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Article ; Online: Evidence-Based Minireview: Full dose, modified dose, or no anticoagulation for patients with cancer and acute VTE and thrombocytopenia.

Patell, Rushad / Zwicker, Jeffrey I

Hematology. American Society of Hematology. Education Program

2022 Volume 2022, Issue 1, Page(s) 312–315

Abstract: Co-incident venous thromboembolism and thrombocytopenia are frequent in patients with active malignancies. The optimal approach for anticoagulation in patients with cancer and thrombocytopenia is not established. Different strategies are often utilized ... ...

Abstract	Co-incident venous thromboembolism and thrombocytopenia are frequent in patients with active malignancies. The optimal approach for anticoagulation in patients with cancer and thrombocytopenia is not established. Different strategies are often utilized including dose-reduced anticoagulation dictated by degree of thrombocytopenia or transfusing platelets in order to facilitate therapeutic anticoagulation. This minireview provides an overview of the data and we outline our approach toward anticoagulation in patients with venous thromboembolism and thrombocytopenia in the setting of cancer.
MeSH term(s)	Humans ; Venous Thromboembolism/drug therapy ; Anticoagulants/therapeutic use ; Hemorrhage/drug therapy ; Thrombocytopenia/drug therapy ; Neoplasms/complications ; Neoplasms/drug therapy
Chemical Substances	Anticoagulants
Language	English
Publishing date	2022-12-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2084287-9
ISSN	1520-4383 ; 1520-4391
ISSN (online)	1520-4383
ISSN	1520-4391
DOI	10.1182/hematology.2022000411
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Article ; Online: The bridging conundrum: perioperative management of direct oral anticoagulants for venous thromboembolism.

Berry, Jonathan / Patell, Rushad / Zwicker, Jeffrey I

Journal of thrombosis and haemostasis : JTH

2023 Volume 21, Issue 4, Page(s) 780–786

Abstract: Most patients diagnosed with venous thromboembolism (VTE) are currently treated with direct oral anticoagulants (DOACs). Before an invasive procedure or surgery, clinicians face the challenging decision of how to best manage DOACs. Should the DOAC be ... ...

Abstract	Most patients diagnosed with venous thromboembolism (VTE) are currently treated with direct oral anticoagulants (DOACs). Before an invasive procedure or surgery, clinicians face the challenging decision of how to best manage DOACs. Should the DOAC be held, for how long, and are there instances where bridging with other anticoagulants should be considered? Although clinical trials indicate that most patients taking DOACs for atrial fibrillation do not require bridging anticoagulation, the optimal strategy for patients with a history of VTE is undefined. In this review, we present a case-based discussion for DOAC interruption perioperatively in patients receiving anticoagulation for management of VTE.
MeSH term(s)	Humans ; Venous Thromboembolism/diagnosis ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/prevention & control ; Hemorrhage/drug therapy ; Anticoagulants ; Blood Coagulation ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/drug therapy ; Administration, Oral
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-01-02
Publishing country	England
Document type	Case Reports ; Review ; Journal Article
ZDB-ID	2112661-6
ISSN	1538-7836 ; 1538-7933
ISSN (online)	1538-7836
ISSN	1538-7933
DOI	10.1016/j.jtha.2022.12.024
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Zs.A 5805: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 295: Show issues

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Article ; Online: Challenges in anticoagulation for patients with brain tumors.

Iyengar, Varun / Patell, Rushad / Zwicker, Jeffrey

Best practice & research. Clinical haematology

2022 Volume 35, Issue 1, Page(s) 101350

Abstract: Venous thromboembolism (VTE) is a common complication in patients with primary and metastatic brain cancer. Treatment of thrombosis in these patients must be balanced against the risk of intracranial hemorrhage (ICH). A number of cohort studies conducted ...

