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Obstetrics and Gynegology2023№10
Risk of thrombotic complications in...

Risk of thrombotic complications in patients with ovarian cancer and some safety aspects of using antifibrinolytic hemostatic agents

DOI
https://dx.doi.org/10.18565/aig.2023.107

Deryabina V.A., Matukhin V.I., Rukhliada N.N., Abramova V.N., Kuts E.E.

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg, Russia

The risk of thrombotic complications is known to increase several times in cancer patients. The malignant process causes changes in the blood coagulation and fibrinolytic systems which negatively affect the prognosis of the patient’s complications. The tumors of the female reproductive system, especially ovarian cancer, are among the most thrombogenic solid tumors. The level of specific markers increases particularly in patients with ovarian cancer. These markers can help to identify patient’s predisposition to the rapid development of venous thromboembolism. There are certain risk factors that increase the likelihood of thrombosis in ovarian cancer: age over 60 years, excess body weight, tumor diameter of more than 100 mm, and the presence of ascites and chronic diseases. Medications used for ovarian cancer are also worth noting. The use of antitumor drugs is known to contribute to thrombotic complications. Conclusion: There is an active discussion about the increased risk of venous thromboembolism in patients who received tranexamic acid and other antifibrinolytic agents to reduce intraoperative blood loss. Although some studies have confirmed the effectiveness of tranexamic acid, there are currently not enough randomized trials to guarantee the absence of a link between the use of antifibrinolytic agents and venous thromboembolism in patients with ovarian cancer. The reasonable use of this group of drugs with obligatory thromboprophylaxis is recommended.

Authors’ contributions: Deryabina V.A., Matukhin V.I., Rukhliada N.N. – developing the concept and design of the study; Deryabina V.A., Matukhin V.I. – collecting and processing the material; Deryabina V.A. – writing the text; Matukhin V.I., Rukhliada N.N., Abramova V.N., Kuts E.E. – editing the article.

Conflicts of interest: The authors declare no possible conflicts of interest.

Funding: The study was conducted without sponsorship.

For citation: Deryabina V.A., Matukhin V.I., Rukhliada N.N., Abramova V.N., Kuts E.E. Risk of thrombotic complications in patients with ovarian cancer and some safety aspects of using antifibrinolytic hemostatic agents. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (10): 60-69 (in Russian) https://dx.doi.org/10.18565/aig.2023.107

Keywords

ovarian cancer
Trousseau syndrome
hemostasis
venous thromboembolism
antifibrinolytics
tranexamic acid
D-dimer
chemotherapy
Full text (in Russian)

