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Analysis of risk factors and prognostic differences in hospital-acquired thrombosis between very preterm infants and moderate to late preterm infants.

OBJECTIVE: Neonates have the highest incidence of thrombosis among pediatric populations, and preterm infants are at a high risk of venous t … outine vascular ultrasound application. A total of 40% of patients received pharmacotherapy (mainly nadroparin calcium, supplemented with rt-PA), with 5% discontinuing medication due to active bleeding. For central venous catheters that were no longer in use, superficial vein thrombosis was managed by immediate catheter removal without anticoagulation. For d …

Cancer-Associated Thrombosis: A New Light on an Old Story.

Cancer-associated thrombosis (CAT) is a rising and significant phenomenon, becoming the second leading cause of death in cancer patients. Pathophysiology of CAT differs from thrombosis in the non-cancer population. There are additional risk factors for thrombosis specific to cancer including cancer type, histology, and treatment, such as chemotherapy. Recently developed scoring systems use these risk factors to stratify the degree of risk and encourage thromboprophylaxis in intermediate- to high-risk patients. Anticoagulation is safely used for prophylaxis and treatment of CAT. Both of these h

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… A total of 1150 patients were randomised in a 2:1 ratio to receive daily subcutaneous nadroparin 3800 IU or placebo for either the entire duration of chemotherapy or four months [ 91 ]. … Trial | Year | Number of Patients | Intervention | VTE Rates | Major Bleeding Events PROTECHT [ 91 ] | 2008 | 1150 | Nadroparin 3800 IU once daily versus placebo | Nadroparin: 2.1% Placebo: 3.9% ( p = 0.02) | Nadroparin: 0.7% Placebo: 0% SAVE-ONCO [ 93 ] | 2012 | 3212 | Semuloparin 20 mg once daily versus …

Prevention of venous thromboembolism in ambulatory patients with cancer.

Patients with cancer are at high risk of venous thromboembolic events, and this risk can be further increased in patients with certain cancer types and by cancer treatments. Guidelines on the prevention of cancer-associated thrombosis (CAT) recommend thromboprophylaxis for hospitalised patients; however, this is not routinely recommended for ambulatory patients receiving chemotherapy and is limited to specified high-risk patients. Identification of the ambulatory patients at risk of CAT who would most benefit from anticoagulant therapy is therefore critical to reduce the incidence of this comp

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… The PROTECHT study investigated the thromboprophylactic effect of nadroparin once daily (od) versus placebo in patients with lung, gastrointestinal, pancreatic, breast, ovarian, or head and neck cancers. 45 Nadroparin significantly reduced the rate of the primary composite endpoint of symptomatic venous … or arterial thromboembolic events versus placebo (p=0.02), and a lower rate of VTE was specifically observed in patients receiving nadroparin versus placebo (1.4% and 2.9%, respectively). …

Clinical guide SEOM on venous thromboembolism in cancer patients.

Venous thromboembolism (VTE) is a common event in cancer patients and one of the major causes of cancer-associated mortality and a leading cause of morbidity. In recent years, the incidence rates of VTE have notably increased; however, VTE is still commonly underestimated by oncologists. VTE is considered an adverse prognostic factor in cancer patients in all settings. In 2011 the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of prophylaxis and treatment of VTE in cancer patients. In an effort to incorporate evidence obtained since the original publication, SE

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… Agnelli G Gussoni G Bianchini C Verso M Mandalà M Cavanna L Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: A randomized, placebo-controlled, double-blind study Lancet Oncol 2009 10 943 949 10.1016/ … Van Doormaal FF Di Nisio M Otten HM Richel DJ Prins M Buller HR Randomized trial of the effect of the low molecular weight heparin nadroparin on survival in patients with cancer J Clin Oncol 2011 29 2071 2076 10.1200/JCO.2010.31.9293 21502549 45. …

Primary Thromboprophylaxis in Patients with Malignancies: Daily Practice Recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO), the Society of Thrombosis and Hemostasis Research (GTH), and the Austrian Society of Hematology and Oncology (ÖGHO).