Abstract	Venous thromboembolism (VTE) is a common complication in patients with primary and metastatic brain cancer. Treatment of thrombosis in these patients must be balanced against the risk of intracranial hemorrhage (ICH). A number of cohort studies conducted over the last several years have assessed the risk of ICH in patients with primary or secondary brain tumors in the setting of anticoagulation. Anticoagulation with warfarin or low-molecular weight heparin significantly increases the risk of ICH in the setting of primary brain cancers. In contrast, therapeutic anticoagulation does not appear to alter the risk of ICH among patients with metastatic brain tumors. This review summarizes current data regarding anticoagulant and antiplatelet therapy in patients with brain tumors, including emerging data on direct-acting oral anticoagulants, and other related topics, such as the use of inferior vena cava filters and resumption of anticoagulation following ICH.
MeSH term(s)	Anticoagulants ; Brain Neoplasms ; Humans ; Intracranial Hemorrhages ; Vena Cava Filters ; Venous Thromboembolism
Chemical Substances	Anticoagulants
Language	English
Publishing date	2022-06-12
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2048027-1
ISSN	1532-1924 ; 1521-6926
ISSN (online)	1532-1924
ISSN	1521-6926
DOI	10.1016/j.beha.2022.101350
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Se 1029: Show issues

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Article ; Online: The prevalence of thrombocytopenia in patients with acute cancer-associated thrombosis.

Hsu, Charles / Patell, Rushad / Zwicker, Jeffrey I

Blood advances

2022 Volume 7, Issue 17, Page(s) 4721–4727

Abstract: Venous thromboembolism (VTE) and thrombocytopenia are frequently encountered complications in patients with cancer. Although there are several studies evaluating the safety and efficacy of anticoagulation regimens in patients with cancer-associated ... ...

Abstract	Venous thromboembolism (VTE) and thrombocytopenia are frequently encountered complications in patients with cancer. Although there are several studies evaluating the safety and efficacy of anticoagulation regimens in patients with cancer-associated thrombosis (CAT) with thrombocytopenia, there is a paucity of data assessing the scope of the concurrent diagnoses. This study evaluates the prevalence of thrombocytopenia among patients with acute CAT. A retrospective cohort analysis of adult patients with cancer was conducted at Beth Israel Deaconess Medical Center between 2010 and 2021 with CAT (acute VTE within 6 months after new diagnosis of malignancy). VTE included acute deep vein thrombosis, pulmonary embolism, abdominal or intrathoracic venous thrombosis, and cerebral sinus thrombosis. The lowest platelet count within 2 weeks of (before or after) the index VTE event was identified to assess the frequency and grade of concurrent thrombocytopenia. We identified 3635 patients with CAT (80% solid tumors, 18% hematologic malignancies, and 2% multiple concurrent cancer diagnoses). Thrombocytopenia (defined as platelet count <100 000/μL) occurred in 22% (95% CI 21%-24%) of patients with CAT with solid tumors diagnoses and 47% (95% CI 43%-51%) of patients with CAT and hematologic malignancies. Severe thrombocytopenia (platelet count <50 000/μL) occurred in 7% (95% CI 6%-8%) of patients with solid tumors and 30% (95% CI 27%-34%) of patients with hematologic malignancies. Concurrent diagnoses of CAT and thrombocytopenia are very common, especially among patients with hematologic malignancies.
MeSH term(s)	Humans ; Venous Thromboembolism/complications ; Anticoagulants/adverse effects ; Retrospective Studies ; Prevalence ; Neoplasm Recurrence, Local ; Venous Thrombosis ; Thrombocytopenia/etiology ; Thrombocytopenia/chemically induced ; Thrombosis/chemically induced ; Hematologic Neoplasms/complications
Chemical Substances	Anticoagulants
Language	English
Publishing date	2022-09-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2915908-8
ISSN	2473-9537 ; 2473-9529
ISSN (online)	2473-9537
ISSN	2473-9529
DOI	10.1182/bloodadvances.2022008644
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Zs.A 7153: Show issues

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Article ; Online: Inpatient prophylaxis in cancer patients: where is the evidence?

Patell, Rushad / Zwicker, Jeffrey I

Thrombosis research

2020 Volume 191 Suppl 1, Page(s) S85–S90

Abstract: Venous thromboembolism (VTE) is a leading cause of preventable in-hospital mortality. Cancer is associated with an increased risk of VTE which is further compounded by acute hospitalization for medical illness. The absolute incidence of VTE of ... ...

