Figueroa, R. (Rocío)
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- Insights into venous thromboembolism prevention in hospitalized cancer patients: Lessons from a prospective study(Public Library of Science, 2018) Garcia-Mouriz, A. (Alberto); Gil-Bazo, I. (Ignacio); Paramo, J.A. (José Antonio); Hermida, J. (José); Lopez-Picazo, J.M. (José M.); Alfonso, A. (A.); Figueroa, R. (Rocío); Lecumberri, R. (Ramón)Hospitalized cancer patients are at high risk of venous thromboembolism (VTE). Despite current recommendations in clinical guidelines, thromboprophylaxis with low molecular weight heparin (LMWH) is underused. We performed an observational prospective study to analyse factors influencing prophylaxis use, VTE events and mortality in cancer-hospitalized patients. 1072 consecutive adult cancer patients were included in an University Hospital from April 2014 to February 2017, and followed-up for 30 days after discharge. The rate of LMWH prophylaxis was 67.6% (95% confidence interval [CI] 64.7% to 70.4%), with a 2.8% rate of VTE events (95% CI 1.9% to 3.9%) and 3.5% rate of major bleeding events (95% CI 2.5% to 4.8%). 80% of VTE events occurred despite appropriate thromboprophylaxis. Overall, 30-day mortality rate was 13.2% (95% CI 11.2% to 15.3%). Active chemotherapy treatment, hospital stay 4 days, and metastatic disease were associated with a higher use of LMWH. On the contrary, patients with hematologic malignancies, anemia or thrombocytopenia were less prone to receive thromboprophylaxis. The main reasons for not prescribing LMWH prophylaxis were thrombocytopenia (23.9%) and active/recent bleeding (21.8%). The PRETEMED score, used for VTE risk stratification, correlated with 30-day mortality. There is room for improvement in thromboprophylaxis use among hospitalized-cancer patients, especially among those with hematologic malignancies. A relevant number of VTE events occurred despite prophylaxis with LMWH. Therefore, identification of risk factors for thromboprophylaxis failure is needed.
- Venetoclax ramp-up strategies for chronic lymphocytic leukaemia in the United Kingdom: a real world multicentre retrospective study(Wiley, 2023) Preston, G. (Gavin); Worth, T. (Tina); Munir, T. (Tahla); Martinez-Calle, N. (Nicolas); Ferguson, J.P. (John-Paul); Gohill, S.(Satyen); Kennedy, B. (Ben); Figueroa, R. (Rocío); Halperin, D. (Daniel); Schuh, A. (Anna); Fox, C. P. (Christopher P.); Furtado, M. (Michelle); Dungarwalla, M. (Moez); Eyre, T.A. (Toby A.); Patten, P. (Piers); Melotti, D. (Dario); Rampotas, A. (Alexandros); Elmusharaf, N. (Nagah); Vidler, J. (Jennifer)This retrospective, observational study evaluated patterns of inpatient versus outpatient tumour lysis syndrome (TLS) monitoring during venetoclax ramp-up in 170 patients with chronic lymphocytic leukaemia. The primary outcome was clinical/biochemical TLS. Two clinical and four biochemical TLS occurred (4.1%). Five of the six events occurred in high-risk patients, four occurred at 20 mg dose and three at the 6-h time-point. Inpatient versus outpatient TLS rates within the high-risk subgroup were 15% and 8%. Risk category was the only predictor of TLS events in multivariate analysis. Outpatient escalation did not associate with clinically meaningful TLS events, suggesting outpatient escalation has manageable associated TLS risks, including in high-risk cohorts. These observations require confirmation in larger studies.
- Differences in venous thromboembolism prevention and outcome between hospitalized patients with solid and hematologic malignancies(Thieme, 2019) Figueroa, R. (Rocío); Alfonso-Piérola, A. (Ana); Marcos-Jubilar, M. (María); Lopez-Picazo, J.M. (José M.); Garcia-Mouriz, A. (Alberto); Gil-Bazo, I. (Ignacio); Rifon, J. J. (Jose J.); Hermida, J. (José); Paramo, J.A. (José Antonio); Lecumberri-Villamediana, R. (Ramón)Venous thromboembolism (VTE) is a common complication in cancer patients, leading to significant morbidity, mortality, and resources consumption. Around 20% of VTE events are related with an underlying malignancy.1 The incidence of cancer-associated thrombosis is increasing in recent years due to different reasons such as longer survival and improved sensitivity of imaging techniques. Hospitalization is a recognized additional risk factor.2 Current evidence-based clinical practice guidelines (CPGs) uniformly recommend pharmacological prophylaxis with low-molecular-weight heparin (LMWH) in hospitalized cancer patients, unless contraindicated.3–5 However, the quality of the evidence that supports LMWH prophylaxis in cancer inpatients is not strong as recommendations are based on the results of clinical trials involving medical inpatients with different conditions (not only cancer).6 CPG statement applies to both, solid and hematologic malignancies, given that a similar VTE-associated risk has been reported. In fact, in the validated Khorana’s risk assessment model, lymphoma is regarded as a high-risk tumor-site category.
- Insights into venous thromboembolism prevention in hospitalized cancer patients: Lessons from a prospective study(2018) Figueroa, R. (Rocío); Alfonso-Piérola, A. (Ana); Lopez-Picazo, J.M. (José M.); Gil-Bazo, I. (Ignacio); Garcia-Mouriz, A. (Alberto); Hermida, J. (José); Paramo, J.A. (José Antonio); Lecumberri, R. (Ramón)Hospitalized cancer patients are at high risk of venous thromboembolism (VTE). Despite current recommendations in clinical guidelines, thromboprophylaxis with low molecular weight heparin (LMWH) is underused. We performed an observational prospective study to analyse factors influencing prophylaxis use, VTE events and mortality in cancer-hospitalized patients. 1072 consecutive adult cancer patients were included in an University Hospital from April 2014 to February 2017, and followed-up for 30 days after discharge. The rate of LMWH prophylaxis was 67.6% (95% confidence interval [CI] 64.7% to 70.4%), with a 2.8% rate of VTE events (95% CI 1.9% to 3.9%) and 3.5% rate of major bleeding events (95% CI 2.5% to 4.8%). 80% of VTE events occurred despite appropriate thromboprophylaxis. Overall, 30-day mortality rate was 13.2% (95% CI 11.2% to 15.3%). Active chemotherapy treatment, hospital stay ≥ 4 days, and metastatic disease were associated with a higher use of LMWH. On the contrary, patients with hematologic malignancies, anemia or thrombocytopenia were less prone to receive thromboprophylaxis. The main reasons for not prescribing LMWH prophylaxis were thrombocytopenia (23.9%) and active/recent bleeding (21.8%). The PRETEMED score, used for VTE risk stratification, correlated with 30-day mortality. There is room for improvement in thromboprophylaxis use among hospitalized-cancer patients, especially among those with hematologic malignancies. A relevant number of VTE events occurred despite prophylaxis with LMWH. Therefore, identification of risk factors for thromboprophylaxis failure is needed.