References

  1. Gaona-Luviano P., Medina-Gaona L.A., Magaña-Pérez K. Epidemiology of ovarian cancer. Chin. Clin. Oncol. 2020; 9(4): 47. https://dx.doi.org/10.21037/cco-20-34.
  2. Stewart C., Ralyea C., Lockwood S. Ovarian cancer: an integrated review. Semin. Oncol. Nur. 2019; 35(2): 151-6. https://dx.doi.org/10.1016/j.soncn.2019.02.001.
  3. Achen G., Dolivet E., Turck M., Fauvet R. Incidence and impact of venous thrombosis in the diagnosis and therapeutic management of ovarian cancer. Gynecol. Obstet. Fertil. Senol. 2020; 48(6): 506-13. (in French). https://dx.doi.org/10.1016/j.gofs.2020.03.007.
  4. Tasaka N., Minaguchi T., Hosokawa Y., Takao W., Itagaki H., Nishida K. et al. Prevalence of venous thromboembolism at pretreatment screening and associated risk factors in 2086 patients with gynecological cancer. J. Obstet. Gynaecol. Res. 2020; 46(5): 765-73. https://dx.doi.org/10.1111/jog.14233.
  5. Воробьев А.В., Макацария А.Д., Бреннер Б. Синдром Труссо: забытое прошлое или актуальное настоящее? Акушерство и гинекология. 2018; 2: 27-34. [Vorobyev A.V., Makatsaria A.D., Brenner B. Trousseau’s syndrome: The forgotten past or actual present? Obstetrics and Gynecology. 2018; (2): 27-34. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.2.27-34.
  6. Hisada Y., Geddings J. E., Ay C., Mackman N. Venous thrombosis and cancer: from mouse models to clinical trials. J. Thromb. Haemost. 2015; 13(8): 1372-82. https://dx.doi.org/10.1111/jth.13009.
  7. Калинкина Э.Ф., Слувко Н.П., Кондратьева О.В., Тарасов Д.Г. Синдром Труссо и рак яичников. РМЖ. Мать и дитя. 2020; 3(2): 95-9. [Kalinkina E.F., Sluvko N.P., Kondrat’eva O.V., Tarasov D.G. Trousseau syndrome and ovarian cancer. Russian Journal of Woman and Child Health. 2020; 3(2): 95-9. (in Russian)]. https://dx.doi.org/10.32364/2618-8430-2020-3-2-95-99.
  8. Воробьев А.В., Чабров А.М., Савченко А.А., Булгакова С.В., Макацария А.Д. Вопросы патогенеза синдрома Труссо. Акушерство, гинекология и репродукция. 2015; 2: 99-109. [Vorobev A.V., Chabrov A.M., Savchenko A.A., Bulgakova S.V., Makatsaria A.D. Pathogenesis of Trousseau’s syndrome. Obstetrics, Gynecology and Reproduction. 2015; 9(2): 99-109. (in Russian)]. https://dx.doi.org/10.17749/2070-4968.2015.9.2.099-109.
  9. Шульман С., Макацария А.Д., Воробьев А.В., Бицадзе В.О., Хизроева Д.Х., Солопова А.Г. Злокачественные новообразования и тромбозы. Акушерство и гинекология. 2019; 7: 14-23. [Shulman S., Makatsaria A.D., Vorobyev A.V., Bitsadze V.O., Khizroeva D.H., Solopova A.G. Malignant neoplasms and thromboses. Obstetrics and Gynecology. 2019; (7): 14-23. (in Russian)]. https://dx.doi.org/10.18565/aig.2019.7.14-23.
  10. Федоткина Ю.А., Панченко Е.П. Тромбозы в онкологии. ч. 1. Атеротромбоз. 2017; 1: 11-5. [Fedotkina Y.A., Panchenko E.P. Thromboses in oncology. Part 1. Atherothrombosis. 2017; (1): 11-5. (in Russian)]. https://dx.doi.org/10.21518/2307-1109-2017-1-11-15.
  11. Swier N., Versteeg H.H. Reciprocal links between venous thromboembolism, coagulation factors and ovarian cancer progression. Thromb. Res. 2017; 150: 8-18. https://dx.doi.org/10.1016/j.thromres.2016.12.002.
  12. Ахметзянов Ф.Ш., Камалов И.А., Ахметзянова Ф.Ф. Злокачественные опухоли, осложненные тромбообразованием. Поволжский онкологический вестник. 2021; 12(4): 20-7. [Ahmetzyanov F.Sh., Kamalov I.A., Ahmetzyanova F.F. Malignant tumors complicated by thrombosis. Oncology Bulletin of the Volga Region. 2021; 12(4): 20-7. (in Russian)]
  13. Кедрова А.Г., Шабловский О.Р., Леваков С.А., Ванке Н.С. Возможности применения низкомолекулярных гепаринов в комплексном лечении женщин с опухолями женской репродуктивной системы. Опухоли женской репродуктивной системы. 2017; 13(2): 47-55. [Kedrova A.G., Shablovsky O.R., Levakov S.A., Vanke N.S. Possibilities of using low-molecular-weight heparin in the complex treatment of women with tumors of the reproductive system. Tumors of Female Reproductive system. 2017;13(2): 47-55. (in Russian)]. https://dx.doi.org/10.17650/1994-4098-2017-13-2-47-5.