Abstract	Venous thromboembolism (VTE) is a leading cause of preventable in-hospital mortality. Cancer is associated with an increased risk of VTE which is further compounded by acute hospitalization for medical illness. The absolute incidence of VTE of hospitalized cancer patients ranges between 2% and 17% but the rates vary considerably depending on the type of study, method of VTE surveillance and whether pharmacologic thromboprophylaxis is administered. Complicating the interpretation of thromboprophylaxis trials is the paucity of reported data on the relative benefit of thromboprophylaxis relative to an increased risk of hemorrhage inherent to cancer patients. Efforts over the last decade have improved the rates of adherence to in-hospital pharmacologic thromboprophylaxis regimens. Whether these efforts also improve outcomes continues to be debated. In this review, the prevalence of VTE and hemorrhage in hospitalized cancer patients is presented in the context of pharmacologic thromboprophylaxis data along with a discussion of emerging approaches towards VTE risk-adapted prescription of antithrombotics during hospitalization.
MeSH term(s)	Anticoagulants/therapeutic use ; Hemorrhage ; Hospitalization ; Humans ; Inpatients ; Neoplasms/complications ; Neoplasms/drug therapy ; Risk Factors ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control
Chemical Substances	Anticoagulants
Language	English
Publishing date	2020-07-04
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/S0049-3848(20)30403-5
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Zs.A 863: Show issues

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Article ; Online: Defining the Educational Needs for a Community-Based Hematology/Oncology Career: A National Needs Assessment.

Agrawal, Shubham / Patell, Rushad / Dodge, Laura E / Pegher, Jennifer W / Coleman, Robert L / Waterhouse, David Michael / Roberts, Daniel Aaron / Rangachari, Deepa

JCO oncology practice

2024 , Page(s) OP2300698

Abstract: Purpose: Little is known about the specific needs during training for hematology/oncology providers practicing in community-based settings. We conducted a national survey of hematologists/oncologists employed in community or academic-community hybrid ... ...

Abstract	Purpose: Little is known about the specific needs during training for hematology/oncology providers practicing in community-based settings. We conducted a national survey of hematologists/oncologists employed in community or academic-community hybrid settings to delineate their educational needs. Methods: An electronic questionnaire was developed and distributed nationally through professional organizations. We primarily assessed whether survey participants received any specific training during fellowship for community-based practice. Participants were also surveyed regarding training experiences that might have affected their preparation. Relative risk (RR) and 95% CI were calculated using modified Poisson regression to identify factors associated with receiving training specifically for community-based settings. Results: Of 125 participants from across 25 states, 63% were male and 58% identified as White. Less than half (41.6%, binomial 95% CI, 32.8 to 50.7) received any training in a community-based setting. Participants identified rotations in community settings (47%), direct mentorship from community-based physicians (40%), and longitudinal clinic in a community setting (36%) as experiences that would have been valuable. Specific curricula of interest included medical operations and administration (63%), health policy (35%), and quality improvement (27%). Respondents in clinical practice for <10 years were more likely to have received any training specifically for a community-based career (RR, 2.13 [95% CI, 1.18 to 3.86]). Conclusion: Our study demonstrates substantial unmet needs as they relate to deliberately training fellows destined for community-based careers. Prospective design of clinical training and curricula emphasizing longitudinal exposures to and key aspects of health care delivery in the community setting are paramount to achieving optimal goal-concordant hematology/oncology training during fellowship.
Language	English
Publishing date	2024-02-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	3028198-2
ISSN	2688-1535 ; 2688-1527
ISSN (online)	2688-1535
ISSN	2688-1527
DOI	10.1200/OP.23.00698
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Zs.A 7198: Show issues

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Article ; Online: Communication from the ISTH SSC Subcommittee on Hemostasis and Malignancy: A meta-analysis to assess the risk of bleeding and thrombosis following CAR T-cell therapy.

Bindal, Poorva / Patell, Rushad / Chiasakul, Thita / Lauw, Mandy N / Ko, Amica / Wang, Tzu-Fei / Zwicker, Jeffrey I

Journal of thrombosis and haemostasis : JTH

2024

Abstract: Background: Chimeric antigen receptor T cell (CAR T-cell) therapy is increasingly utilized for treatment of hematologic malignancies. Hematologic toxicities including thrombosis and bleeding complications have been reported. Accurate estimates for ... ...