Patients with cancer, both hematologic and solid malignancies, are at increased risk for thrombosis and thromboembolism. In addition to general risk factors such as immobility and major surgery, shared by non-cancer patients, cancer patients are exposed to specific thrombotic risk factors. These include, among other factors, cancer-induced hypercoagulation, and chemotherapy-mediated endothelial dysfunction as well as tumor-cell-derived microparticles. After an episode of thrombosis in a cancer patient, secondary thromboprophylaxis to prevent recurrent thromboembolism has long been established

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… In fact, a subgroup analysis of the PROTECHT study [ 37 ] confirmed the greatest benefit (number needed to treat [NNT] 15) of LMWH (3800 anti-Xa units nadroparin QD) for high-risk patients, i.e., those with a Khorana Score ≥ 3 [ 44 ]. … QD | Severe kidney dysfunction (creatinine clearance </= 30 mL/min): Great care is necessary Nadroparin | Prophylaxis of VTE | Prophylaxis: 2850–5700 IE s.c. …

Updated meta-analysis on prevention of venous thromboembolism in ambulatory cancer patients.

Randomized clinical trials have evaluated the role of anticoagulants in the prevention of venous thromboembolism (VTE) in ambulatory cancer patients treated with chemotherapy. This meta-analysis is aimed at providing an updated evaluation of the efficacy and safety of anticoagulant prophylaxis in this clinical setting. Medline and Scopus were searched to retrieve randomized controlled trials on the prevention of VTE in ambulatory cancer patients. Two groups of trials were identified with VTE or death as the primary outcome, respectively. VTE was the primary outcome of this analysis. Anticoagul

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… Thromb Haemost . 2003 ; 90 ( 2 ): 235 – 244 . 12888870 10.1160/TH02-11-0283 21 Agnelli G Gussoni G Bianchini C Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind … Mayo Clin Proc . 2006 ; 81 ( 6 ): 758 – 767 . 16770976 10.4065/81.6.758 35 van Doormaal FF Di Nisio M Otten HM Richel DJ Prins M Buller HR Randomized trial of the effect of the low molecular weight heparin nadroparin on survival in patients with cancer . …

Safety and Effectiveness of Direct Oral Anticoagulants Versus Low-Molecular-Weight Heparin for Cancer-Associated Thrombosis: A Systematic Review and Meta-analysis.

BACKGROUND: Cancer-associated thrombosis is a condition associated with high mortality rates, yet limited evidence exists regarding the safety and effectiveness of low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs), focusing on a fixed follow-up period based on clinical practice guideline recommendations. OBJECTIVE: This study aimed to compare the safety and effectiveness of DOACs versus LMWH in patients with cancer-associated thrombosis over a 6-month follow-up period. METHODS: PubMed, Embase, and Cochrane Library databases were systematically searched up to 30 June,

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… inclusion criteria were included: (1) study design: an RCT or retrospective/prospective cohort study; (2) language: English; (3) population: adult patients with CAT; (4) interventions: DOACs (apixaban, edoxaban, rivaroxaban, or dabigatran); (5) control: LMWH (dalteparin, enoxaparin, tinzaparin, bemiparin, nadroparin … period Lee et al. (2019) [ 14 ] | Retrospective cohort study | South Korea | 1 center | 20120101–20161231 | 6 | Gastrointestinal tract cancer (including stomach cancer, colorectal cancer, and pancreaticobiliary cancers) | 281 | Mean (SD): 66.5 (11.6) | 79.7 | Rivaroxaban | Dalteparin, enoxaparin, or nadroparin …

Thrombotic complications in patients with cancer: Advances in pathogenesis, prevention, and treatment-A report from ICTHIC 2021.

Venous thromboembolism (VTE) is a common complication in cancer patients, resulting in deep vein thrombosis (DVT) or pulmonary embolism (PE), and is responsible for high morbidity and mortality. This article discusses evidence and future perspectives on pathogenesis and prevention and treatment of thrombotic complications in patients with cancer. In April 2021, international basic researchers and clinicians met for the virtual edition of the 10th International Conference on Thrombosis & Hemostasis Issues in Cancer. Pathogenic mechanisms, markers and scores for risk assessment, diagnosis and th

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… would need further investigation. 42 The incidence of VTE associated with cancer has increased in the past decade because of novel cancer therapies, high‐resolution imaging, and improved survival. 43 The benefit of thromboprophylaxis in unselected outpatients with solid tumors was demonstrated with nadroparin … Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo‐controlled, double‐blind study. Lancet Oncol. 2009;10(10):943–949. doi: 10.1016/S1470-2045(09)70232-3 45. …

Venous thromboembolism in cancer patients: an underestimated major health problem.

