28 results match your criteria: "University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute[Affiliation]"

Mortality and venous thromboembolism (VTE) are major risks for patients with hematological malignancies. However, they are commonly underrepresented in major clinical trials of VTE. Treatment decisions are further complicated by the unique characteristics they frequently exhibit, such as thrombocytopenia.

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Inferior vena cava (IVC) filters are considered when patients with venous thromboembolism (VTE) develop a contraindication to anticoagulation. Use of IVC filters is increasing, despite associated complications and lack of data on efficacy in reducing VTE-related mortality. We characterized the pattern of IVC filter use at a large community hospital between 2018 and 2022.

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A meta-analysis to assess the risk of bleeding and thrombosis following chimeric antigen receptor T-cell therapy: Communication from the ISTH SSC Subcommittee on Hemostasis and Malignancy.

J Thromb Haemost

July 2024

Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, New York, USA; Weill Cornell Medical School, New York City, New York, USA. Electronic address:

Background: Chimeric antigen receptor T-cell (CAR T-cell) therapy is increasingly utilized for treatment of hematologic malignancies. Hematologic toxicities including thrombosis and bleeding complications have been reported. Accurate estimates for thrombotic and bleeding outcomes are lacking.

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Background: Patients with cancer commonly require a central venous catheter, which is associated with an increased risk of venous thromboembolism (VTE). Despite the frequent occurrence, the optimal anticoagulation management and outcomes for patients with cancer and catheter-related upper extremity deep vein thrombosis (DVT) are unclear.

Objective: We performed a systematic review and meta-analysis to evaluate the rates of recurrent VTE and bleeding in patients with cancer and catheter-related upper extremity DVT.

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Article Synopsis
  • A study was conducted to analyze the type and duration of antithrombotic therapy in patients treated with catheter-based thrombolysis and venous stents for acute deep vein thrombosis (DVT) from 2005 to 2019.
  • The research included 173 patients, mainly young females with risk factors for thrombotic diseases, revealing that most received anticoagulant-only therapy post-stenting, while a smaller group received combined therapies.
  • The findings suggest that anticoagulant therapy without antiplatelet agents is the most common approach, indicating a need for further research on the impact of these treatments on patient outcomes.
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Background: Patients with cancer have an increased risk of both venous thromboembolism (VTE) requiring anticoagulation and thrombocytopenia. The optimal management is unclear. We performed a systematic review and meta-analysis to evaluate the outcomes in these patients.

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Immune checkpoint inhibitors (ICIs) target programmed cell death (PD) 1 receptor and its ligand PD-L1, and have become an integral part of treatment regimens in many cancers including lung cancer, renal cell carcinoma, melanoma, and more. Cancer is associated with a significantly increased risk of venous thromboembolism compared to non-cancer patients, and the risks increase further with anticancer therapies including ICIs. Cancer-associated thrombosis can lead to hospitalizations, delayed cancer treatment, and mortality.

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Direct oral anticoagulants (DOACs) are commonly used oral factor Xa inhibitors in recent years. However, in some special clinical situations, the appropriate use of these anticoagulants may be of concern. In this article, we address the 5 commonly asked questions regarding their use for the treatment of venous thromboembolism, including in the setting of obesity, renal impairment, gastrointestinal (GI) malignancy, catheter-related thrombosis, and drug-drug interactions.

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Patients with cancer have an increased risk of thrombosis requiring anticoagulants and/or antiplatelet agents, and they can also encounter thrombocytopenia due to cancer itself or cancer therapies. They often undergo many procedures such as tissue or bone marrow biopsies, placement of central access lines, diagnostic or therapeutic draining procedures, lumbar puncture, and more. Management of antithrombotic agents or thrombocytopenia around the time of these procedures is highly variable.

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Patients with cancer have increased risks of venous and arterial thromboembolism and/or atrial fibrillation, for which anticoagulation is commonly used. For these indications, three main types of anticoagulants are recommended or used: low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs), and vitamin K antagonists (VKAs), all have different advantages and disadvantages. Drug-drug interactions (DDIs) with anticoagulation are often cautioned against by major guidelines, but evidence remains scarce regarding the best management approach for specific drug combinations, particularly with DOACs.

