Journal of Thrombosis and Thrombolysis

Incidence and risk factors for venous thromboembolism in gynecological cancer: the GOTIC-VTE trial

Prospective analysis of pre and postoperative laboratory parameters associated with thrombosis in patients with ovarian cancer

Patients with ovarian cancer have a high risk of developing thrombosis. We aimed to investigate pre and post operative biomarkers associated with thrombosis including deep vein thrombosis and pulmonary thromboembolism in patients treated for ovarian cancer. We collected pre and post operative blood samples from 133 patients undergoing surgery for ovarian cancer between December 2021 and August 2022. The measured parameters were white blood cell count, hemoglobin, platelets, monocytes, serum glucose, CA125, D-dimer, fibrinogen, prothrombin time, activated partial thromboplastin time, fibrinogen degradation products, antithrombin III, protein C, protein S, plasminogen, plasminogen activator inhibitor 1, homocysteine, N-terminal pro-brain natriuretic peptide, interleukin 6, thrombopoietin, soluble P-selectin and granulocyte stimulating factor. Body mass index of patients were collected. Differences between patients who developed thrombosis and those without were compared with Wilcoxon rank-sum test and we analyzed the continuous variables using logistic regression. Twenty-one (15.8%) patients developed thrombosis ranging from 6 to 146 days (median 15 days) after surgery. Pre operative values of homocysteine (p = 0.033) and IL-6 (p = 0.043) were significantly increased and post operative aPTT (p = 0.022) was prolonged and plasminogen (p = 0.041) was decreased in patients with thrombosis. It is important to find novel biomarkers for thrombosis to carefully manage patients who are prone to develop thrombosis despite preventive measures were applied.

Haemostatic gene variations in cervical cancer-associated venous thrombosis: considerations for clinical strategies

Venous thromboembolism (VTE) is a life-threatening haemostatic disease frequently diagnosed among the cancer population. The Khorana Score is currently the primal risk assessment model to stratify oncological patients according to their susceptibility to VTE, however, it displays a limited performance. Meanwhile, intensive research on VTE pathophysiology in the general population has uncovered a range of single-nucleotide polymorphisms (SNPs) associated with the condition. Nonetheless, their predictive ability concerning cancer-associated thrombosis (CAT) is controversial. Cervical cancer (CC) patients undergoing chemoradiotherapy often experience VTE, which negatively affects their survival. Thus, aiming for an improvement in thromboprophylaxis, new thrombotic biomarkers, including SNPs, are currently under investigation. In this study, the predictive capability of haemostatic gene SNPs on CC-related VTE and their prognostic value regardless of VTE were explored. Six SNPs in haemostatic genes were evaluated. A total of 401 CC patients undergoing chemoradiotherapy were enrolled in a retrospective cohort study. The implications for the time to VTE occurrence and overall survival (OS) were assessed. CAT considerably impacted the CC patients' OS (log-rank test, P  C) showed a significant association with the risk of CC-related VTE (CC/CT vs. TT, log-rank test, P = 0.002; C allele, Cox model, hazard ratio (HR) = 6.99 and P = 0.009), while F2 rs1799963 (G > A) demonstrated an important prognostic value regardless of VTE (AA/AG vs. GG, log-rank test, P = 0.020; A allele, Cox model, HR = 2.76 and P = 0.026). For the remaining SNPs, no significant associations were detected. The polymorphisms SERPINE1 rs2070682 and F2 rs1799963 could be valuable tools in clinical decision-making, aiding in thromboprophylaxis and CC management, respectively.

Long term anticoagulation for Catheter-Related deep vein thrombosis of the upper extremities in women with cancer: retrospective analysis of effectiveness and safety outcomes

Abstract Catheter-related upper extremity deep vein thrombosis (CRT-UEDVT) is a possible complication in patients with cancer carrying a central venous catheter. Anticoagulation is the primary treatment, but optimal duration is unclear. This study evaluated effectiveness and safety of different lengths of anticoagulation in women with cancer and CRT-UEDVT. We conducted a retrospective analysis on women ≥ 18 years-old, who had active cancer and had received anticoagulant treatment for CRT-UEDVT. Effectiveness was assessed in terms of VTE recurrence and thrombosis recanalization. Safety was determined by assessing major bleedings (MB) and clinically relevant non-major bleedings (CRNMB) during treatment. A total of 113 women where included. All of them had completed at least 3 months of anticoagulant therapy, while 106 and 97 had completed 6 and 12 months of anticoagulant therapy, respectively. The median follow-up was 568.5 days (IQR 300–910). Patients primarily presented with ovarian, breast, and endometrial cancers. Anticoagulant therapy was mainly parenteral during the initial 3 months and between 3 and 6 months, shifting predominantly to direct oral anticoagulants during months 6–12. The annual VTE recurrence rate was 0.5%. The annual rate of MB and CRNMB was 1.9%. Complete thrombosis recanalization was achieved in 52.0%, 69.1%, and 87.3% of patients at 3, 6, and 12 months, respectively. Our study provides interesting insights into the management and clinical outcomes of women with cancer and CRT-UEDVT. Prospective studies are needed to fully understand advantages and disadvantages of different lengths of anticoagulation in this set of patients. Graphical abstract