{"title":"New drugs, old problems: immune checkpoint inhibitors and cancer-associated thrombosis","authors":"Mehrie H. Patel, Alok A. Khorana","doi":"10.4081/btvb.2024.113","DOIUrl":"https://doi.org/10.4081/btvb.2024.113","url":null,"abstract":"A frequent side effect of cancer treatment is venous thromboembolism (VTE), which is made more likely by systemic anticancer medication. Immune checkpoint inhibitors (ICIs) have emerged as a paradigm-shifting treatment for many cancers. Early trials investigating the efficacy of ICIs did not identify thrombosis as a significant adverse event of concern. An initial meta-analysis reported a 1.1% [95% confidence interval (CI) 0.5-2.1] risk of arterial thromboembolism (ATE) and a 2.7% (95% CI 1.8-4.0) rate of vein thrombosis. ICIs have, however, been linked to ATE and VTE in an increasing number of post-marketing investigations. The reported incidence rates of cumulative VTE range from 5-8% at 6 months to 10-12% at 12 months, while the rates of ATE vary from 1-2% at 6 months to 17 months. Furthermore, a number of studies show a correlation between reduced survival and ICI-related thromboembolism. In order to provide a compiled and thorough narrative on the mechanisms, incidence, risk factors, and survival related to ICI-associated VTE and ATE, this narrative review summarizes the literature.","PeriodicalId":517891,"journal":{"name":"Bleeding, Thrombosis and Vascular Biology","volume":"50 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140970389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Endothelial cell dysfunction in cancer: a not-so-innocent bystander","authors":"Betül Ünlü, Neha Joshi, Jamie M. O'Sullivan","doi":"10.4081/btvb.2024.116","DOIUrl":"https://doi.org/10.4081/btvb.2024.116","url":null,"abstract":"The body’s homeostasis depends on the vascular endothelium, which controls angiogenesis, vascular tone, inflammation, cell trafficking, hemostasis, and the movement of nutrients and waste out of the body. Endothelial cells (ECs) are the primary gatekeepers of many of these vessel wall functions, despite only having a single cell’s thickness. Normally quiescent ECs in the context of cancer are activated by anti-cancer therapies, the tumor microenvironment, and factors secreted by the tumor. Crucially, this dysfunctional endothelium actively participates in tumor metastasis and progression rather than just acting as a passive bystander. Compared to the healthy vasculature, ECs in the tumor vasculature are heterogeneous and have a different gene expression profile. Tumor-associated ECs, in particular, exhibit increased pro-angiogenic characteristics and upregulated expression of adhesion molecules and proinflammatory cytokines, facilitating the intra- and extravasation of spreading tumor cells. Furthermore, the downregulation of important anticoagulant molecules and increased endothelial secretion of prothrombotic molecules can directly encourage cancer-associated thrombosis. Many anti-cancer therapies are also less effective in their delivery and function when there is dysfunction in the tumor endothelium. The review highlights some of the most recent research showing how tumor-associated ECs influence angiogenesis, inflammation, coagulation, and metastasis to contribute to the progression of tumors. Undoubtedly, a better understanding of how the tumor microenvironment subverts quiescent ECs and how phenotypic alterations in the vessel wall support the survival and spread of tumor cells will aid in the identification of new therapeutic targets to slow the advancement of cancer.","PeriodicalId":517891,"journal":{"name":"Bleeding, Thrombosis and Vascular Biology","volume":"41 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140970654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Venous thromboembolism and mortality in patients with hematological malignancies","authors":"Kristen M. Sanfilippo, Tzu-Fei Wang","doi":"10.4081/btvb.2024.119","DOIUrl":"https://doi.org/10.4081/btvb.2024.119","url":null,"abstract":"Mortality and venous thromboembolism (VTE) are major risks for patients with hematological malignancies. However, they are commonly underrepresented in major clinical trials of VTE. Treatment decisions are further complicated by the unique characteristics they frequently exhibit, such as thrombocytopenia. In addition to discussing treatment challenges, knowledge gaps, and future directions, our goal in this narrative review is to provide an overview of the epidemiology and risk factors of mortality in patients with hematological malignancies and VTE.","PeriodicalId":517891,"journal":{"name":"Bleeding, Thrombosis and Vascular Biology","volume":"27 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140967650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Barca-Hernando, Victor Garcia-Garcia, L. Jara-Palomares
