Thrombosis in Cancer: A Medical Professional`s Guide to Cancer Associated Thrombosis

134 Pages·2022·6.726 MB·English

by  Supratik Rayamajhi, Prajwal Dhakal, Shiva Shrotriya, Nishraj Basnet

Thrombosis in Cancer:
A Medical Professional's Guide to
Cancer Associated Thrombosis
Edited by
Supratik Rayamajhi
Prajwal Dhakal
Shiva Shrotriya
&
Nishraj Basnet
Department of Medicine,
Michigan State University,
USA
(cid:55)(cid:75)(cid:85)(cid:82)(cid:80)(cid:69)(cid:82)(cid:86)(cid:76)(cid:86)(cid:3)(cid:76)(cid:81)(cid:3)(cid:38)(cid:68)(cid:81)(cid:70)(cid:72)(cid:85)(cid:29)
A Medical Professional's Guide to Cancer Associated Thrombosis
Editors: Supratik Rayamajhi, Prajwal Dhakal, Shiva Shrotriya, and Nishraj Basnet
ISBN (Online): 978-1-68108-784-9
ISBN (Print): 978-1-68108-785-6
ISBN (Paperback): 978-1-68108-786-3
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CONTENTS
FOREWORD ........................................................................................................................................... i
PREFACE ................................................................................................................................................ ii
LIST OF CONTRIBUTORS .................................................................................................................. iii
CHAPTER 1 OVERVIEW OF CANCER-ASSOCIATED THROMBOSIS ................................... 1
Prajwal Dhakal and Nishraj Basnet
INTRODUCTION .......................................................................................................................... 1
EPIDEMIOLOGY .......................................................................................................................... 2
PROGNOSIS AND IMPACT OF VTE IN CANCER PATIENTS ............................................ 3
CONSENT FOR PUBLICATION ................................................................................................ 4
CONFLICT OF INTEREST ......................................................................................................... 4
ACKNOWLEDGEMENTS ........................................................................................................... 4
REFERENCES ............................................................................................................................... 4
CHAPTER 2 PATHOPHYSIOLOGY AND RISK FACTORS FOR CANCER-ASSOCIATED
THROMBOSIS ........................................................................................................................................ 7
Fawzi Abu Rous, Layan A Elkhatib and Prajwal Dhakal
PATHOPHYSIOLOGY ................................................................................................................. 8
RISK FACTORS ............................................................................................................................ 12
Tumor Related Factors ............................................................................................................ 12
Treatment-Related Factors ...................................................................................................... 13
Surgery .......................................................................................................................... 13
Hospitalization .............................................................................................................. 13
Chemotherapy, Hormonal Therapy, and Radiotherapy ................................................ 13
Supportive Therapy ....................................................................................................... 15
Patient-Related Factors ........................................................................................................... 15
BIOMARKERS ............................................................................................................................... 16
RISK MODELS .............................................................................................................................. 17
CONSENT FOR PUBLICATION ................................................................................................ 19
CONFLICT OF INTEREST ......................................................................................................... 19
ACKNOWLEDGEMENTS ........................................................................................................... 19
REFERENCES ............................................................................................................................... 19
CHAPTER 3 IMPACT OF VENOUS THROMBOEMBOLISM ON CANCER SURVIVAL ..... 27
Manoj Rai
BACKGROUND ............................................................................................................................. 27
INCIDENCE ................................................................................................................................... 27
MORTALITY ................................................................................................................................. 28
VTE RECURRENCE ..................................................................................................................... 29
EFFECT OF ANTICOAGULATION IN CANCER ................................................................... 29
CONCLUSION ............................................................................................................................... 30
CONSENT FOR PUBLICATION ................................................................................................ 30
CONFLICT OF INTEREST ......................................................................................................... 30
ACKNOWLEDGEMENTS ........................................................................................................... 30
REFERENCES ............................................................................................................................... 30
CHAPTER 4 OCCULT CANCER WORKUP IN IDIOPATHIC VENOUS
THROMBOEMBOLISM ....................................................................................................................... 33
Manoj Rai
INTRODUCTION .......................................................................................................................... 33
CONSENT FOR PUBLICATION ................................................................................................ 36
CONFLICT OF INTEREST ......................................................................................................... 36
ACKNOWLEDGEMENTS ........................................................................................................... 36
REFERENCES ............................................................................................................................... 36
CHAPTER 5 CHEMOTHERAPY INDUCED THROMBOSIS ...................................................... 40
Manoj Rai and Nishraj Basnet
INTRODUCTION .......................................................................................................................... 40
PATHOPHYSIOLOGY ................................................................................................................. 41
