fondaparinux and Breast-Neoplasms

Venous thromboembolism (VTE) is a serious threat for all cancer patients. This study was aimed to assess the VTE treatment of cancer patients in the ambulatory care setting.. This is a prospective non-interventional study, which includes ambulatory cancer patients from office-based oncologists. A standardized case report form was used to obtain data on patient characteristics, treatment regimens, duration of treatment, and side effects.. Specialists from 34 centers included data from 76 patients. The median patient age was 62 years (range 33-81 years). The 4 most common cancer types were breast cancer (32%), colorectal cancer (18%), lymphoma and lung cancer (each 8%). 18% of the acute VTE cases were treated as inpatients, 80% as outpatients, and 99% with low-molecular-weight heparin (LMWH), unfractionated heparin (UFH), or fondaparinux. After the acute phase, secondary prophylaxis with LMWH/UFH/fondaparinux was planned in 61% of the patients, with oral anticoagulation in 39%. During acute-phase treatment and secondary prophylaxis, no patient had recurrent VTE. 4 patients (5%) experienced minor bleedings.. This study shows that many ambulatory cancer patients with VTE have early tumors, no metastases, and an excellent performance score. Most patients receive LMWHs for secondary prophylaxis, as recommended by the national and international guidelines. Still, a relevant percentage is switched to oral anticoagulants. © 2015 S. Karger GmbH, Freiburg.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Breast Neoplasms; Colorectal Neoplasms; Female; Fondaparinux; Germany; Guideline Adherence; Heparin; Heparin, Low-Molecular-Weight; Humans; Lung Neoplasms; Lymphoma; Male; Middle Aged; Neoplasms; Polysaccharides; Prospective Studies; Recurrence; Surveys and Questionnaires; Venous Thromboembolism

Cancer cells may alter the efficiency of the antithrombotic agents. To explore this possibility, the present study compared the capacity of the LMWH enoxaparin and the specific inhibitors of Xa (apixaban and fondaparinux) to inhibit thrombin generation triggered by pancreas adenocarcinoma cells (BXPC3) and human breast carcinoma cells (MCF7).. Samples of platelet poor (PPP) or platelet rich plasma (PRP) spiked with apixaban, fondaparinux or enoxaparin were added in micro wells carrying cancer cells and assessed for thrombin generation. In the control experiment thrombin generation was triggered with tissue factor reagent.. The three antithrombotics inhibited thrombin generation in a concentration dependent manner. The BXPC3 and MCF7 cells reversed in a different intensity the effect of the studied agents. According to the histological type of the cancer the antithrombotic efficiency of apixaban was preserved or partially reversed. Fondaparinux, was more vulnerable to the presence of cancer cells as compared to apixaban. The effect of BXCP3 or MCF7 cells on the antithrombotic potency of enoxaparin was of similar magnitude as that on apixaban.. The type of cancer cells is determinant for the antithrombotic efficiency of the specific factor Xa inhibitors. In contrast it does not significantly influence the potency of enoxaparin. The present study shows that the impact of the type of cancer cells on the antithrombotic activity of the specific Xa inhibitors should not be neglected. This has to be taken into consideration for the design of dose-finding studies of the direct orally active FXa inhibitors in patients with different histological types of cancer.

Topics: Anticoagulants; Blood Platelets; Breast Neoplasms; Cell Line, Tumor; Enoxaparin; Factor Xa; Female; Fibrinolytic Agents; Fondaparinux; Heparin, Low-Molecular-Weight; Humans; Inhibitory Concentration 50; MCF-7 Cells; Pancreatic Neoplasms; Polysaccharides; Pyrazoles; Pyridones; Thrombin; Thrombosis

Topics: Adenocarcinoma, Bronchiolo-Alveolar; Adrenal Cortex Hormones; Anticoagulants; Breast Neoplasms; Drug Hypersensitivity; Enoxaparin; Female; Fondaparinux; Histamine Antagonists; Humans; Hypersensitivity, Delayed; Lung Neoplasms; Middle Aged; Nadroparin; Patch Tests; Polysaccharides; Treatment Outcome; Vena Cava, Superior; Venous Thrombosis