Abstract:
:Patients with cancer have a 6-7-fold higher risk of venous thromboembolism (VTE) as compared with non-cancer patients. Effective and safe anticoagulation for the prevention and treatment of VTE is the cornerstone of the management of patients with cancer, aiming to decrease morbidity and mortality and to improve quality of life. Unfractionated heparin, low molecular weight heparins, fondaparinux and vitamin K antagonists (VKAs) are used in the prevention and treatment of VTE in cancer patients. Heparins and fondaparinux are administered subcutaneously. VKAs are orally active, but they have a narrow therapeutic window, numerous food and drug interactions, and treatment requires regular laboratory monitoring and dose adjustment. These limitations among others have important negative impact on the quality of life of patients and decrease adherence to the treatment. New orally active anticoagulant (NOAC) agents are specific inhibitors of activated factor Xa (FXa) (rivaroxaban and apixaban) or thrombin (dabigatran). It is expected that NOACs will improve antithrombotic treatment. Cancer patients are a particular group that could benefit from treatment with NOACs. However, NOACs present some significant interactions with drugs frequently used in cancer patients, which might influence their pharmacokinetics, compromising their efficacy and safety. In the present review, we analyzed the available data from the subgroups of patients with active cancer who were included in Phase III clinical trials that assessed the efficacy and safety of NOACs in the prevention and treatment of VTE. The data from the Phase III trials in prophylaxis of VTE by rivaroxaban or apixaban highlight that these two agents, although belonging to the same pharmacological group (direct inhibitors of factor Xa), have substantially different profiles of efficacy and safety, especially in hospitalized acutely ill medical patients with active cancer. A limited number of patients with VTE and active cancer were included in the Phase III trials (EINSTEIN, AMPLIFY, and RE-COVER) which evaluated the efficacy and safety of NOACs in the acute phase and secondary prevention of VTE. Although, from a conceptual point of view, NOACs could be an attractive alternative for the treatment of VTE in cancer patients, the available data do not support this option. In addition, due to the elimination of the NOACs by the liver and renal pathway as well as because of their pharmacological interactions with drugs which are frequently used in cancer patients, an eventual use of these drugs in cancer patients should be extremely cautious and be restricted only to patients presenting with contraindications for low molecular weight heparins, fondaparinux, or VKAs. The analysis of the available data presented in this review reinforces the request for the design of new Phase III clinical trials for the assessment of the efficacy and safety of NOACs in specific populations of patients with cancer.
journal_name
Ther Clin Risk Managjournal_title
Therapeutics and clinical risk managementauthors
Gerotziafas GT,Mahé I,Elalamy Idoi
10.2147/TCRM.S49063subject
Has Abstractpub_date
2014-06-13 00:00:00pages
423-36eissn
1176-6336issn
1178-203Xpii
tcrm-10-423journal_volume
10pub_type
杂志文章,评审abstract::We report the case of a 30-year-old Japanese woman with anorexia nervosa and vertebral fractures who was treated with etidronate. She had a history of anorexia nervosa, chronic back pain, osteoporosis, and multiple vertebral fractures (morphometric fractures) that responded poorly to treatment with alfacalcidol (1 μg ...
journal_title:Therapeutics and clinical risk management
pub_type:
doi:10.2147/TCRM.S21357
更新日期:2011-01-01 00:00:00
abstract::The purpose of this review was to test contraceptive efficacy, cycle control, tolerability, and acceptability as found in the non-comparative studies with NuvaRing((R)) by those found in the randomized trials comparing NuvaRing and combined oral contraceptives (COCs). All large non-comparative studies and all relevant...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/tcrm.s1964
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:Multifactor cardiovascular disease is the leading cause of death; besides well-known cardiovascular risk factors, several emerging factors such as mental stress, diet type, and physical inactivity, have been associated to cardiovascular disease. To date, preventive strategies are based on the concept of abso...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S16523
更新日期:2011-01-01 00:00:00
abstract::Ongoing neuronal death in Parkinson's disease (PD) causes an altered neurotransmission of various biogenic amines, particularly dopamine. As these changes do not follow a distinct pattern, they vary individually, and are differently pronounced. As a result, a heterogeneous onset of motor and nonmotor features occurs i...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章,评审
doi:10.2147/TCRM.S86393
更新日期:2016-08-02 00:00:00
abstract::Procarbazine HCl is a 'nonclassical' oral alkylating anticancer agent that was first synthesized in the late 1950s. It has been used in the treatment of many cancers, but its main use is in the treatment of Hodgkin's lymphoma and brain tumors and, to a lesser extent, Non-Hodgkin's lymphoma and primary central nervous ...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/tcrm.2007.3.2.213
更新日期:2007-06-01 00:00:00