PROPHYLAXIS DURING CHEMOTHERAPY ........................................................................ 42
CONSENT FOR PUBLICATION ................................................................................................ 43
CONFLICT OF INTEREST ......................................................................................................... 43
ACKNOWLEDGEMENTS ........................................................................................................... 43
REFERENCES ............................................................................................................................... 43
CHAPTER 6 CATHETER-RELATED THROMBOSIS IN CANCER ........................................... 47
Prajwal Dhakal
INTRODUCTION .......................................................................................................................... 47
EPIDEMIOLOGY AND RISK FACTORS ................................................................................. 48
PATHOPHYSIOLOGY AND TYPES OF CRT ......................................................................... 48
Pericatheter Sheath or Fibrin Sleeve ....................................................................................... 49
Intraluminal Clot ..................................................................................................................... 50
Mural Thrombus ..................................................................................................................... 50
Other Causes ........................................................................................................................... 50
CLINICAL PRESENTATION ...................................................................................................... 50
DIAGNOSIS .................................................................................................................................... 51
TREATMENT ................................................................................................................................. 52
Removal of Catheter ............................................................................................................... 52
Systemic Anticoagulation ....................................................................................................... 53
Other Options .......................................................................................................................... 53
PREVENTION OF CRT IN CANCER PATIENTS ................................................................... 54
CONCLUSION ............................................................................................................................... 55
CONSENT FOR PUBLICATION ................................................................................................ 56
CONFLICT OF INTEREST ......................................................................................................... 56
ACKNOWLEDGEMENTS ........................................................................................................... 56
REFERENCES ............................................................................................................................... 56
CHAPTER 7 MANAGEMENT OF CANCER-ASSOCIATED THROMBOSIS ........................... 62
Lilit Karapetyan, Calvin Abro, Seda Grigoryan and Prajwal Dhakal
INTRODUCTION .......................................................................................................................... 63
INITIAL TREATMENT ................................................................................................................ 63
Anticoagulants ........................................................................................................................ 63
Low Molecular Weight Heparin .................................................................................... 63
Factor Xa Inhibitors ...................................................................................................... 65
Unfractionated Heparin ................................................................................................ 66
Warfarin ........................................................................................................................ 66
LONG TERM MANAGEMENT .................................................................................................. 67
ROLE OF DIRECT ORAL ANTICOAGULANTS .................................................................... 68
FINANCIAL ASPECTS OF CHOOSING ANTICOAGULATION ......................................... 73
MECHANICAL DEVICES ........................................................................................................... 73
Inferior Vena Cava Filters ...................................................................................................... 73
IMPACT ON SURVIVAL WITH ANTI-THROMBOTIC THERAPY .................................... 76
CONSENT FOR PUBLICATION ................................................................................................ 78
CONFLICT OF INTEREST ......................................................................................................... 78
ACKNOWLEDGEMENTS ........................................................................................................... 78
REFERENCES ............................................................................................................................... 78
CHAPTER 8 SPECIAL CASES IN CANCER-ASSOCIATED THROMBOSIS ........................... 85
Omar Albanyan and Ikponmwosa Enofe
INTRODUCTION .......................................................................................................................... 85
VTE and Thrombocytopenia ................................................................................................... 85
RECURRENT VTE ........................................................................................................................ 86
VTE IN RENAL IMPAIRMENT .................................................................................................. 87
INCIDENTAL VTE IN CANCER ................................................................................................ 87
MYELOPROLIFERATIVE DISORDERS AND VTE ............................................................... 88
BONE MARROW TRANSPLANTATION AND VTE .............................................................. 89
CONSENT FOR PUBLICATION ................................................................................................ 90
CONFLICT OF INTEREST ......................................................................................................... 90
ACKNOWLEDGEMENTS ........................................................................................................... 90
REFERENCES ............................................................................................................................... 90
CHAPTER 9 ANTITUMOR EFFECTS OF HEPARIN ................................................................... 95
Samanjit Kandola and Manoj Rai