Abstract	Background: Chimeric antigen receptor T cell (CAR T-cell) therapy is increasingly utilized for treatment of hematologic malignancies. Hematologic toxicities including thrombosis and bleeding complications have been reported. Accurate estimates for thrombotic and bleeding outcomes are lacking. Methods: We searched MEDLINE, EMBASE, and Cochrane CENTRAL up to February 2022 for studies reporting thrombotic or bleeding outcomes in patients receiving CAR T-cell therapy. Pooled event rates were calculated using a random-effects model. We performed subgroup analyses stratified by follow up duration, CAR T-cell target antigen, and underlying hematologic malignancy. Results: We included 47 studies with a total 7040 patients. High heterogeneity between studies precluded reporting of overall pooled rates of thrombotic and bleeding events. In studies with follow-up duration of ≤6 months, the pooled incidence of venous thrombotic events were 2.4% (95% CI 1.4-3.4, I Conclusion: The risk of both thrombosis and bleeding following CAR T-cell therapy appears to be highest in the initial months following infusion.
Language	English
Publishing date	2024-04-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2112661-6
ISSN	1538-7836 ; 1538-7933
ISSN (online)	1538-7836
ISSN	1538-7933
DOI	10.1016/j.jtha.2024.03.021
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Zs.A 5805: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Palliative Medicine Fellows' Discussions, Perceptions, and Training Regarding Medical Cannabis.

Sherry, Dylan R / Patell, Rushad / Han, Harry J / Dodge, Laura E / Braun, Ilana M / Buss, Mary K

Journal of pain and symptom management

2024

Abstract: Context: Medical cannabis is increasingly considered for palliation of pain, nausea/vomiting, anorexia, and other symptoms.: Objectives: We aimed to determine whether training in hospice and palliative medicine (HPM) adequately prepares fellows to ... ...

Abstract	Context: Medical cannabis is increasingly considered for palliation of pain, nausea/vomiting, anorexia, and other symptoms. Objectives: We aimed to determine whether training in hospice and palliative medicine (HPM) adequately prepares fellows to counsel patients about medical cannabis. Methods: A previously validated questionnaire was adapted for HPM fellows. Domains included fellows' practices recommending cannabis and their knowledge of its effectiveness and risks compared with standard treatments. U.S. HPM fellowships were sent surveys in 2022 and 2023. Results: Forty six programs participated, 123 fellows responded (response rate of 42%) including 69% female; 55% White, and 28% Asian. Of respondents, 65% reported receiving formal training regarding medical cannabis; 57% reported discussing medical cannabis with over five patients; 23% recommended medical cannabis to more than five patients in the preceding year. Only 19%, however, felt sufficiently informed to issue cannabis-related recommendations. HPM fellows with prior training were not more likely to feel sufficiently informed to discuss cannabis (RR: 1.17; 95% CI: 0.82-1.66) or to recommend cannabis to patients (RR: 2.05, 95% CI: 0.89-4.71). Fellows rate cannabis as equally or more effective than conventional treatments for the following symptoms: anorexia/cachexia (63%), nausea/vomiting (43%), pain (25%), and neuropathic pain (21%). Conclusion: Most HPM fellows report formal training in the use of medical cannabis. Over half of trainees reported discussing medical cannabis with patients, but few considered themselves sufficiently informed to make cannabis-related clinical recommendations. These results suggest both a need for expanded high-quality evidence for medical cannabis in palliative care and for improved formal education for HPM fellows.
Language	English
Publishing date	2024-02-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	639142-4
ISSN	1873-6513 ; 0885-3924
ISSN (online)	1873-6513
ISSN	0885-3924
DOI	10.1016/j.jpainsymman.2024.02.562
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Zs.A 2252: Show issues

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Article ; Online: Clonal myeloid disorders following CAR T-cell therapy.

Andersen, Michael / Bindal, Poorva / Michaels, Phillip / Elavalakanar, Pavania / Liegel, Jessica / Dias, Ajoy / Arnason, Jon / Patell, Rushad

Annals of hematology

2023 Volume 102, Issue 12, Page(s) 3643–3645

MeSH term(s)	Humans ; Immunotherapy, Adoptive/adverse effects ; T-Lymphocytes ; Receptors, Antigen, T-Cell ; Clone Cells ; Leukemia, Myeloid, Acute/therapy
Chemical Substances	Receptors, Antigen, T-Cell
Language	English
Publishing date	2023-09-26
Publishing country	Germany
Document type	Letter
ZDB-ID	1064950-5
ISSN	1432-0584 ; 0939-5555 ; 0945-8077
ISSN (online)	1432-0584
ISSN	0939-5555 ; 0945-8077
DOI	10.1007/s00277-023-05454-5
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Uh III Zs.181: Show issues

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Article ; Online: Venous Thromboembolism in Total Hip and Total Knee Arthroplasty.

