high IL6. These results support the need for different thromboprophylaxis approaches for different severity groups.

6.
Roeker, L. E.; Scarfo, L.; Chatzikonstantinou, T.; Abrisqueta, P.; Eyre, T. A.; Cordoba, R.; Prat, A. M.; Villacampa, G.; Leslie, L. A.; Koropsak, M.; Quaresmini, G.; Allan, J. N.; Furman, R. R.; Bhavsar, E. B.; Pagel, J. M.; Hernandez-Rivas, J. A.; Patel, K.; Motta, M.; Bailey, N.; Miras, F.; Lamanna, N.; Alonso, R.; Osorio-Prendes, S.; Vitale, C.; Kamdar, M.; Baltasar, P.; Osterborg, A.; Hanson, L.; Baile, M.; Rodriguez-Hernandez, I.; Valenciano, S.; Popov, V. M.; Garcia, A. B.; Alfayate, A.; Oliveira, A. C.; Eichhorst, B.; Quaglia, F. M.; Reda, G.; Jimenez, J. L.; Varettoni, M.; Marchetti, M.; Romero, P.; Grau, R. R.; Munir, T.; Zabalza, A.; Janssens, A.; Niemann, C. U.; Perini, G. F.; Delgado, J.; San Segundo, L. Y.; Roncero, M. I. G.; Wilson, M.; Patten, P.; Marasca, R.; Iyengar, S.; Seddon, A.; Torres, A.; Ferrari, A.; Cuellar-Garcia, C.; Wojenski, D.; El-Sharkawi, D.; Itchaki, G.; Parry, H.; Mateos-Mazon, J. J.; Martinez-Calle, N.; Ma, S.; Naya, D.; Van der Spek, E.; Seymour, E. K.; Vazquez, E. G.; Rigolin, G. M.; Mauro, F. R.; Walter, H. S.; Labrador, J.; De Paoli, L.; Laurenti, L.; Ruiz, E.; Levin, M. D.; Simkovic, M.; Spacek, M.; Andreu, R.; Walewska, R.; Perez-Gonzalez, S.; Sundaram, S.; Wiestner, A.; Cuesta, A.; Broom, A.; Kater, A. P.; Muina, B.; Velasquez, C. A.; Ujjani, C. S.; Seri, C.; Antic, D.; Bron, D.; Vandenberghe, E.; Chong, E. A.; Lista, E.; Garcia, F. C.; Del Poeta, G.; Ahn, I.; Pu, J. J.; Brown, J. R.; Campos, J. A. S.; Malerba, L.; Trentin, L.; Orsucci, L.; Farina, L.; Villalon, L.; Vidal, M. J.; Sanchez, M. J.; Terol, M. J.; De Paolis, M. R.; Gentile, M.; Davids, M. S.; Shadman, M.; Yassin, M. A.; Foglietta, M.; Jaksic, O.; Sportoletti, P.; Barr, P. M.; Ramos, R.; Santiago, R.; Ruchlemer, R.; Kersting, S.; Huntington, S. F.; Herold, T.; Herishanu, Y.; Thompson, M. C.; Lebowitz, S.; Ryan, C.; Jacobs, R. W.; Portell, C. A.; Isaac, K.; Rambaldi, A.; Nabhan, C.; Brander, D. M.; Montserrat, E.; Rossi, G.; Garcia-Marco, J. A.; Coscia, M.; Malakhov, N.; Fernandez-Escalada, N.; Skanland, S. S.; Coombs, C. C.; Ghione, P.; Schuster, S. J.; Foa, R.; Cuneo, A.; Bosch, F.; Stamatopoulos, K.; Ghia, P.; Mato, A. R.; Patel, M..
Blood ; 136:14, 2020.
Article in English | Web of Science | ID: covidwho-1088505
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