  14. Torre L.A., Bray F., Siegel R.L., Ferlay J., Lortet-Tieulent J., Jemal A. Global cancer statistics, 2012. CA Cancer J. Clin. 2015; 65(2): 87-108. https://dx.doi.org/10.3322/caac.21262.
  15. Besbes S., Shah S., Al-Dybiat I., Mirshahi S., Helfer H., Najah H. et al. Thrombopoietin secretion by human ovarian cancer cells. Int. J. Cell Biol. 2017; 2017: 1873834. https://dx.doi.org/10.1155/2017/1873834.
  16. Hisada Y., Mackman N. Cancer-associated pathways and biomarkers of venous thrombosis. Blood. 2017; 130(13): 1499-506. https://dx.doi.org/10.1182/blood-2017-03-743211.
  17. Wu X., Xue X., Tang J., Cheng X., Tian W., Jiang R. et al. Evaluation of risk factors for venous thromboembolism in Chinese women with epithelial ovarian cancer. Int. J. Gynecol. Cancer. 2013; 23(1): 65-72. https://dx.doi.org/10.1097/IGC.0b013e318276dd87.
  18. Годзоева А.О., Зазерская И.Е., Власов В.С., Вавилова Т.В., Горелова И.В., Кустаров В.Н., Жамбалова Т.В. Оценка фибрин-мономера и D-димера у пациенток с бесплодием в программах вспомогательных репродуктивных технологий. Акушерство и гинекология. 2020; 9: 73-81. [Godzoeva A.O., Zazerskaya I.E., Vlasov V.S., Vavilova T.V., Gorelova I.V., Kustarov V.N., Zhambalova T.V. Fibrin monomer and D-dimer in infertile women undergoing assisted reproductive technology. Obstetrics and Gynecology. 2020; (9): 73-81. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.9.73-81.
  19. Wu J., Fu Z., Liu G., Xu P., Xu J., Jia X. Clinical significance of plasma D-dimer in ovarian cancer: A meta-analysis. Medicine (Baltimore). 2017; 96(25): e7062. https://dx.doi.org/10.1097/MD.0000000000007062.
  20. Sakurai M., Satoh T., Matsumoto K., Michikami H., Nakamura Y., Nakao S. et al. High pretreatment plasma D-dimer levels are associated with poor prognosis in patients with ovarian cancer independently of venous thromboembolism and tumor extension. Int. J. Gynecol. Cancer. 2015; 25(4): 593-8. https://dx.doi.org/10.1097/IGC.000000000000415.
  21. Komatsu H., Shimada M., Osaku D., Deura I., Sato S., Oishi T. et al. Deep vein thrombosis and serum D-dimer after pelvic lymphadenectomy in gynecological cancer. Int. J. Gynecol. Cancer. 2020; 30(6): 860-4. https://dx.doi.org/10.1136/ijgc-2019-000914.
  22. Shim H., Kim H.J., Lee D.-E., Kwak M.H., Park S.Y., Lim M.C. et al. Prospective analysis of pre and postoperative laboratory parameters associated with thrombosis in patients with ovarian cancer. Res. Square. 2023. https://dx.doi.org/10.21203/rs.3.rs-2888253/v1.
  23. Zhou Q., Zhu C., Shen Z., Zhang T., Li M., Zhu J. et al. Incidence and potential predictors of thromboembolic events in epithelial ovarian carcinoma patients during perioperative period. Eur. J. Surg. Oncol. 2020; 46(5): 855-61. https://dx.doi.org/10.1016/j.ejso.2020.01.026.
  24. Ebina Y., Uchiyama M., Imafuku H., Suzuki K., Miyahara Y., Yamada H. Risk factors for deep venous thrombosis in women with ovarian cancer. Medicine (Baltimore). 2018; 97(23): e11009. https://dx.doi.org/10.1097/MD.0000000000011009.
  25. Tamura R., Yoshihara K., Matsuo K., Yachida N., Miyoshi A., Takahashi K. et al. Proposing a molecular classification associated with hypercoagulation in ovarian clear cell carcinoma. J. Gynecol. Oncol. 2021; 163(2): 327-33. https://dx.doi.org/10.1016/j.ygyno.2021.08.009.
  26. Kubo K., Nakamura K., Okamoto K., Matsuoka H., Ida N., Haruma T. et al. The combination of D-dimer and glasgow prognostic score can be useful in predicting VTE in patients with stage IIIC and IVA ovarian cancer. Acta med. Okayama. 2022; 76(2): 129-35. https://dx.doi.org/10.18926/AMO/63406.
  27. Yamada Y., Kawaguchi R., Iwai K., Niiro E., Morioka S., Tanase Y. et al. Preoperative plasma D-dimer level is a useful prognostic marker in ovarian cancer. J. Obstet. Gynaecol. 2020; 40(1): 102-6. https://dx.doi.org/10.1080/01443615.2019.1606176.
