warfarin and Head-and-Neck-Neoplasms

Tumour progression allows for aberrant angiogenesis. Consequently, cancer-associated thrombosis is a prevalent complication that is coupled with poor prognosis. Anticoagulants have therefore been prescribed with chemotherapeutic agents to target potential thrombo-embolic risk. A systematic review was carried out to summarise existing evidence on the interactions between anticoagulants and oral cancer. This treatment paradigm has demonstrated beneficial results in some oncology patients, thus associating anticoagulants with anticancer effects. Increasing prevalence of oral cancer presents a need to source alternative therapeutic means to prevent disease progression, and thus the use of anticoagulants in these patients may provide an avenue for this to occur. The paucity of evidence regarding the interactions between oral squamous cell carcinoma and anticoagulants emphasises the urgency with which further research should be conducted.

Topics: Administration, Oral; Anticoagulants; Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Mouth Neoplasms; Squamous Cell Carcinoma of Head and Neck; Warfarin

Plasma warfarin and its R,S enantiomer concentrations, one-stage prothrombin times, and mean daily warfarin doses were analyzed in 196 patients given warfarin. These individuals were part of a controlled clinical trial that examined the effect of warfarin as an adjuvant to "standard" treatment in a variety of malignancies. Neither the plasma warfarin concentration nor the daily warfarin dose required to produce a given degree of prothrombin-time prolongation was influenced by age or body weight in these subjects. When the data were analyzed by performance status, we noted several variations of interest. Individuals with different tumor types demonstrated disparities in warfarin disposition. Patients with colorectal cancer, for example, required lower mean daily warfarin doses to achieve a given degree of one-stage prothrombin time prolongation. Analysis of warfarin enantiomers (R,S) in a selected group of patients demonstrated a lower-than-normal ratio (2:1) for the colorectal cancer group (1.42:1) because of an apparent decrease in the plasma R component. In contrast, patients with head and neck cancer demonstrated a ratio of 2.85:1, and the R component was elevated. Warfarin disposition and the effect of warfarin on vitamin K-dependent clotting factor production were altered in the patients with cancer reported in this study. The mechanisms for these alterations are complex and not completely understood.

Topics: Aging; Body Weight; Colorectal Neoplasms; Head and Neck Neoplasms; Humans; Neoplasms; Prospective Studies; Prothrombin Time; Psychomotor Performance; Stereoisomerism; United States; United States Department of Veterans Affairs; Warfarin

VA Cooperative Study #75 was established to test in a controlled, randomized trial the hypothesis that warfarin anticoagulation would favorably affect the course of certain types of malignancy. No differences in survival were observed between warfarin-treated and control groups for advanced non-small cell lung, colorectal, head and neck and prostate cancers. However, warfarin therapy was associated with a significant prolongation in the time to first evidence of disease progression (P = 0.016) and a significant improvement in survival (P = 0.018) for patients with small cell carcinoma of the lung, including the subgroup of patients with disseminated disease at the time of randomization (P = 0.013). A trend toward improved survival with warfarin treatment was observed for the few patients admitted to this study with non-small cell lung cancer who had minimal disease at randomization. These results suggest that warfarin, as a single anticoagulant agent, may favorably modify the course of some, but not all, types of human malignancy, among which is small cell carcinoma of the lung. Further trials of warfarin may be indicated in patients with limited disease who have cell types that failed to respond when advanced disease was present.

Topics: Adenocarcinoma; Blood Coagulation; Carcinoma, Small Cell; Clinical Trials as Topic; Colonic Neoplasms; Female; Head and Neck Neoplasms; Humans; Lung Neoplasms; Male; Neoplasm Metastasis; Prostatic Neoplasms; Random Allocation; Warfarin

Head and neck skin cancer surgery using a full thickness skin graft is a common procedure. Evidence concerning the effects of perioperative antithrombotic treatment on complications is limited. The aim of this study was to evaluate whether perioperative antithrombotic treatment is associated with risk of necrosis, bleeding or infection after full thickness skin graft surgery. Retrospective single-center cohort study with medical records review. Patients operated with a head and neck full thickness skin graft in 2010 and 2013-2015 had available data and were included. Any antithrombotic treatment was continued and all patients were routinely followed-up on days 7-10 after surgery. Data on demographics, concurrent disease, clinical characteristics, antithrombotic medications and postoperative necrosis, bleeding and infection were collected from electronic medical records. Associations with complications were examined using multivariate logistic regression adjusted for age, sex, reoperation, size of excision, site of surgery and concurrent disease. In total, 302 patients (53% women) were included. Antithrombotic treatment (

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aspirin; Cohort Studies; Female; Fibrinolytic Agents; Head and Neck Neoplasms; Humans; Male; Middle Aged; Multivariate Analysis; Perioperative Care; Postoperative Complications; Retrospective Studies; Skin Neoplasms; Skin Transplantation; Warfarin; Young Adult