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Background: Routinely used cardiac medications, based on pharmacokinetics, are hypothesized to increase drug levels of direct oral anticoagulants (DOACs), with the potential to increase the risk of hemorrhage. We set out to compare the risk for hemorrhage following initiation of amiodarone, verapamil, or diltiazem (moderate cytochrome P450 3A4 and/or P-glycoprotein activity) vs metoprolol or amlodipine (weak or no activity), among older adults prescribed DOACs.

Methods: We conducted a population-based, retrospective cohort study of all adults (aged ≥ 66 years) on a DOAC (dabigatran, apixaban, rivaroxaban;  = 295,038) who were newly prescribed amiodarone (n = 4872), verapamil (n = 1284), or diltiazem (n = 14,638), compared with metoprolol or amlodipine, from Ontario, Canada (2009-2016).

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Introduction: Medical assistance in dying (MAiD) was legalized in Canada in 2016. Cancer accounts for 60% to 65% of MAiD cases. Lung cancer, the most common cause of cancer death, is expected to makeup a large number of MAiD cases.

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Background: Apixaban was effective in preventing venous thromboembolism (VTE) in ambulatory cancer patients with Khorana score ≥2 initiating chemotherapy, but with an increased risk of bleeding. Patients with cancer have a higher risk of renal dysfunction, which may be associated with increased risks of thrombotic or bleeding complications. We sought to assess the efficacy and safety of apixaban thromboprophylaxis according to renal function in the AVERT trial.

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Background: Guidelines recommend thromboprophylaxis for patients with multiple myeloma (MM) at high risk for venous thromboembolism (VTE). However, the optimal risk prediction model for VTE in MM remains unclear. Khorana et al developed a VTE risk score (Khorana score) in ambulatory cancer patients receiving chemotherapy.

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The duration of anticoagulation in patients with catheter- related thrombosis (CRT) is not standardized. This is a multiinstitutional prospective pilot study in patients with cancer and upper extremity CRT. Patients received therapeutic enoxaparin for 1 month after catheter removal.

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Venous thromboembolism (VTE) with concurrent thrombocytopenia is frequently encountered in patients with cancer. Therapeutic anticoagulation in the setting of thrombocytopenia is associated with a high risk of hemorrhage. Retrospective analyses suggest the utility of modified-dose anticoagulation in this population.

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Article Synopsis
  • Thrombotic antiphospholipid syndrome (TAPS) causes blood clots in various vessels, requiring patients to take anticoagulants, traditionally warfarin.
  • A study compared the effectiveness of apixaban, a newer anticoagulant that doesn’t need monitoring, against warfarin over 12 months in TAPS patients.
  • Results showed more strokes in patients on apixaban (6 out of 23) compared to none on warfarin (0 out of 25), leading to the conclusion that apixaban may not be a suitable substitute for warfarin in preventing clots in TAPS patients.
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Objectives: Obesity is associated with increased risks of atrial fibrillation (AF) and venous thromboembolism (VTE) for which anticoagulation is commonly used. However, data on the efficacy and safety of oral anticoagulants in patients with morbid obesity are limited.

Methods: We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) for AF or VTE in patients with morbid obesity.

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Article Synopsis
  • Standard treatment for catheter-associated upper extremity deep vein thrombosis (UE-DVT) typically involves anticoagulation, and the best timing for catheter removal is unclear regarding its impact on the risk of pulmonary embolism (PE).
  • A retrospective study involving 626 patients with hematologic cancers and UE-DVT analyzed the outcomes of early (within 48 hours) versus delayed catheter removal among those treated with anticoagulation.
  • The results showed that early removal did not increase the risk of PE compared to delayed removal, with similar rates of complications and deaths in both groups within 7 days post-diagnosis.
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Background: Patients with cancer have an increased risk of venous thromboembolism (VTE) and it is commonly detected incidentally. The outcomes and optimal management for patients with cancer and incidental VTE remain debated.

Objectives: We conducted a systematic review and meta-analysis to evaluate the outcomes in patients with cancer and incidentally detected VTE compared to those with symptomatic events.

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Patients with acute leukemia frequently develop thrombocytopenia and hemostatic complications caused by coagulopathy. Coagulopathy complicates the management of these patients and can lead to significant morbidity and mortality. This guidance document aims to review and provide guidance on the management of hemostatic complications in adult patients with acute leukemia, addressing four main issues, including platelet transfusion, disseminated intravascular coagulation, L-asparaginase-related hypofibrinogenemia, and the use of antifibrinolytic agents.

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