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Congresses

Declaration of sponsorship Pfizer and Bristol Myers Squibb
Read time: 80 mins
Last updated:25th Feb 2022
Published:25th Feb 2022

The ACC scientific sessions took place in Chicago and over the course of the virtual meeting, landmark trials including the CARAVAGGIO trial as well as many other studies were presented online with panel discussion and question and answer sessions. Please see below the highlight presentations from the scientific sessions.

Apixaban for the treatment of VTE associated with cancer: The CARAVAGGIO study

Oral apixaban has shown to be non-inferior to SC dalteparin for the treatment of cancer-associated venous thromboembolism (VTE) in the phase 3, multinational CARAVAGGIO trial presented by Prof. Giancarlo Agnelli (University of Perugia, Italy). The absence of an increase in the risk of major bleeding (MB) at gastrointestinal (GI) sites was of particular interest. These results, which were simultaneously presented at ACC 2020 and published in the New England Journal of Medicine, expand opportunities for patients with cancer-associated thrombosis (CAT) who are eligible for treatment with direct acting oral anticoagulants (DOACs), including patients with GI cancer1,2.

Find out more about results of the CARAVAGGIO study

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With a record-breaking audience of more than 116,000 delegates from 211 countries, the ESC Congress 2020 provided four days of live and on-demand scientific presentations covering a wide spectrum of topics relevant to cardiovascular medicine. The studio in Amsterdam hosted dozens of key opinion leaders on site, while ‘Hot Line’ trial presenters connected live from around the world and questions submitted by audience members were addressed in the discussions. Scientific CAT-related highlights from the congress are presented below.

Effectiveness and safety of apixaban, low-molecular weight heparin, and warfarin among high-risk subgroups of venous thromboembolism patients with active cancer

This study, presented by Alexander Thomas Cohen (London, UK), evaluated recurrent VTE and MB among VTE patients with active cancer within 6 months of initiating apixaban, low molecular weight heparin (LMWH), or warfarin stratified by cancer type, cancer treatment, and VTE characteristics. Across these high-risk subgroups of VTE cancer patients, apixaban generally had a lower risk of recurrent VTE and MB vs. LMWH and lower risk of recurrent VTE compared to warfarin. Warfarin patients generally had a similar risk of recurrent VTE and MB vs. LMWH. The findings are generally consistent with results from the overall population3.

Risk factors for major bleeding during prolonged anticoagulation therapy in cancer-associated venous thromboembolisms: From the COMMAND VTE Registry

In this study, presented by Yuji Nishimoto (Amagasaki, Japan), investigators aimed to identify the risk factors for MB during prolonged anticoagulation therapy in cancer-associated VTE patients. The study demonstrated that MB events were common during prolonged anticoagulation therapy in real world cancer-associated VTE patients. Terminal cancer, chronic kidney disease, and GI cancer were independent risk factors for MB4.

Patterns of anticoagulation for atrial fibrillation in cancer patients referred for cardio-oncological evaluation

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The ISTH 2020 Virtual Congress hosted State-of-the-Art sessions featuring world-renowned speakers on major topics including the clinical management of VTE in cancer patients and encompassed DOAC and new therapeutic tools for VTE treatment. Please see below the highlight presentations from the scientific sessions.

Anticoagulation therapy management in oncological patients: Experience in a centre

The aim of this study, presented by Dr Feliciano, was to evaluate the efficacy and safety of DOACs in cancer patients. The presenters of this descriptive and retrospective observational study concluded that DOACs are a very interesting therapeutic option in patients with VTE and an active neoplasia6.

Risk of arterial thromboembolism in cancer patients: A population-based cohort study

This registry study, presented by Dr Mulder, found substantial differences in the occurrence of arterial thromboembolism (ATE) between cancer patients and the general population. The presentation demonstrated that elderly patients were especially affected7,8.

Apixaban levels in cancer-associated thrombosis in low-weight individuals

In this presentation, Dr Bravo-Villa explains how investigators routinely treat patients with CAT weighing between 60–120 kg with full-dose apixaban and those below 60 kg receive full-dose anticoagulation for the first month and decrease to 2.5 mg BID thereafter. The study sought to determine whether low-weight individuals are being similarly anticoagulated as determined by apixaban plasma levels. Patients with CAT and low weight may be underrepresented in published studies and may be over-anticoagulated with regular therapeutic-dose apixaban. The authors concluded that prospective studies assessing thrombotic and bleeding risk in these individuals are warranted9.

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Are you up to date with the latest research regarding the use of anticoagulants? Watch the highlights from 2020’s pivotal studies focused on venous thromboembolism (VTE) prevention and management in cancer associated thrombosis (CAT) in an interview with Dr Ander Cohen

Has there been any new research on the use of direct acting oral anticoagulants (DOACs) for VTE in CAT in 2020?


Dr Cohen gives us a concise overview of publications that provide data to support decision making for the use of Factor Xa inhibitors in treating CAT. Gain key takeaways from the most recent studies that compare the use of direct acting oral anticoagulants (DOACs) to low molecular weight heparin (LMWH).

Has 2020 seen improvement in our ability to stratify VTE risk among patients with cancer and identify those who may benefit from thromboprophylaxis?


A clear understanding of risk underpins clinical decision making.