{"title":"Location of metastasis and complications in patients with venous thromboembolism and cancer: systematic review","authors":"M. Barca-Hernando, Victor Garcia-Garcia, L. Jara-Palomares","doi":"10.4081/btvb.2024.114","DOIUrl":"https://doi.org/10.4081/btvb.2024.114","url":null,"abstract":"According to current guidelines, patients with venous thromboembolism (VTE) and active cancer should receive prolonged anticoagulant treatment (>6 months). In patients with cancer-associated thrombosis (CAT), metastasis is a factor in recurrent VTE and bleeding; however, the function of metastasis location remains unclear. In order to assess the risk of complications (such as bleeding or recurrent VTE) based on the location of metastases in patients with CAT, we conducted a systematic review. The PubMed database search was used to perform a systematic review. MESH terms pertaining to metastasis, VTE, and neoplasms were employed. Patients with CAT who were at least eighteen years old and receiving therapeutic doses of anticoagulants were included, as were details regarding the locations of metastases and the availability of patients who had complications (bleeding or recurrent VTE). Among the 1,447 articles found by the search, 7 retrospective studies met all eligibility requirements and were added to the analysis. The majority of these studies addressed brain metastases. Studies found that intracranial hemorrhage occurred between 4% and 19% of the time. In the context of brain metastases and VTE, other studies examined the safety and effectiveness of direct oral anticoagulants in comparison to low-molecular-weight heparin. This systematic review draws attention to the paucity of data regarding the impact of metastasis location on complications in CAT patients. Further research is required to assess the effect of metastasis location on the risk of VTE complications in patients with CAT.","PeriodicalId":517891,"journal":{"name":"Bleeding, Thrombosis and Vascular Biology","volume":"29 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140969615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trends and updates on the epidemiology of cancer-associated thrombosis: a systematic review","authors":"Ang Li, Emily Zhou","doi":"10.4081/btvb.2024.108","DOIUrl":"https://doi.org/10.4081/btvb.2024.108","url":null,"abstract":"For cancer patients, cancer-associated thrombosis (CAT) is a serious complication. An updated epidemiology of CAT over the last ten years is summarized in this review. A comprehensive analysis of pertinent population cohort research released between 2011 and 2024 was carried out. In patients with unselected cancers, the 12-month incidence of CAT is roughly 3-5% (9-fold increase vs to the matched non-cancer population); however, in patients with advanced cancers requiring systemic therapy, the risk rises to 6-8% (20-fold increase vs. to the matched non-cancer population). Anticoagulation use and adherence have improved, but the risk of recurrence is still high, at 5-8% at 6 months and 7-15% at 12 months. The type, stage, and treatment of cancer, a history of venous thromboembolism (VTE), prolonged hospitalization or immobilization, and obesity are significant clinical predictors of the development of CAT. The modified Vienna-CATS and EHR-CAT have the best performance (area under the curve 0.68-0.71) among the clinical risk prediction scores for CAT using the original Khorana score backbone that has been externally validated. However, additional research is required to guarantee appropriate implementation and utilization of these models. Even with contemporary antineoplastic treatments, CAT is still a major complication for cancer patients. We encourage interdisciplinary partnerships among hematologists, data scientists, epidemiologists, and oncologists to guarantee the integration of customized VTE risk evaluation into standard oncologic treatment.","PeriodicalId":517891,"journal":{"name":"Bleeding, Thrombosis and Vascular Biology","volume":"68 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140968281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roberto Mario Santi, Annamaria Fulghesu, Ezio Zanon, E. De Candia, Elvira Grandone, Giancarlo Di Renzo, Claudia Succu, V. Tosto, Vincenzina Bruni, Paolo Gresele
