PB0938 - Treatment of Splanchnic Vein Thrombosis with Anticoagulant Therapy in Cancer Patients: A Systematic Review and Meta-analysis

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

AZ

Amin Zahrai, BSc

Researcher
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
Ottawa, Ontario, Canada

Co-Author(s)

Marc Carrier, MD

MD, MSc
Ottawa Hospital Research Institute, Ottawa, ON, Canada
Ottawa, Ontario, Canada
AD

Aurélien Delluc

Professor, MD, PhD
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Ottawa, Ontario, Canada

Background: Nowadays, SVTs occur more commonly in patients with cancer, who have a higher thrombotic risk than non-cancer patients. Clinical guidelines on treatment of SVTs come mostly from small observational studies and expert clinician recommendations. Anticoagulants are often recommended to treat SVTs in cancer patients.

Aims: To determine the anticoagulation type, duration, dosing, effectiveness and safety in adult patients with cancer-associated SVTs.

Methods: We searched EMBASE, MEDLINE and CENTRAL electronic databases for clinical studies that evaluate anticoagulants given for cancer-associated SVTs in adult patients using an expert-developed specific search strategy from inception to April 30, 2021, without any restrictions. Clinicaltrials.gov was also investigated for additional studies. We evaluated SVT recurrence, recanalization and extension, major and clinically relevant non-major bleeding and all-cause mortality, between patients receiving anticoagulants and those not receiving anticoagulants for cancer-associated SVT. We screened studies in duplicates for inclusion, will quantitatively pool the results of included studies and perform subgroup analyses of involved subpopulations.

Results: 3332 studies were retrieved for screening and 18 studies (12 full text publications and 6 abstracts) have been included for data extraction to date. A preliminary review of each included study appears to favor using anticoagulants to treat SVTs in cancer patients with favorable outcomes such as recurrence, extension, recanalization and all-cause mortality. Bleeding outcomes appear to be more variable across studies. Meta-analysis is ongoing.

Conclusion(s): Physicians need to balance the risk of thrombosis with that of bleeding when treating patients with cancer-associated SVTs using anticoagulants. While meta-analysis is pending, a preliminary overview of included studies demonstrated that anticoagulants can be useful in reducing the thrombotic and mortality risks in these patients, while risk of bleeding varied across clinical studies. Our study may lead to improvements in the health and economic burden of cancer-associated SVTs.