Download PDF
Int J Angiol 2020; 29(04): 256-259
DOI: 10.1055/s-0039-1694780
Case Report

Successful Treatment of Recurrent Thrombosis Associated with Malignancy with Apixaban and Follow-up for 1 Year

Timothy Boey
1   Anglo-Chinese Junior College, Singapore
,
Ashita Ashish Sule
2   Raffles Girl's School (Secondary), Singapore
,
Ashish Anil Sule
3   Department of General Medicine, Vascular Medicine and Hypertension, Tan Tock Seng Hospital, Singapore
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

This case report aims to highlight a successful example of using novel oral anticoagulants (NOACs), such as apixaban, to prevent recurrent venous thromboembolism (VTE) in patients with solid-organ malignancy, as an alternative to low-molecular weight heparin (LMWH). Discussed is the case of a 67-year-old woman diagnosed with recurrent thrombosis in the upper-right limb and malignancy of right breast with metastasis to the axillary lymph nodes. Over a follow-up period of more than 1 year, there was no recurrence of VTE and D-dimer decreased, illuminating the possibility of apixaban as an alternative form of treatment for recurrent VTE in patients with malignancy. This appears to be one of the first case reports in Singapore.

Keywords

antifactor Xa - deep vein thrombosis - early - enoxaparin - Low-molecular weight heparin - peak - subclavian


Publication History

Article published online:
07 August 2019

© 2020. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Annie Young AM. Anticoagulation therapy in selected cancer patients at risk of recurrence of venous thromboembolism: results of the Select-D™ pilot trial. Blood 2017; 130 (Suppl. 01) 625
    CrossrefPubMedGoogle Scholar
  • 2 Raskob GE, van Es N, Verhamme P. et al. Hokusai VTE Cancer Investigators. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 2018; 378 (07) 615-624
    CrossrefPubMedGoogle Scholar
  • 3 Vedovati MC, Germini F, Agnelli G, Becattini C. Direct oral anticoagulants in patients with VTE and cancer: a systematic review and meta-analysis. Chest 2015; 147 (02) 475-483
    CrossrefPubMedGoogle Scholar
  • 4 Qureshi W, Ali Z, Amjad W. et al. Venous thromboembolism in cancer: an update of treatment and prevention in the era of newer anticoagulants. Front Cardiovasc Med 2016; 3 (24) 24
    CrossrefPubMedGoogle Scholar
  • 5 Welsh J, Smith JD, Yates KR, Greenman J, Maraveyas A, Madden LA. Tissue factor expression determines tumour cell coagulation kinetics. Int J Lab Hematol 2012; 34 (04) 396-402
    CrossrefPubMedGoogle Scholar
  • 6 Falanga A, Gordon SG. Isolation and characterization of cancer procoagulant: a cysteine proteinase from malignant tissue. Biochemistry 1985; 24 (20) 5558-5567
    CrossrefPubMedGoogle Scholar
  • 7 Denko NC, Giaccia AJ. Tumor hypoxia, the physiological link between Trousseau's syndrome (carcinoma-induced coagulopathy) and metastasis. Cancer Res 2001; 61 (03) 795-798
    PubMedGoogle Scholar
  • 8 Boccaccio C, Sabatino G, Medico E. et al. The MET oncogene drives a genetic programme linking cancer to haemostasis. Nature 2005; 434 (7031): 396-400
    CrossrefPubMedGoogle Scholar
  • 9 Trousseau A. Clinique médicale de l'Hôtel-Dieu de Paris. Paris: J. B. Baillière et fils Publisher; 1865
    Google Scholar
  • 10 Varki NM, Varki A. Heparin inhibition of selectin-mediated interactions during the hematogenous phase of carcinoma metastasis: rationale for clinical studies in humans. Semin Thromb Hemost 2002; 28 (01) 53-66
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Wahrenbrock M, Borsig L, Le D, Varki N, Varki A. Selectin-mucin interactions as a probable molecular explanation for the association of Trousseau syndrome with mucinous adenocarcinomas. J Clin Invest 2003; 112 (06) 853-862
    CrossrefPubMedGoogle Scholar
  • 12 Blom JW, Malignancies CD. prothrombotic mutations, and the risk of venous thrombosis. JVS 2006; 43 (04) 866
    PubMedGoogle Scholar
  • 13 Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Risk Factors for Deep Vein Thrombosis and Pulmonary Embolism. Arch Intern Med 2000; 160 (06) 809-815
    CrossrefPubMedGoogle Scholar
  • 14 Tesselaar ME, Romijn FP, Van Der Linden IK, Prins FA, Bertina RM, Osanto S. Microparticle-associated tissue factor activity: a link between cancer and thrombosis?. J Thromb Haemost 2007; 5 (03) 520-527
    CrossrefPubMedGoogle Scholar
  • 15 Koga M, Sugimoto A, Furo M, Iseki H. Apixaban for the treatment of cancer-associated venous thromboembolism and left atrial appendage thrombus refractory to optimal anticoagulation with warfarin: a case report. Eur Heart J 2018; 2: 1-4
    PubMedGoogle Scholar
  • 16 Agnelli G, Buller HR, Cohen A. et al. AMPLIFY Investigators. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 2013; 369 (09) 799-808
    CrossrefPubMedGoogle Scholar
  • 17 Agnelli G, Buller HR, Cohen A. et al. AMPLIFY-EXT Investigators. Apixaban for extended treatment of venous thromboembolism. N Engl J Med 2013; 368 (08) 699-708
    CrossrefPubMedGoogle Scholar
  • 18 Carrier M, Le Gal G, Cho R, Tierney S, Rodger M, Lee AY. Dose escalation of low molecular weight heparin to manage recurrent venous thromboembolic events despite systemic anticoagulation in cancer patients. J Thromb Haemost 2009; 7 (05) 760-765
    CrossrefPubMedGoogle Scholar
  • 19 Hutten BA, Prins MH, Gent M, Ginsberg J, Tijssen JG, Büller HR. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol 2000; 18 (17) 3078-3083
    CrossrefPubMedGoogle Scholar
  • 20 Prandoni P, Lensing AW, Piccioli A. et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100 (10) 3484-3488
    CrossrefPubMedGoogle Scholar
  • 21 Carrier M, Abou-Nassar K, Mallick R. et al. AVERT Investigators. Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med 2019; 380 (08) 711-719
    CrossrefPubMedGoogle Scholar
  • 22 Weycker D, Li X, Wygant G. et al. Safety and effectiveness of apixaban versus warfarin in the treatment and prevention of venous thromboembolism. Journal of the American College of Cardiology 2018; 71 (11, Suppl.): A1953
    CrossrefPubMedGoogle Scholar
  • 23 de Jong LA, Gout-Zwart JJ, Stevanovic J. et al. Extended treatment with apixaban for venous thromboembolism prevention in the Netherlands: clinical and economic effects. TH Open. 2018; 2 (03) e315-e324
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Agnelli G, Becattini C, Bauersachs R. et al. Caravaggio Study Investigators. Apixaban versus dalteparin for the treatment of acute venous thromboembolism in patients with cancer: the caravaggio study. Thromb Haemost 2018; 118 (09) 1668-1678
    Article in Thieme ConnectPubMedGoogle Scholar