abstract:BACKGROUND:Acute diarrhea is the major cause of child morbidity and mortality in low-income nations. It is the second most common cause of death among children <5 years of age globally. The indispensable role of community pharmacists is clearly observed in the prevention and treatment of diarrhea. However, there is a p...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S98474
更新日期:2016-04-05 00:00:00
abstract:Background:Treatment-related problems (TRPs) may pose risks for patients if unaddressed. With the increased complexity of health care, it is important to target pharmacists' efforts to patients that are at high risk for TRPs. Objectives:The present study aimed to identify medications most commonly associated with TRPs...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S180747
更新日期:2018-11-16 00:00:00
abstract:AIM:To evaluate the efficacy of glycopyrrolate oral solution (1 mg/5 mL) in managing problem drooling associated with cerebral palsy and other neurologic conditions. METHOD:Thirty-eight patients aged 3-23 years weighing at least 27 lb (12.2 kg) with severe drooling (clothing damp 5-7 days/week) were randomized to glyc...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S26893
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:This retrospective cohort study evaluated whether manual lymphatic drainage (MLD) therapy increases the risk of recurrence of breast cancer. METHODS:We analyzed 1,106 women who were diagnosed with stage 0-3 breast cancer between 2007 and 2011 and experienced remission after surgery and adjuvant therapy. The...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S79118
更新日期:2015-02-27 00:00:00
abstract::Adoptive T-cell immunotherapy is a rapidly growing field and is shifting the paradigm of clinical cancer treatment. Axicabtagene ciloleucel (axi-cel) is an anti-CD19 chimeric antigen receptor T-cell therapy that was initially developed at the National Cancer Institute and has recently been commercially approved by the...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章,评审
doi:10.2147/TCRM.S145039
更新日期:2018-05-31 00:00:00
abstract::Methicillin-resistant Staphylococcus aureus (MRSA) and Candidal prosthetic joint infections (PJIs) are very rare, and the optimal management for these patients is still unknown. A 54-year-old man with traumatic arthritis due to previous electric injury successfully retained the implant despite the successive infection...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S165247
更新日期:2018-06-20 00:00:00
abstract:Background and aim:The aim of this study was to investigate the association between low-density lipoprotein cholesterol (LDL-C) and the development of severe acute pancreatitis (SAP). Patients and methods:A total of 674 patients with acute pancreatitis were enrolled. Non-linearity in the relationship between LDL-C and...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S159387
更新日期:2018-05-30 00:00:00
abstract::Mucositis pain is a major clinical problem associated with cancer treatment. Mucosal tissue injury is a dose-limiting side effect and also limits nutritional intake and oral function, resulting in weight loss and nutritional deficits for many patients. The pathophysiology of mucositis is thought to be a complex array ...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/tcrm.2006.2.3.251
更新日期:2006-09-01 00:00:00
abstract::The Clinical Assessment Program and Teflaro(®) Utilization Registry (CAPTURE) is a multicenter study evaluating the clinical use of ceftaroline fosamil in patients with community-acquired bacterial pneumonia (CABP) or acute bacterial skin and skin structure infection. Data were collected between August 2011 and Februa...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S75191
更新日期:2015-04-02 00:00:00
abstract::Hepatitis C virus (HCV) management in the transplant setting is still an open issue. The therapeutic strategies being addressed include: (a) pre-transplant prophylaxis (to prevent the infection of the transplanted organ); (b) post-transplant prophylaxis (to reduce the possibility of developing acute hepatitis); (c) ma...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:
更新日期:2006-03-01 00:00:00
abstract:Purpose:We conducted this meta-analysis to evaluate the efficacy of hybrid grafts in anterior cruciate ligament reconstruction (ACLR). Methods:We performed an electronic search of the Cochrane Library, PubMed, Embase, and ScienceDirect from the inception of these databases to February 2018, based on the terms "anterio...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S187979
更新日期:2019-03-14 00:00:00
abstract:BACKGROUND:Influenza A H1N1 and H3N2 are two influenza waves that have been identified in past years. METHODS:Data from 77 inpatients from three tertiary hospitals were included and statistical analysis was performed in three different clusters. RESULTS:Thirty-four patients (44.2%) had respiratory distress upon admis...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S57429
更新日期:2014-02-07 00:00:00
abstract::Pemphigus vulgaris (PV) is a life-threatening disease belonging to the pemphigus group of autoimmune intra-epidermal bullous diseases of the skin and mucosae. The therapeutic management of PV remains challenging and, in some cases, conventional therapy is not adequate to induce clinical remission. The cornerstone of P...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章,评审
doi:10.2147/TCRM.S142471
更新日期:2018-04-27 00:00:00
abstract::[This corrects the article on p. 741 in vol. 14, PMID: 29719401.]. ...