Venous thromboembolism (VTE) is a major health problem among patients with cancer, its incidence in this particular population is widely increasing. Although VTE is associated with high rates of mortality and morbidity in cancer patients, its severity is still underestimated by many oncologists. Thromboprophylaxis of VTE now considered as a standard of care is still not prescribed in many institutions; the appropriate treatment of an established VTE is not yet well known by many physicians and nurses in the cancer field. Patients are also not well informed about VTE and its consequences. Many

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… To address this question, two prospective randomized studies compared LMWH with placebo [ 46 , 77 ], PROTECHT (nadroparin, 1,150 patients) and SAVE-ONCO (semuloparin, 3,212 patients). … Chemotherapy-associated thromboembolic risk in cancer outpatients and effect of nadroparin thromboprophylaxis: results of a retrospective analysis of the PROTECHT study. 10.1186/1479-5876-9-179 PMC3220644 22013950 44. Khorana AA, Herman K, Rubens D, Francis CW. …

Cancer-Associated Thrombosis: A Clinical Scoping Review of the Risk Assessment Models Across Solid Tumours and Haematological Malignancies.

Cancer-associated thrombosis (CAT) is a leading cause of death in cancer patients receiving outpatient chemotherapy. The latest guidelines emphasize stratifying the patients in terms of CAT risks periodically. Multiple risk assessment models (RAMs) were developed to classify patients and guide thromboprophylaxis to high-risk patients. This study aimed to discuss and highlight different RAMs across various malignancy types with their related advantages and disadvantages. A scoping review was conducted using predefined search terms in three scientific databases, including Google Scholar, Science

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… Uterine, Cervical, Ovarian, Pancreas, Stomach | Site of cancer and D-dimer | 0.66 in CATS 0.68 in MICA | Comparison study with no statistical significance 2 * | Advantages: only two factors score Disadvantage: Suboptimal performance in the comparison trial PROTECHT Score (2012) | Placebo arm, n = 381 Nadroparin … Chemotherapy-associated thromboembolic risk in cancer outpatients and effect of nadroparin thromboprophylaxis: results of a retrospective analysis of the PROTECHT study. J Transl Med . 2011;9(1):179. doi: 10.1186/1479-5876-9-179 40. Verso M, Agnelli G, Barni S, Gasparini G, LaBianca R. …

Guidance for the prevention and treatment of cancer-associated venous thromboembolism.

Venous thromboembolism (VTE) is a highly prevalent complication of malignancy with emerging changes in incidence, diagnosis and treatment paradigms. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. We address a) the appropriate workup to search for occult malignancy in patients with idiopathic VTE, b) identification of high-risk cancer patients for primary thromboprophylaxis, c) the appropriate immediate and long-term treatment for people with cancer diagnosed with acute t

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… Rates of VTE in high-risk patients (Khorana Score ≥3) enrolled in PROTECHT were 11.1 % in the placebo arm and 4.5 % in the nadroparin arm (NNT = 15, compared to 77 for low- and intermediate-risk patients) [ 28 ]. … Agnelli G Gussoni G Bianchini C Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind study Lancet Oncol 2009 10 10 943 949 10.1016/S1470-2045(09)70232-3 19726226 …

Quality of Life in Patients With Cancer Under Prolonged Anticoagulation for High-Risk Deep Vein Thrombosis: a Long-Term Follow-Up.

Current guidelines recommend to prolong anticoagulant treatment in patients with cancer with venous thromboembolism (VTE); only few studies evaluated other parameters than cancer itself for selecting patients at higher risk of recurrent VTE. Long-term management of VTE is thus challenged by several controversies mainly for patients compliance. We here report results of a long-term follow-up in patients with deep vein thrombosis under anticoagulant treatment with low-molecular-weight heparin (LMWH) for residual vein thrombosis (RVT) detected at compression ultrasonography (CUS), 6 months after

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… Study Design Patients, with a first episode of cancer-related DVT of the lower limbs, were evaluated after 6 months of LMWH, administered at therapeutic dosage (nadroparine, approximately 100 UI anti-FXa bid) for the first month, then reduced at 75% for the following 5 months. …

Multidisciplinary Care for the Prevention and Treatment of Venous Thromboembolism in Patients with Cancer-Associated Thrombosis (CAT): Impact of Educational Interventions on CAT-Related Events and on Patients' and Clinicians' Awareness.