{"title":"Diagnosis and management of abnormal uterine bleeding in adolescence","authors":"Roberto Mario Santi, Annamaria Fulghesu, Ezio Zanon, E. De Candia, Elvira Grandone, Giancarlo Di Renzo, Claudia Succu, V. Tosto, Vincenzina Bruni, Paolo Gresele","doi":"10.4081/btvb.2024.106","DOIUrl":"https://doi.org/10.4081/btvb.2024.106","url":null,"abstract":"During menarche and adolescence, abnormal uterine bleeding (AUB) may serve as a crucial indicator of a hidden bleeding disorder. When a young woman is suspected of having a bleeding disorder, the obstetrician-gynecologist should collaborate with a hemostasis specialist to arrange the necessary laboratory testing and determine the best course of action. The Italian Society for the Study of Hemostasis and Thrombosis and the Italian Society of Gynecology and Obstetrics jointly offer recommendations on the diagnosis and treatment of AUB. They also suggest diagnostic and therapeutic pathways to decrease diagnostic delay and improve treatment effectiveness and safety.","PeriodicalId":517891,"journal":{"name":"Bleeding, Thrombosis and Vascular Biology","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140997649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tailored therapy with turoctocog alfa pegol according to patient’s lifestyle and hemorrhagic phenotype: from clinical trial to real-life","authors":"Ilaria Nichele, Giuseppe Carli, A. Tosetto","doi":"10.4081/btvb.2024.104","DOIUrl":"https://doi.org/10.4081/btvb.2024.104","url":null,"abstract":"Although the use of prophylaxis regimens with prolonged half-life factors is now widespread in the world of hemophilia A, there is a lack of real-life evidence on the impact of these products on joint health, adherence, and quality of life of patients. Turoctocog alfa pegol is a glycoPEGylated recombinant factor VIII (FVIII) with an extended half-life (EHL), developed for prophylaxis, treatment of bleeds, and perioperative management in patients with hemophilia A. We report here on three cases of three patients affected by severe hemophilia A, with variable bleeding phenotype and lifestyle, to describe our clinical practice on prophylaxis with turoctocog alfa pegol. As confirmed in our cases, FVIII trough levels remained coherent with those experienced in the registration trial after the switch to the commercial EHL drug. Moreover, the cases highlight how the current clinical management of hemophilia can personalize treatment in several specific conditions.","PeriodicalId":517891,"journal":{"name":"Bleeding, Thrombosis and Vascular Biology","volume":"22 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140673275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ReDIP, the Italian network for the diagnosis of congenital platelet function disorders","authors":"Marco Cattaneo, Claudia Ghali, M. Scavone","doi":"10.4081/btvb.2024.134","DOIUrl":"https://doi.org/10.4081/btvb.2024.134","url":null,"abstract":"Congenital platelet function disorders (cPFD) are associated with an increased risk of mucocutaneous bleeding of various levels of severity; they may be classified based on abnormalities of platelet components that share common characteristics: i) platelet receptors for adhesive proteins; ii) platelet receptors for soluble agonists; iii) platelet granules; iv) signal transduction pathways; v) procoagulant phospholipids; less well characterized PFD aregrouped in a sixth category of miscellaneous abnormalities [...].","PeriodicalId":517891,"journal":{"name":"Bleeding, Thrombosis and Vascular Biology","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140672918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Palestinian patient associations appeal on World Hemophilia Day","authors":"Sara Mellano","doi":"10.4081/btvb.2024.136","DOIUrl":"https://doi.org/10.4081/btvb.2024.136","url":null,"abstract":"Ensuring access to life-saving therapies for Palestinian hemophilia patients and safeguarding their right to health, along with committing to long-term goals such as establishing a Palestinian Hemophilia Federation and systematically implementing updated and internationally recognized treatment protocols, is the appeal directed to the international community by Palestinian sector associations [...].","PeriodicalId":517891,"journal":{"name":"Bleeding, Thrombosis and Vascular Biology","volume":"132 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The diagnostic procedure for subjects with suspected pulmonary embolism. A recent comparison among the recommendations available from the international guidelines","authors":"G. Palareti","doi":"10.4081/btvb.2024.122","DOIUrl":"https://doi.org/10.4081/btvb.2024.122","url":null,"abstract":"Acute pulmonary embolism (PE) is a common and potentially life-threatening disease characterized by the occlusion of arterial lung vasculature, typically due to thrombi traveling from a thrombotic vein in the lower limb. Several guidelines have been proposed worldwide to assist clinicians in its diagnosis, however, they are not consistent on the usage of diagnostic tools. This commentary reviews the literature and discusses the concordance/discordance between these international guidelines on PE diagnosis.","PeriodicalId":517891,"journal":{"name":"Bleeding, Thrombosis and Vascular Biology","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140389569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}