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      Rivaroxaban treatment for cancer-associated venous thromboembolism in a patient with heparin-induced thrombocytopenia: a case report

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          Abstract

          Low molecular weight heparin (LMWH) is the first-line therapy in acute cancer-associated venous thromboembolism (CAT). However, heparin-induced thrombocytopenia (HIT) is a life-threatening adverse drug reaction that occurs in anticoagulation therapy with LMWH. This article reports the case of a 66-year-old Chinese male who received nadroparin 4100IU twice daily for treating CAT. Unfortunately, the epistaxis persisted and the blood count examination revealed serious thrombocytopenia on postoperative day 5. The patient was diagnosed with HIT and thereafter LMWH therapy was replaced with rivaroxaban. During three months follow-up, the patient had a good recovery without recurrent CAT or bleeding.

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          2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

          Stavros V Konstantinides, Guy Meyer, Cecilia Becattini … (2019)
          Article 0 comments Cited 954 times – based on 0 reviews     Review now
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            Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report.

            Clive Kearon, Elie A. Akl, Joseph Ornelas … (2016)
            We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics.
            Article 0 comments Cited 709 times – based on 0 reviews     Review now
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              Development and validation of a predictive model for chemotherapy-associated thrombosis.

              Alok A. Khorana, Nicole M Kuderer, Eva Culakova … (2008)
              Risk of venous thromboembolism (VTE) is elevated in cancer, but individual risk factors cannot identify a sufficiently high-risk group of outpatients for thromboprophylaxis. We developed a simple model for predicting chemotherapy-associated VTE using baseline clinical and laboratory variables. The association of VTE with multiple variables was characterized in a derivation cohort of 2701 cancer outpatients from a prospective observational study. A risk model was derived and validated in an independent cohort of 1365 patients from the same study. Five predictive variables were identified in a multivariate model: site of cancer (2 points for very high-risk site, 1 point for high-risk site), platelet count of 350 x 10(9)/L or more, hemoglobin less than 100 g/L (10 g/dL) and/or use of erythropoiesis-stimulating agents, leukocyte count more than 11 x 10(9)/L, and body mass index of 35 kg/m(2) or more (1 point each). Rates of VTE in the derivation and validation cohorts, respectively, were 0.8% and 0.3% in low-risk (score = 0), 1.8% and 2% in intermediate-risk (score = 1-2), and 7.1% and 6.7% in high-risk (score >/= 3) category over a median of 2.5 months (C-statistic = 0.7 for both cohorts). This model can identify patients with a nearly 7% short-term risk of symptomatic VTE and may be used to select cancer outpatients for studies of thromboprophylaxis.
              Article 0 comments Cited 282 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Transl Cancer Res
                Journal ID (iso-abbrev): Transl Cancer Res
                Journal ID (publisher-id): TCR
                Title: Translational Cancer Research
                Publisher: AME Publishing Company
                ISSN (Print): 2218-676X
                ISSN (Electronic): 2219-6803
                Publication date (Print and electronic): October 2019
                Publication date (Print): October 2019
                Volume: 8
                Issue: 6
                Pages: 2481-2484
                Affiliations
                [1 ]deptDepartment of Pharmacy, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai 200127, China;
                [2 ]deptDepartment of Respiration, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai 200127, China
                Author notes
                [#]

                These authors contributed equally to this work.

                Correspondence to: Zhi-Chun Gu, MD. Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China. Email: guzhichun213@ 123456163.com .
                Article
                Publisher ID: tcr-08-06-2481
                DOI: 10.21037/tcr.2019.09.55
                PMC ID: 8797388
                PubMed ID: 35117000
                SO-VID: e09a4d1f-eb40-460f-aaf9-0dc0436d990d
                Copyright © 2019 Translational Cancer Research. All rights reserved.
                License:

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

                History
                Date received : 28 June 2019
                Date accepted : 24 September 2019
                Funding
                Funded by: Research Funds of Shanghai Health and Family Planning commission
                Award ID: 20184Y0022
                Funded by: Cultivation fund of clinical research of Renji hospital
                Award ID: PY2018-III-06
                Funded by: Clinical Pharmacy Innovation Research Institute of Shanghai Jiao Tong University School of Medicine
                Award ID: CXYJY2019ZD001
                Award ID: CXYJY2019QN004
                Funded by: Program for Key but Weak Disciplines of Shanghai Municipal Commission of Health and Family Planning
                Award ID: 2016ZB0304
                Categories
                Subject: Brief Report

                Keywords: heparin-induced thrombocytopenia (hit),cancer-associated venous thromboembolism (cat),anticoagulant,rivaroxaban
                Data availability:
                Keywords: heparin-induced thrombocytopenia (hit), cancer-associated venous thromboembolism (cat), anticoagulant, rivaroxaban

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