Cancer is a leading cause of death. Venous thromboembolism (VTE) is an often-overlooked cause of morbidity and mortality in cancer patients that can be readily prevented and treated. Actions are needed to reduce the morbidity and mortality of patients with cancer-associated thrombosis (CAT). There is a need to increase awareness of the impact of CAT on cancer patients' morbidity and mortality, on their quality of life and to understand the importance of more effective preventions and treatments of VTE in cancer patients. Moreover, it is of great importance to systematically assess the risk of

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… Two examples of this failure are the two large studies on prophylaxis with semuloparin or nadroparin in cancer patients receiving chemotherapy, SAVE-ONCO and, respectively. Patients had solid tumors with locally advanced or metastatic disease extension and high thromboembolic risk. … In this subgroup, the incidence of VTE was 11.1% in the placebo arm and 4.5% in the nadroparin arm; thus, the NNT to prevent an event was 15, a significant reduction compared with the total study population where the NNT was 53. …

BCR-ABL1 tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia.

The management of chronic myeloid leukemia with BCR-ABL1 tyrosine kinase inhibitors has evolved chronic myeloid leukemia into a chronic, manageable disease. A patient-centered approach is important for the appropriate management of chronic myeloid leukemia and optimization of long-term treatment outcomes. The pharmacist plays a key role in treatment selection, monitoring drug-drug interactions, identification and management of adverse events, and educating patients on adherence. The combination of tyrosine kinase inhibitors with unique safety profiles and individual patients with unique medica

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… Prothrombin time and international normalized ratio should be monitored in imatinib- and nilotinib-treated patients taking warfarin, while dasatinib-treated patients taking warfarin, heparin, enoxaparin, nadroparin, and dalteparin may have an elevated risk of bleeding. 46 Also, because there is an increased … bioactivation | CYP 3A4 inhibition → decreased clopidogrel bioactivation Dalteparin | NR | Increased risk of bleeding | NR Enoxaparin | NR | Increased risk of bleeding | NR Heparin | PgP inhibition → increased imatinib exposure | • Increased risk of bleeding • PgP inhibition → increased dasatinib exposure | NR Nadroparin …

Livedoid vasculopathy: A multidisciplinary clinical approach to diagnosis and management.

Livedoid vasculopathy (LV) is a rare, chronic, and occlusive disease of the veins supplying the upper parts of the skin. The pathogenesis of the disease is not precisely understood, and its attacks are often unpredictable but tend to worsen during the summer. LV affects women more often. This increased risk for LV in women might be related to sex-specific physiological conditions, such as pregnancy, or a higher incidence of LV-associated conditions, such as connective tissue diseases, hypercoagulable states, and venous stasis in women. The typical clinical appearance of LV consists of three ma

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… interactions Heparin ( Abou Rahal et al., 2012 ; Di Giacomo et al., 2010 ; Francès and Barete, 2004 ) Decreases blood viscosity; increases fibrinolytic activity; increases activity of tissue plasminogen activator Dose of 5000 U/12 hr, subcutaneously Bleeding, thrombocytopenia LMWH (enoxaparin, dalteparin, nadroparin … Heparin ( Abou Rahal et al., 2012 ; Di Giacomo et al., 2010 ; Francès and Barete, 2004 ) | Decreases blood viscosity; increases fibrinolytic activity; increases activity of tissue plasminogen activator | Dose of 5000 U/12 hr, subcutaneously | Bleeding, thrombocytopenia LMWH (enoxaparin, dalteparin, nadroparin …

Venous and Arterial Thromboembolism in Patients With Cancer: JACC: CardioOncology State-of-the-Art Review.

