WTD-350On October 13th 2014, the International Society on Thrombosis and Haemostasis is organizing the first ‘World Thrombosis Day’. The goal of the ISTH is to set up an annual event that brings together organizations and leaders passionately dedicated to reducing the disease burden caused by thrombosis. While ‘World Thrombosis Day’ will provide information about all forms of thrombosis and over time will address all thrombotic disorders, the focus initially will be on venous thromboembolism (VTE), one of the most common and potentially deadly, yet under-appreciated, thrombotic events. In Europe alone, nearly half a million people die from VTE each year - more than the combined death total from AIDS, breast- and prostate cancer and highway accidents.

The long-term goal of ‘World Thrombosis Day’ is consistent with the World Health Assembly's global target of reducing premature deaths by non-communicable disease (of which cardiovascular diseases are an important part) by 25% by 2025 and the WHO global action plan for the prevention and control of non-communicable diseases in the 2013-2020 timeframe.

To find out how you can support efforts, please contact Louise Bannon, director of marketing and membership at This email address is being protected from spambots. You need JavaScript enabled to view it..

 


 

thrombo-embolic-350Figure. Only tinzaparin has an unchanged half-life when renal function declines as far as to 20 mL/min.Venous thromboembolism (VTE) is a frequent cause of mortality and morbidity in patients with malignancy. In a review recently published in the Journal of Blood Disorders and Transfusion, a Working Group consisting of Professor Elalamy, Professor Canon, Professor Jochmans, Professor Awada and several other prominent authors, proposes the use of a higher molecular weight LMWH such as tinzaparin because it is associated with a lower risk of plasma accumulation and offers the possibility of maintaining the standard therapeutic dose in patients with renal impairment who are at increased risk of bleeding as well as thrombotic complications.

Thrombosis is one of the leading causes of death in patients with malignancy after cancer itself. Thus, prompt recognition and treatment of VTE are required in order to reduce the risk of VTE-related mortality in patients with malignancies. This report of I. Elalamy et al, reviews the interrelationship between cancer, renal insufficiency and VTE.The Working Group behind this review article concludes that LMWHs decrease the risk of recurrent venous thrombosis in cancer patients without increasing major bleeding complications. LMWHs are therefore recommended as first line antithrombotic treatment in cancer patients with a clear clinical benefit. In patients with renal dysfunction, who are at both increased risk of bleeding and of thrombotic complications, preference should be given to unfractionated heparin or a LMWH with a mean molecular weight such as tinzaparin, having less risk of plasma accumulation and offering the possibility to maintain full therapeutic dose.

Reference

Elalamy I, Canon JL, Bols A, et al. Thrombo-embolic Events in Cancer Patients with Impaired Renal Function. J Blood Disorders Transf 2014;5:202.

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Kyrle-350Many clinical and laboratory risk factors of a first cancer-associated VTE have been identified. In contrast, the pathogenesis of recurrent VTE in cancer patients is less well studied. There is only very limited information on the importance of clinical risk factors and the role of biomarkers in this context. In a recently published article, Paul Kyrle discusses the use of a risk assessment model that is able to predict the risk for VTE recurrence.1

Patients with cancer-associated VTE usually receive low-molecular-weight heparin for at least 3 to 6 months. Nevertheless, the recurrence risk during anticoagulation is as high as 10% and treatment-related major bleeding is more common in cancer-patients than in non-cancer patients. Thus, improvement of current treatment concepts is warranted.

Predicting the overall thrombotic risk can be improved by risk assessment models (RAMs). Several RAMs have been developed for non-cancer patients, but there is only one prediction tool for cancer patients. In principal, RAMs are applied with the ultimate goal to identify patients who may benefit from treatment strategies deduced from the outcome of the model. The prerequisites for achieving such a goal are as follows: (i) the prediction tool allows stratifying patients into different VTE risk categories; (ii) the prediction tool is generalizable in terms of its applicability to different patient populations; (iii) there is knowledge about the risk of bleeding related to anti-coagulation when the prediction tool is applied in routine care.

Recently, Louzada and co-workers developed a prediction score for VTE recurrence which is based on patient sex, cancer type and stage and history of VTE.2 By combining these 4 clinical patient characteristics, the so-called Ottawa score allows stratification of cancer patients according to their VTE recurrence risk. The prediction tool was successfully validated in more than 800 patients from 2 prospective VTE treatment studies.

The next step would be its application to different cancer patient populations with varying prevalences of VTE risk to assess its generalizability. The ultimate challenge would then be to translate the risk estimates obtained by the model to clinical decision making on the basis of the results of management studies. In the case of patients with cancer-associated VTE, this would mean proving the concept that patients with a high propensity of VTE (as assessed by the model) benefit from extended and/ or more intense anti-coagulation and, conversely, that in patients with a low recurrence risk, anti-coagulant treatment at a lower dose and/or for a shorter period of time is sufficient.

References

1.Kyrle P. Predicting recurrent venous thromboembolism in cancer: is it possible? Thromb Res 2014;133(S2):S17-S22.
2.Louzada ML, Carrier M, Lazo-Langner A, et al. Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation 2012;126:448-54.

 


 

Innohep-app-350This special App is developed to guide you in dosing of Innohep® for VTE or PE prophylaxis and treatment, such as the weight-based dosing of Innohep® in patients with or without co-morbidities, including oncology out-patients.

The Innohep® App is intended to be used when determining the dose of tinzaparin for patients weighing less than 165 kg. It will be released for iPhone and Android in October.

 

 

 

 

 

 

 


 

video-350Listen here to a video-interview with Prof. Dr. L. Noens, hematologist, Universitair Ziekenhuis Gent, on the management of thromboembolism in patients at high risk of developing thrombosis, such as patients with e.g. renal impairment, of higher age, co-morbidities, thrombocytopenia, multiple myeloma and/or other hematological diseases.

  • In patients at low risk of development of thrombosis, aspirin can be your choice of treatment
  • In patients at high risk of thrombosis, LMWH are the drugs of 1st choice
  • In patients with renal insufficiency and high risk of thrombosis, depending on the patient profile and situation, one can decide using a LMWH that doesn’t need dose adjustment