Haemostatic agents including thrombin-based haemostatic matrix are widely used in patients undergoing cardiac, vascular and spinal surgery. These agents promote local haemostasis through activation of the clotting cascade. To our knowledge, this case series is the first report of pulmonary embolization associated with FloSeal following head and neck oncology resection and free flap reconstruction.. We present five patients who were diagnosed with symptomatic pulmonary embolism after oncologic head and neck free flap reconstructions in 2014 and 2015.. There were five patients consisting of three males and two females. The mean age was 67 years, ranging from 60 to 74 years. Pulmonary embolism occurred between 3 and 30 days with a mean of 12 days. Four out of the five reported cases showed involvement of more than one lobe, and two cases had bilateral pulmonary involvement. All but one patient underwent infratemporal fossa dissections as part of the cancer resection. Ten millilitres of FloSeal was applied to the pterygoid plexi in the four patients to achieve haemostasis. All patients received heparin infusion followed by warfarin therapy for at least 6 months with no mortality or complications relating to pulmonary embolism to date.. Although inconclusive due to study design and small numbers, this series raises the possibility that there may be an association between the use of haemostatic matrix in head and neck oncologic reconstructions and pulmonary embolism. Haemostatic matrix must be used in caution when there is a direct contact with venous endolumens such as the pterygoid plexus and soleus.

Topics: Aged; Anticoagulants; Female; Free Tissue Flaps; Head and Neck Neoplasms; Hemostatics; Heparin; Humans; Infusions, Intravenous; Male; Middle Aged; Plastic Surgery Procedures; Postoperative Complications; Pulmonary Embolism; Retrospective Studies; Risk Factors; Thrombin; Warfarin

Many patients who have operations on the head and neck for skin cancer also take warfarin to prevent thromboembolic events, and there is still debate about whether treatment should be continued, adjusted, or temporarily stopped. The main concern is to balance the risk of haemorrhagic and thromboembolic events. In this prospective controlled study we compared bleeding complications in operations for skin cancer of the head and neck between 86 patients who took warfarin (100 tumours) and 87 (100 tumours) who did not. Surgeons of different grades did the operations under the guidance of the same consultant. All those on warfarin had above normal international normalised ratios (INRs) (mean (SD) 2.5 (0.51), mode 2.6, range 1.1-4.0). In the warfarin group 8% of excisions had a bleeding complication compared with 9% in the control group. One patient in each group suffered a severe bleed that required a return to theatre. The difference in tendency to bleed between the groups was not significant (p=0.30), and the site and type of reconstruction did not influence the risk of bleeding significantly. This study shows that patients on warfarin who are within the normal therapeutic range, can be operated on safely for skin cancer by all levels of trained staff.

Topics: Anticoagulants; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Case-Control Studies; Dermatologic Surgical Procedures; Facial Neoplasms; Follow-Up Studies; Head and Neck Neoplasms; Humans; International Normalized Ratio; Plastic Surgery Procedures; Postoperative Hemorrhage; Prospective Studies; Risk Factors; Safety; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Thromboembolism; Warfarin

We examined records of patients who underwent ultrasound-guided fine needle aspiration biopsy (USGFNAB) of neck lesions to determine whether there was a significantly increased incidence of bleeding complications in patients on antithrombotic and/or anticoagulant (AT/AC) medications compared to patients not receiving AT/AC therapy. Our institutional review board approved this Health Insurance Portability and Accountability Act-compliant retrospective examination of patients' medical data without requiring informed consent. The records of 593 patients (422 women and 171 men ranging from 18 to 91 years of age) who underwent USGFNAB of 788 total neck lesions over an 18-month period were reviewed to determine AT/AC medication used and evidence of USGFNAB-related bleeding complications. Of these, 144 patients (24.3%) were taking one or more AT/AC medications including aspirin, clopidogrel, heparin, and warfarin. The χ2 test was used to assess statistically significant differences in the incidence of USGFNAB-related bleeding complications between patients who were on daily AT/AC medications (test group) and patients who were not (control group). Six USGFNAB-related hematomas (1.0%) occurred. Two hematomas developed in patients on AT/AC medications, and 4 hematomas developed in patients who did not take AT/AC medications (χ = 0.27, df = 1, P = 0.603). This study shows no statistically significant difference in the incidence of hematoma formation after USGFNAB of neck lesions in patients taking AT/AC medications compared to patients not taking AT/AC medications. On the basis of these data, there is no benefit, with regard to incidence of bleeding complications, to discontinuing AT/AC medications in patients undergoing USGFNAB of neck masses.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Biopsy, Fine-Needle; Chi-Square Distribution; Clopidogrel; Female; Head and Neck Neoplasms; Hematoma; Hemorrhage; Heparin; Humans; Male; Middle Aged; Retrospective Studies; Ticlopidine; Ultrasonography, Interventional; Warfarin