Simon, Samantha J / Patell, Rushad / Zwicker, Jeffrey I / Kazi, Dhruv S / Hollenbeck, Brian L

JAMA network open

2023 Volume 6, Issue 12, Page(s) e2345883

Abstract: Importance: The optimal pharmacologic thromboprophylaxis agent after total hip and total knee arthroplasty is uncertain and consensus is lacking. Quantifying the risk of postoperative venous thromboembolism (VTE) and bleeding and evaluating comparative ... ...

Abstract	Importance: The optimal pharmacologic thromboprophylaxis agent after total hip and total knee arthroplasty is uncertain and consensus is lacking. Quantifying the risk of postoperative venous thromboembolism (VTE) and bleeding and evaluating comparative effectiveness and safety of the thromboprophylaxis strategies can inform care. Objective: To quantify risk factors for postoperative VTE and bleeding and compare patient outcomes among pharmacological thromboprophylaxis agents used after total hip and knee arthroplasty. Design, setting, and participants: This retrospective cohort study used data from a large health care claims database. Participants included patients in the United States with hip or knee arthroplasty and continuous insurance enrollment 3 months prior to and following their surgical procedure. Patients were excluded if they received anticoagulation before surgery, received no postsurgical pharmacological thromboprophylaxis, or had multiple postsurgery thromboprophylactic agents. In a propensity-matched analysis, patients receiving a direct oral anticoagulant (DOAC) were matched with those receiving aspirin. Exposures: Aspirin, apixaban, rivaroxaban, enoxaparin, or warfarin. Main outcomes and measures: The primary outcome was 30-day cumulative incidence of postdischarge VTE. Other outcomes included postdischarge bleeding. Results: Among 29 264 patients included in the final cohort, 17 040 (58.2%) were female, 27 897 (95.2%) had inpatient admissions with median (IQR) length of stay of 2 (1-2) days, 10 948 (37.4%) underwent total hip arthroplasty, 18 316 (62.6%) underwent total knee arthroplasty; and median (IQR) age was 59 (55-63) years. At 30 days, cumulative incidence of VTE was 1.19% (95% CI, 1.06%-1.32%) and cumulative incidence of bleeding was 3.43% (95% CI, 3.22%-3.64%). In the multivariate analysis, leading risk factors associated with increased VTE risk included prior VTE history (odds ratio [OR], 5.94 [95% CI, 4.29-8.24]), a hereditary hypercoagulable state (OR, 2.64 [95% CI, 1.32-5.28]), knee arthroplasty (OR, 1.65 [95% CI, 1.29-2.10]), and male sex (OR, 1.34 [95% CI, 1.08-1.67]). In a propensity-matched cohort of 7844 DOAC-aspirin pairs, there was no significant difference in the risk of VTE in the first 30 days after the surgical procedure (OR, 1.14 [95% CI, 0.82-1.59]), but postoperative bleeding was more frequent in patients receiving DOACs (OR, 1.36 [95% CI, 1.13-1.62]). Conclusions and relevance: In this cohort study of patients who underwent total hip or total knee arthroplasty, underlying patient risk factors, but not choice of aspirin or DOAC, were associated with postsurgical VTE. Postoperative bleeding rates were lower in patients prescribed aspirin. These results suggest that thromboprophylaxis strategies should be patient-centric and tailored to individual risk of thrombosis and bleeding.
MeSH term(s)	Humans ; Male ; Female ; United States/epidemiology ; Middle Aged ; Anticoagulants/therapeutic use ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; Arthroplasty, Replacement, Knee/adverse effects ; Arthroplasty, Replacement, Knee/methods ; Cohort Studies ; Retrospective Studies ; Aftercare ; Patient Discharge ; Aspirin/adverse effects ; Postoperative Hemorrhage/epidemiology
Chemical Substances	Anticoagulants ; Aspirin (R16CO5Y76E)
Language	English
Publishing date	2023-12-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.45883
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