  • Further your insight into the identification of individuals with cancer at risk of VTE who could benefit from thromboprophylaxis, as Dr Cohen discusses a review undertaken with colleagues in 202011.
  • Scores to assess risk and identify individuals for treatment include the COMPASS-CAT RAM risk assessment model, the Khorana score, the Vienna CATS score, the PROTECHT score, and the CONKO score. Risk factors broadly relate to tumour, treatment, patient, and biomarkers11.
  • Research provides continued refinement of risk-stratification methods. Listen to the latest understanding of which groups of patients might benefit, including for treatment with DOACs as trials for these factor Xa inhibitor undergo further sub-analysis.

How has our understanding of the safety and efficacy of DOACs in patients with cancer improved during 2020?

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Roundtable event 2021: The most impactful topics and data presented at International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC)

ICTHIC is an international conference that promotes recent advances in the understanding of thrombohemorrhagic complications in cancer patients. This roundtable event led by experts Professor Gary Lyman, Dr Alexander Cohen and Professor Anna Falanga covers various topics including updates to the guidelines and new recommendations for cancer associated thrombosis (CAT) prevention and treatment, the role of CAT prevention and prophylaxis treatments on CAT and the impact of COVID-19.

Introduction


Expert speakers Professor Gary Lyman, Dr Alexander Cohen and Professor Anna Falanga introduce themselves.

Updates to key guidelines in 2020/2021 and discussions on new recommendations that are most impactful in clinical practice

An overview of some guideline updates in 2020-202112 and the new recommendations for CAT that are most impactful in clinical practice. Our experts also cover ways to improve the timeliness and relevance of these guidelines by which adherence can also be improved.

The roles of thrombosis prophylaxis and risk assessment in cancer associated thrombosis (CAT)

A discussion on the role of a thromboprophylaxis approach in hospital patients with cancer and the surgical setting. Additionally, our experts discuss the role of risk assessment, the future direction in the field of CAT as well as the introduction of new biomarkers.

How to integrate a more patient-centric approach to cancer associated thrombosis (CAT) therapy and the effect of the COVID-19 pandemic on thrombotic issues in cancer patients

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References

  1. Agnelli, G. et al. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. N. Engl. J. Med. 2020;382:1599–1607.
  2. Conference Highlights - ACC 2020. Available at: https://conferences.m3medical.com/acc-2020/ (accessed 18 September).
  3. ESC Congress 2020 — The Digital Experience - Programme. Available at: https://programme.escardio.org/ESC2020/Abstracts/218535-effectiveness-and-safety-of-apixaban-low-molecular-weight-heparin-and-warfarin-among-high-risk-subgroups-of-venous-thromboembolism-patients-with-active-cancer?r=/ESC2020/On-Demand?s%3D%24expression%3Dapixaban (accessed 18 September).
  4. ESC Congress 2020 — The Digital Experience - Programme. Available at: https://programme.escardio.org/ESC2020/Abstracts/219413-risk-factors-for-major-bleeding-during-prolonged-anticoagulation-therapy-in-cancer-associated-venous-thromboembolisms-from-the-command-vte-registry?r=/ESC2020/On-Demand?s%3D%24expression%3DCOMMAND (accessed 18 September).
  5. ESC Congress 2020 — The Digital Experience - Programme. Available at: https://programme.escardio.org/ESC2020/Abstracts/219450-patterns-of-anticoagulation-for-atrial-fibrillation-in-cancer-patients-referred-for-cardio-oncological-evaluation?r=/ESC2020/On-Demand?s%3D%24expression%3Datrial fibrillation cancer (accessed 18 September).
  6. Anticoagulation Therapy Management in Oncological Patients: Experience in a Center - ISTH Congress Abstracts. Available at: https://abstracts.isth.org/abstract/anticoagulation-therapy-management-in-oncological-patients-experience-in-a-center/ (accessed 18 September).
  7. Conference Highlights - ISTH 2020. Available at: https://conferences.m3medical.com/isth-2020/ (accessed 18 September).
  8. Risk of Arterial Thromboembolism in Cancer Patients: A Population-Based Cohort Study - ISTH Congress Abstracts. Available at: https://abstracts.isth.org/abstract/risk-of-arterial-thromboembolism-in-cancer-patients-a-population-based-cohort-study/ (accessed 18 September).
  9. Apixaban Levels In Cancer-Associated Thrombosis In Low-Weight Individuals - ISTH Congress Abstracts. Available at: https://abstracts.isth.org/abstract/apixaban-levels-in-cancer-associated-thrombosis-in-low-weight-individuals/ (accessed 18 September).
  10. Cancer Associated Thrombosis: Are DOACs a Treatment Option? Systematic Review and Meta-analysis of Randomised Controlled Trials - ISTH Congress Abstracts. Available at: https://abstracts.isth.org/abstract/cancer-associated-thrombosis-are-doacs-a-treatment-option-systematic-review-and-meta-analysis-of-randomised-controlled-trials/ (accessed 18 September).
  11. Khorana AA, Cohen AT, Carrier M, Meyer G, Pabinger I, Kavan P, et al. Prevention of venous thromboembolism in ambulatory patients with cancer. ESMO Open. 2020;5(6):948.
  12. Streiff MB, Abutalib SA, Farge D, Murphy M, Connors JM, Piazza G. Update on Guidelines for the Management of Cancer-Associated Thrombosis. The Oncologist. 2020; 26(1):e24–e40.
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