Safety and feasibility of therapeutic anticoagulation for newly diagnosed venous thromboembolism in women who undergo neoadjuvant chemotherapy for advanced ovarian cancer Journal Article
| Authors: | Boerner, T.; Lam, C.; Basaran, D.; Liu, Y. L.; Grisham, R. N.; Tew, W. P.; Long Roche, K.; Zivanovic, O.; Abu-Rustum, N. R.; Gardner, G. J.; Sonoda, Y.; Chi, D. S.; Soff, G.; Jewell, E. |
| Article Title: | Safety and feasibility of therapeutic anticoagulation for newly diagnosed venous thromboembolism in women who undergo neoadjuvant chemotherapy for advanced ovarian cancer |
| Abstract: | Objective We sought to investigate the safety and feasibility of therapeutic anticoagulation for newly diagnosed venous thromboembolism among women who undergo neoadjuvant chemotherapy for the treatment of advanced ovarian cancer. Methods A retrospective study using data extrapolated from a prospectively maintained institutional database was used to identify all patients with ovarian cancer who underwent neoadjuvant chemotherapy from April 2015 through September 2018 at our institution. All patients who received therapeutic anticoagulation for newly diagnosed venous thromboembolism at initial diagnosis or during neoadjuvant chemotherapy were included. Results Of 290 patients who underwent neoadjuvant chemotherapy for advanced ovarian cancer during the study period, 67 (23%) had newly diagnosed venous thromboembolism at the time of initial diagnosis or developed venous thromboembolism during neoadjuvant chemotherapy. Of these 67 patients, 64 (96%) received therapeutic anticoagulation. A total of 13 (20%) of 64 patients who underwent therapeutic anticoagulation experienced a bleeding episode while on anticoagulation; 4 (31%) of the 13 events were of major severity. Three patients developed major internal bleeding in the peritoneal cavity, and one patient suffered from a major vaginal bleeding episode. All four patients were hospitalized (range, 5-11 days) and received ≥2 units of red blood cells for anemia. None of these patients died from fatal bleeding or had to delay starting chemotherapy. Of note, all four patients received low-molecular-weight heparin via subcutaneous injection. Overall, 13 (20%) of 64 patients required an anticoagulant dose reduction, mostly due to weight loss or new bleeding episodes. Conclusion Therapeutic anticoagulation in this setting appeared safe, with a low risk of major bleeding complications. Furthermore, anticoagulation did not result in delay of chemotherapy or cytoreductive surgery. © 2023 BMJ Publishing Group. All rights reserved. |
| Keywords: | adult; aged; major clinical study; bevacizumab; advanced cancer; ascites; cancer combination chemotherapy; drug dose reduction; drug efficacy; drug safety; drug withdrawal; side effect; paclitaxel; cancer patient; antineoplastic agent; ovarian cancer; carboplatin; multiple cycle treatment; ovary cancer; anemia; thrombocytopenia; cohort analysis; steroid; anticoagulant therapy; deep vein thrombosis; data base; retrospective study; risk factor; hematuria; lung embolism; acute kidney failure; disease severity; feasibility study; warfarin; heparin; hospital patient; nicotinamide adenine dinucleotide adenosine diphosphate ribosyltransferase inhibitor; romiplostim; idiopathic thrombocytopenic purpura; neoadjuvant chemotherapy; drug substitution; blood clotting disorder; erythrocyte transfusion; hematoma; epistaxis; enoxaparin; thrombocyte transfusion; platelet count; low molecular weight heparin; venous thromboembolism; anticoagulant agent; apixaban; rivaroxaban; rectum hemorrhage; steroid therapy; vagina bleeding; abdominal bleeding; international normalized ratio; body weight loss; hemoperitoneum; human; female; article; bridging anticoagulation |
| Journal Title: | International Journal of Gynecological Cancer |
| Volume: | 34 |
| Issue: | 1 |
| ISSN: | 1048-891X |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2024-01-01 |
| Start Page: | 113 |
| End Page: | 121 |
| Language: | English |
| DOI: | 10.1136/ijgc-2023-004576 |
| PUBMED: | 38088180 |
| PROVIDER: | scopus |
| PMCID: | PMC11265789 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- MSK corresponding author is Elizabeth Jewell -- Source: Scopus |
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