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, represents a major cause of morbidity and mortality in patients with cancer. Arterial thromboembolism, including myocardial infarction and stroke, is also prevalent. Risk differs in subgroups, with higher rates observed in specific cancers including pancreas, stomach, and multiple myeloma. Thromboprophylaxis is recommended for most patients with active cancer hospitalized for medical illnesses and after major cancer surgery. Outpatient thromboprophylaxis is not routinely recommended, but emerging data suggest

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… The PROTECHT (Prophylaxis Thromboembolic Event Chemotherapy) study included patients with lung, breast, GI, head and neck, and ovarian cancers randomly assigned to receive daily subcutaneous nadroparin (3,800 U) or placebo. … Rates of VTE in high-risk patients were 11.1% with placebo and 4.5% with nadroparin (number needed to treat [NNT] 15 vs. 77 in low- and intermediate-risk patients) without increasing the risk of major or clinically relevant nonmajor bleeding (CRNMB) ( 53 ). …

Thromboembolic events in cancer patients on active treatment with cisplatin-based chemotherapy: another look!

BackgroundThe risk of thromboembolic events is higher among cancer patients, especially in patients undergoing chemotherapy. Cisplatin-based regimens claim to be associated with a very high thromboembolic rate. In this study, we report on our own experience with thrombosis among patients on active cisplatin-based chemotherapy.MethodsMedical records and hospital databases were searched for all the patients treated with any cisplatin-based regimen for any kind of cancer. Thrombosis was considered cisplatin-related if diagnosed any time after the first dose and up to 4 weeks after the last. The K

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… Barni S Labianca R Agnelli G Bonizzoni E Verso M Mandalà M Chemotherapy-associated thromboembolic risk in cancer outpatients and effect of nadroparin thromboprophylaxis: results of a retrospective analysis of the PROTECHT study J Transl Med 2011 9 179 10.1186/1479-5876-9-179 22013950 PMC3220644 30. …

Venous thromboembolism in the cancer population: pathology, risk, and prevention.

Patients with cancer have an increased risk of developing venous thromboembolism (VTE) and the incidence of these events has been increasing over the past decade. Venous thromboembolic events include both deep venous thrombosis and pulmonary embolism. These events contribute to higher morbidity and mortality rates. Understanding the complex pathogenesis of and risk factors for cancer-associated VTE will help guide advanced practitioners to improve outcomes with prophylaxis. The American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the European Society of Medical

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… thromboembolic disease–v.2.2011 NCCN clinical practice guidelines in oncology http://www.nccn.org/professionals/physician_gls/pdf/vte.pdf 10.6004/jnccn.2008.0055 18926086 40 Niers T M H Di Nisio M Klerk C P W Baarslag H J Büller H R Biemond B J Prevention of catheter-related venous thrombosis with nadroparin …

Primary prevention of venous thromboembolism in medical and surgical oncology patients.

Recent data suggest that patients with a malignancy have a seven-fold increased risk for venous thromboembolism (VTE) compared with those without cancer, suggesting that these patients may benefit from thromboprophylaxis. Mechanisms for the prevention of thromboembolism can be divided into two broad categories: mechanical and pharmacological. Although generally used in combination with pharmacotherapy, little evidence exists for the efficacy of mechanical modalities either in the broader population of patients at risk for VTE or for patients with cancer specifically. A recent study using gradu

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… In the United Kingdom, five LMWHs are available for clinical use for specific indications, including dalteparin, enoxaparin sodium, tinzaparin, nadroparin sodium, and bemiparin. Dalteparin very recently gained a European licence for use as a thromboprophylactic in patients with cancer. …

Cancer-associated thrombosis: prevention and treatment.

Patients with cancer are at high risk to develop venous thromboembolism, and they are also more likely to develop complications from anticoagulant treatment. Because little research has focused on the oncology population to date, the optimal methods of prophylaxis and treatment remain uncertain in some clinical situations. Currently, low molecular weight heparin and warfarin are the most frequently used pharmacologic agents; however, they have their limitations. Other therapeutic options, such as inferior caval filters, are poorly studied and remain controversial. A summary of the most recent

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… Patients ( n ) | Regimen | Duration of treatment | Outcome | Incidences | | | Study | Control | | | vte | Major bleeding | | | | | | | Study (%) | Control (%) | p Value | Study (%) | Control (%) | p Value Nurmohamed et al. , 1996 15 | Craniotomy or spinal surgery for tumour or injury | 485 | Nadroparin …