journal_title:Therapeutics and clinical risk management
pub_type: 已发布勘误
doi:10.2147/TCRM.S177217
更新日期:2018-06-26 00:00:00
abstract:OBJECTIVE:International travelers from non-endemic areas are at high risk of contracting malaria due to their lack of immunity. Prevention is therefore of outmost importance and is achieved through effective and safe chemoprophylaxis, which reduces the risk of fatal disease. Among the various antimalarial drugs availab...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/tcrm.s3782
更新日期:2008-10-01 00:00:00
abstract::There are a number of oral agents emerging as potential disease-modifying agents in multiple sclerosis (MS). Among these investigational agents, teriflunomide has shown promise in large, multicenter, phase III clinical trials with respect to safety and efficacy in relapsing MS patients, and is the latest disease-modif...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S30947
更新日期:2013-01-01 00:00:00
abstract::Angioid streaks are visible irregular crack-like dehiscences in Bruch's membrane that are associated with atrophic degeneration of the overlying retinal pigmented epithelium. Angioid streaks may be associated with pseudoxanthoma elasticum, Paget's disease, sickle-cell anemia, acromegaly, Ehlers-Danlos syndrome, and di...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:
更新日期:2009-02-01 00:00:00
abstract:Background:The effect of continuous positive airway pressure (CPAP) on nasal symptoms in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) remains controversial. In addition, possible mechanism(s) remains unclear. Objective:To examine whether CPAP contributes to the onset and exacerbation of allergic rhi...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S170548
更新日期:2018-08-24 00:00:00
abstract::Behçet's disease is an autoinflammatory vasculitis of unknown origin characterized by recurrent oral and genital ulcers, uveitis, arthritis and skin lesions. Additionally, involvement of the gastrointestinal tract, central nervous system and large vessels may occur. The disease is prevalent in countries along the anci...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/tcrm.s4446
更新日期:2009-04-01 00:00:00
abstract:INTRODUCTION:Sepsis and septic shock are important causes of mortality in intensive care unit patients, hence early diagnosis and therapy are important in management of their treatment. The available information on sepsis patients is not enough to recommend or to discard the routine evaluation of triglyceride (TG) leve...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S57791
更新日期:2014-02-27 00:00:00
abstract:BACKGROUND:The aim of this open-label, randomized, parallel-group pilot study was to evaluate the efficacy of cefditoren pivoxil and levofloxacin in terms of speed of reduction in inflammatory parameters, clinical recovery, and microbiological eradication. METHODS:Forty eligible patients with acute exacerbation of chr...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S41131
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:The outcome of decompressive craniectomy (DC) for severe traumatic brain injury (sTBI) patients with fixed dilated pupils (FDPs) is not clear. The objective of this study was to validate the outcome of DC in sTBI patients with FDPs. PATIENTS:We retrospectively collected data from 207 sTBI patients with FDPs ...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章
doi:10.2147/TCRM.S89820
更新日期:2015-10-22 00:00:00
abstract::Soft tissue sarcomas (STSs) are a group of rare tumors accounting for less than 1% of all adult malignant tumors, a heterogeneous group of more than 50 histological subtypes. Five percent to 30% of STS patients experience local recurrence and 10%-38% present with clinically detectable metastases. Doxorubicin either al...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章,评审
doi:10.2147/TCRM.S84789
更新日期:2016-01-13 00:00:00
abstract::Allergic rhinitis and urticaria are common allergic diseases that may have a major negative impact on patients' quality of life. Bilastine, a novel new-generation antihistamine that is highly selective for the H1 histamine receptor, has a rapid onset and prolonged duration of action. This agent does not interact with ...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章,评审
doi:10.2147/TCRM.S105189
更新日期:2016-04-13 00:00:00
abstract:AIM:To compare the long-term survival outcomes of radiofrequency ablation and liver resection for single very early/early stage hepatocellular carcinoma (HCC). METHODS:The Cochrane Library (Issue 3, 2015), Embase (1974 to March 15, 2015), PubMed (1950 to March 15, 2015), Web of Science (1900 to March 15, 2015), and Ch...
journal_title:Therapeutics and clinical risk management
pub_type: 杂志文章,评审
doi:10.2147/TCRM.S96760
更新日期:2016-02-23 00:00:00