warfarin and Genital-Neoplasms--Female

Patients with gynecologic malignancies are at an increased risk for venous thromboembolism. National guidelines recommend treatment of an acute venous thromboembolism with low molecular weight heparin for 5-10 days followed by long-term secondary prophylaxis with low molecular weight heparin for at least six months. Non-vitamin K oral anticoagulants are not currently recommended to be used in cancer patients for the management of venous thromboembolism because robust data on their efficacy and safety have yet to become available in cancer patients. The objectives of this study were to determine the proportion of gynecologic oncology patients with venous thromboembolism using rivaroxaban compared to warfarin or low molecular weight heparin as well as compare the safety and efficacy of these anticoagulants.. This study was a retrospective pilot analysis of adult patients with gynecologic malignancies who received either rivaroxaban, warfarin or low molecular weight heparin for treatment of venous thromboembolism at Augusta University Medical Center from 1 July 2013 to 30 June 2015. Statistical comparisons between the enoxaparin and rivaroxaban group were made using T-tests and Chi-square or Fisher's exact tests, where appropriate.. Out of the 49 patients, 37% (18) patients were on rivaroxaban, 53% (26) on enoxaparin, and 10% (5) on warfarin. Only one patient (4%) in the enoxaparin group experienced a recurrent deep vein thrombosis while there were no cases of recurrent venous thromboembolism in the rivaroxaban and warfarin group. The incidence of major bleeding was 17% (. A high proportion of our gynecologic oncology patients received rivaroxaban for the management of venous thromboembolism. The sample size of this pilot analysis was too small to draw any conclusions regarding efficacy and safety of rivaroxaban compared with enoxaparin and warfarin. High rate of rivaroxaban use in gynecologic oncology patients at our institution highlights the need for larger, well-designed randomized controlled trials to confirm the safety and efficacy of its use in this population.

Topics: Academic Medical Centers; Adult; Aged; Anticoagulants; Drug Substitution; Enoxaparin; Factor Xa Inhibitors; Female; Genital Neoplasms, Female; Hemorrhage; Humans; Middle Aged; Pilot Projects; Recurrence; Retrospective Studies; Rivaroxaban; Secondary Prevention; Venous Thromboembolism; Warfarin

To report 2 cases of a probable interaction between cisplatin and warfarin.. Two cases of transient elevation of international normalized ratio (INR) during irinotecan (60 mg/m2 on days 1, 8, and 15) plus cisplatin (60 mg/m2 on day 1) chemotherapy with concomitant warfarin are presented. In both cases, warfarin dosages were stable at the therapeutic target range prior to initiation of chemotherapy. Granisetron hydrochloride (3 mg on days 1, 8, and 15) and dexamethasone (13.2 mg on day 1 and 6.6 mg on days 2, 3, 8, and 15) were used prior to irinotecan administration in both patients. In addition, aprepitant was administered to both patients for 3-5 days with cisplatin. One of these patients also received aprepitant with irinotecan on days 8 and 15. During chemotherapy, INR was transiently elevated almost 1.5-fold over baseline level on day 3. This variation did not occur in subsequent irinotecan cycles on days 8 and 15. The timing of these increases was similar in each of the cycles.. Cisplatin was the common drug in the cases presented and therefore could be related to the INR elevations. To our knowledge, these are the first reports of an interaction between warfarin and irinotecan-cisplatin chemotherapy, but reports of a similar interaction with chemotherapy including platinum derivatives exist. Use of the Horn Drug Interaction Probability Scale indicated a probable interaction between warfarin and cisplatin.. Cisplatin might affect the anticoagulation function of warfarin. Careful INR monitoring is necessary during antineoplastic chemotherapy with cisplatin in patients taking warfarin.

Topics: Anticoagulants; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cisplatin; Drug Interactions; Drug Monitoring; Female; Genital Neoplasms, Female; Humans; International Normalized Ratio; Irinotecan; Middle Aged; Thromboembolism; Treatment Outcome; Venous Thrombosis; Warfarin

We had previously reported an association between the use of recombinant human erythropoietin (rHuEPO) and thrombosis in patients with cervix and vulvo-vaginal cancer treated with chemotherapy and radiation. We hypothesized that low-dose warfarin would be effective prevention for thromboembolic events in this setting.. A retrospective analysis of patients with cervical or vulvo-vaginal carcinoma receiving chemoradiation and rHuEpo was performed. Thirty-two patients received rHuEpo alone, and 24 received warfarin (1-2 mg) and rHuEpo. The primary endpoint was objectively proven symptomatic venous thrombosis.. There was no difference in the baseline characteristics (e.g. age, stage, body mass index, mean and peak hemoglobin, WBC and platelet counts, and number of transfusions) between these two groups. The rate of thrombosis also was not statistically different (P = 0.62). Nine of 24 patients had a symptomatic deep vein thrombosis (DVT) while receiving warfarin compared to 10 of 32 patients not on warfarin. There was no difference between the two groups in the percentage of patients with upper extremity DVT (P = 0.83) or lower extremity DVT (P = 0.64).. Daily low-dose warfarin did not alter the incidence of symptomatic DVT in patients with cervical or vulvo-vaginal cancer who received rHuEpo in conjunction with chemoradiation.

Topics: Anticoagulants; Dose-Response Relationship, Drug; Erythropoietin; Female; Genital Neoplasms, Female; Humans; Middle Aged; Recombinant Proteins; Retrospective Studies; Thrombosis; Uterine Cervical Neoplasms; Vaginal Neoplasms; Vulvar Neoplasms; Warfarin

Anticoagulation therapy in 74 patients with gynecologic malignancy and venous thromboembolism was evaluated as to hemorrhagic complications, recurrent thrombosis, and completion of prescribed course. Clinically significant bleeding complications occurred in 25 patients and the course of anticoagulant therapy was not completed in 29 patients because of bleeding complications or death within 3 months. Venous thromboembolism recurred in 11% of patients. Risk factors associated with hemorrhagic complications and unsuccessful completion of anticoagulation therapy include advanced age, advanced stage of malignancy, incomplete surgical resection of tumor, and systemic chemotherapy. Complications of anticoagulant therapy were found to be excessive when compared to those in reports dealing with noncancer patients and may exceed the benefits of therapy in certain patients. Alternative methods of management for this group of high-risk patients are discussed.

Topics: Adult; Aged; Anticoagulants; Female; Genital Neoplasms, Female; Hemorrhage; Heparin; Humans; Middle Aged; Pulmonary Embolism; Recurrence; Retrospective Studies; Thrombophlebitis; Warfarin

Topics: Adult; Aged; Factor IX; Female; Genital Diseases, Female; Genital Neoplasms, Female; Hemorrhage; Humans; Middle Aged; Postoperative Complications; Preoperative Care; Thromboembolism; Time Factors; Warfarin

Topics: Adult; Aged; Female; Genital Diseases, Female; Genital Neoplasms, Female; Hemorrhage; Humans; Middle Aged; Preoperative Care; Thrombophlebitis; Warfarin