INTRODUCTION .......................................................................................................................... 95
TYPES OF HEPARIN ................................................................................................................... 96
Unfractionated Heparin ........................................................................................................... 96
Low-Molecular-Weight Heparin ............................................................................................ 96
Butanoylated Heparin ............................................................................................................. 97
EFFECTS OF HEPARIN ON TUMOR ....................................................................................... 97
Anti-Angiogenesis Effects ...................................................................................................... 97
Antiproliferative Effects ......................................................................................................... 98
Effects on Immune System ..................................................................................................... 98
CONCLUSION ............................................................................................................................... 99
CONSENT FOR PUBLICATION ................................................................................................ 99
CONFLICT OF INTEREST ......................................................................................................... 99
ACKNOWLEDGEMENTS ........................................................................................................... 99
REFERENCES ............................................................................................................................... 99
CHAPTER 10 VTE PROPHYLAXIS ................................................................................................. 104
Fawzi Abu Rous, Manoj Rai, Osama Mosalem, Layan El-khatib, Calvin Abro and
Abdullah Al-abcha
INTRODUCTION .......................................................................................................................... 104
RISK STRATIFICATION ............................................................................................................. 105
INPATIENT VTE PROPHYLAXIS ............................................................................................. 106
OUTPATIENT VTE PROPHYLAXIS ......................................................................................... 106
PERIOPERATIVE VTE PROPHYLAXIS .................................................................................. 108
SOCIETY GUIDELINES .............................................................................................................. 108
CONCLUSION ............................................................................................................................... 113
CONSENT FOR PUBLICATION ................................................................................................ 113
CONFLICT OF INTEREST ......................................................................................................... 113
ACKNOWLEDGEMENTS ........................................................................................................... 113
REFERENCES ............................................................................................................................... 113
SUBJECT INDEX .................................................................................................................................... (cid:20)(cid:20)(cid:25)
i
FOREWORD
I have been practicing academic clinical hematologist and oncologist for more than 20 years
now. The author, Dr. Supratik Rayamajhi is my cherished colleague who I have known for
the past decade. Most of the other authors are also my colleagues, and I have been an
attending physician and mentor to some. I was thrilled to learn that the authors were busy
writing a book on the topic of cancer-associated thrombosis. I anticipated the publication of
this book and was rewarded with this opportunity to read it. The authors are all uniquely
qualified to write on this important subject based on their experience, research, and insight
into this topic. This is an area that I also have direct and almost daily medical experience with
and can attest to this book’s current relevance and accuracy.
Why should you read this book? Well, are you someone that wants to get right to the point?
Do you dislike long and verbose writing, that goes on and on? Are you someone that wants to
keep current with the ever-changing medical literature? If so, then you are the right person for
this book.
Cancer-associated thrombosis is a broad area but can be parsed into “bite-size” pieces that are
easily “digestible” for consumption for the learner. The day of the giant 1,000-page medical
tome is over. This is a book that highlights an important subject in an easy and to-the-point
quick read that will not bore you with endless unnecessary detail. This book will turn you into
a knowledgeable physician in this field in the shortest amount of time.
I have shown this book to other practicing hematologists and oncologists who have praised it.
We all appreciate its accuracy and brevity without leaving anything of relevance out. I highly
recommend this book to all eager students and practitioners of medicine, especially to anyone
that wants to learn this topic from scratch or to those who might need a brief review.
I am the Director of the Michigan State University/McLaren hematology and oncology
fellowship program and have made this text required reading for our fellows. Read this book
and you will not be disappointed. You will have a whole world of cancer associate thrombosis
knowledge right at your fingertips!
Borys Hrinczenko, MD, PhD
Director
Hematology and Oncology Fellowship Program
Division of Hematology and Oncology
Michigan State University
USA
ii
PREFACE
Cancer and Thrombosis are interrelated. Their relationship adds complexity to the already
challenging domain of cancer management. Thrombosis can at times be a lead to cancer
diagnosis, while it often complicates the situation as a co-existing disorder.
This book is a result of generalists’ endeavor to put together a rather simpler version of
compilation, as it pertains to cancer-associated thrombosis (CAT). Our product is clinically
oriented as compared to some in-depth basic science coverage of preexisting books on CAT.
Our primary target audience naturally remains generalists and graduate-level trainees.
We have strived to stay current in terms of literature review. Specifically, we notice a paucity
of evidence-based literature on thrombosis prophylaxis among cancer patients. We hope to
infuse interest among our audience through an easy read of a complex entity that includes
specific clinical situations and challenges, and hopefully, a palatable end-produce.
We do not have any conflict of interest to disclose during the preparation of this book.
Supratik Rayamajhi, MD
Department of Medicine
Michigan State University
USA