1' Trousseau, Armand' In Clinique Medicale de l'HtelDieu de - PowerPoint PPT Presentation

Title: 1' Trousseau, Armand' In Clinique Medicale de l'HtelDieu de


1
Cancer and Venous Thromboembolism (VTE)
Armand Trousseau
Association recognized since Trousseaus
observation more than 140 years ago.1 Of all
cases of VTE, approximately 20 occur in cancer
patients.2 VTE affects 420 of cancer
patients antemortem but has been reported in
up to 50 on postmortem examination.3-4
Cancer-associated VTE has important clinical
and economic consequences.5-7
Patients with cancer 20
All deep venous thrombosis and pulmonary embolism
1. Trousseau, Armand. In Clinique Medicale de
l'Hôtel-Dieu de Paris, 2nd ed. Paris J.B.
Bailliere et Fils 1865 2. Lee AY. Br J.
Haematol. 2005128291-302. 3. Gao S et al
Expert Rev Anticncer Ther 2004 4 303-320. 4.
Lyman GH et al J Clin Oncol. 2007 25
5490-5505. 5. Sorensen HT, et al. N Engl J Med.
20003431846-1850. 6. Prandoni P, et al. Blood.
20021003484-3488. 7. Khorana AA, et al. J Clin
Oncol. 200624484-490.
2
Risk of Inpatient VTE By Site of Cancer Solid
Tumor
Discharge database of the University Health
System Consortium 115 U.S. academic medical
centers 66,106 adult neutropenic cancer
patients hospitalized 19952002
Adapted from Khorana et al, J Clin Oncol.
200624484-490
3
Risk of Inpatient VTE by Type of Cancer
Hematologic Malignancies
Adapted from Khorana et al, J Clin Oncol.
200624484-490
4
Unsuspected PE On Routine Cancer Staging Impact
on Survival
Retrospective review of 70 patients with
unsuspected PE found on staging CT
20032006 VTE, anticoagulation or
multiple cancers excluded 21 matching based
on Cancer type Age Stage
Unsuspected PE Subsegmental 24.3
Proximal 75.7
Adapted from OConnell CL et al ASH 2008
5
Anticoagulant Prophylaxis to Prevent
Screen-Detected VTE High Risk Hospitalized
Medical Patients Major Bleeding
1Samama MM, et al. N Engl J Med.
1999341793-800. 2Leizorovicz A, et al.
Circulation. 2004110874-9. 3Cohen AT, et al.
BMJ. 2006 332 325-329.
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Thromboembolism With Bevacizumab Venous
Thromboembolism Meta-Analysis of RCTs
Relative Risk 1.33 95 CI 1.131.56 Absolute
Risk Increase 2.2 95 CI 1.13.3
Adapted from Nalluri, S. R. et al. JAMA.
20083002277-2285.
7
Recurrent VTE and Bleeding During Anticoagulant
Treatment Patients with Cancer and Venous
Thrombosis
Adapted from Prandoni P et al. Blood.
20021003484-3488.
8
CLOT Trial Results 12-month Mortality
Solid tumor patients without metastatic
disease HR0.50 (P.03)
Adapted from Lee AY, et al. N Eng J Med.
2003349146-153. Lee A. Y.Y., et al. J Clin
Oncol. 2005232123-2129.
9
ASCO Recommendations for VTE Prophylaxis in
Patients with Cancer Summary
Adapted form Lyman GH et al J Clin Oncol. 2007
255490-5505.
10
Activation of Coagulation in Cancer Patients
No Cancer Cancer P (n72) (n106) Value Ti
ssue factor, pg/mL 349 582 0.0006 Factor VIIa,
mU/mL 69 100 0.0002 TAT, µg/L 2.0 8.0 0.0001 PF
12, nmol/mL 1.0 3.0 0.0001 Factor XIIa,
ng/mL 2.0 3.0 0.02
Data are median measurements. TATthrombin-antithr
ombin complex PFprothrombin factor.
Adapted from Kakkar AK et al. Lancet.
19953461004-1005.
11
American College of Chest Physicians Consensus
Conference on Antithrombotic Therapy
Major Surgery in Cancer Patients
Adapted from Geerts WH, et al. Chest. 2004126
Suppl 3338S-400S.
12
Extended Prophylaxis After Abdominal Surgery
Safety
Adapted from Bottaro FJ, et al. Thromb Haemost.
200899104-11.