  28. Steidel C., Ender F., Rody A., von Bubnoff N., Gieseler F. Biologically active tissue factor-bearing larger ectosome-like extracellular vesicles in malignant effusions from ovarian cancer patients: correlation with incidence of thrombosis. Int. J. Mol. Sci. 2021; 22(2): 790-9. https://dx.doi.org/10.3390/ijms22020790.
  29. Hisada Y., Mackman N. Measurement of tissue factor activity in extracellular vesicles from human plasma samples. Res Pract. Thromb. Haemost. 2018; 3(1): 44-8. https://dx.doi.org/10.1002/rth2.12165.
  30. Ye S., Yang J., Cao D., Bai H., Huang H., Wu M. et al. Characteristic and prognostic implication of venous thromboembolism in ovarian clear cell carcinoma: a 12-year retrospective study. PLoS One. 2015; 10(3): e0121818. https://dx.doi.org/10.1371/journal.pone.0121818.
  31. Basaran D., Boerner T., Suhner J., Sassine D., Liu Y., Grisham R.N. et al. Risk of venous thromboembolism in ovarian cancer patients receiving neoadjuvant chemotherapy. Gynecol. Oncol. 2021; 163(1): 36-40. https://dx.doi.org/10.1016/j.ygyno.2021.07.030.
  32. Kahr H.S., Christiansen O.B., Grove A., Iyer V., Torp-Pedersen C., Knudsen A. et al. Venous thromboembolism in epithelial ovarian cancer. A prospective cohort study. Thromb. Res. 2019; 181: 112-9. https://dx.doi.org/10.1016/j.thromres.2019.07.027.
  33. Greco P.S., Bazzi A.A., McLean K., Reynolds R.K., Spencer R.J., Johnston C.M. et al. Incidence and timing of thromboembolic events in patients with ovarian cancer undergoing neoadjuvant chemotherapy. Obstet. Gynecol. 2017; 129(6): 979-85. https://dx.doi.org/10.1097/AOG.0000000000001980.
  34. Salinaro J.R., McQuillen K., Stemple M., Boccaccio R., Ehrisman J., Lorenzo A.M. et al. Incidence of venous thromboembolism among patients receiving neoadjuvant chemotherapy for advanced epithelial ovarian cancer. Int. J. Gynecol. Cancer. 2020; 30(4): 491-7. https://dx.doi.org/10.1136/ijgc-2019-000980.
  35. Wang T.S., Lei W., Cui W., Wen P., Guo H.F., Ding S.G. et al. A meta-analysis of bevacizumab combined with chemotherapy in the treatment of ovarian cancer. Indian J. Cancer. 2014; 51(7): e95-8. https://dx.doi.org/10.4103/0019-509X.154084.
  36. Wu Y.S., Shui L., Shen D., Chen X. Bevacizumab combined with chemotherapy for ovarian cancer: an updated systematic review and meta-analysis of randomized controlled trials. Oncotarget. 2017; 8(6): 10703-13. https://dx.doi.org/10.18632/oncotarget.12926.
  37. Sampaio A.M., Guimarães G.M.N., Medeiros G.P., Damasceno G.M.M., Silva R.M.A., Nunes R.R. et al. Efficacy and safety of antifibrinolytics in oncological surgery: a systematic review and meta-analysis. Braz. J. Anesthesiol. 2019; 69(5): 484-92. https://dx.doi.org/10.1371/journal.pone.0137886.
  38. Lundin E.S., Johansson T., Zachrisson H., Leandersson U., Bäckman F., Falknäs L. et al. Single-dose tranexamic acid in advanced ovarian cancer surgery reduces blood loss and transfusions: double-blind placebo-controlled randomized multicenter study. Acta Obstet. Gynecol. Scand. 93(4): 335-44. https://dx.doi.org/10.1111/aogs.12333.
  39. Lemoine A., Lambaudie E., Bonnet F., Leblanc E., Alfonsi P. Perioperative care of epithelial ovarian cancer: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa. Gynecol. Obstet. Fertil. Senol. 2019; 47(2): 187-96. (in French). https://dx.doi.org/10.1016/j.gofs.2018.12.005.
  40. Murao S., Nakata H., Roberts I., Yamakawa K. Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis. Crit. Care. 2021; 25(1): 380. https://dx.doi.org/10.1186/s13054-021-03799-9.
  41. Taeuber I., Weibel S., Herrmann E., Neef V., Schlesinger T., Kranke P. et al. Association of intravenous tranexamic acid with thromboemboliceEvents and mortality: a systematic review, meta-analysis, and meta-regression. JAMA Surg. 2021; 156(6): e210884. https://dx.doi.org/10.1001/jamasurg.2021.0884.
  42. Relke N., Chornenki N.L.J., Sholzberg M. Tranexamic acid evidence and controversies: an illustrated review. Res. Pract. Thromb. Haemost. 2021; 5(5): e12546. https://dx.doi.org/10.1002/rth2.12546.
  43. Devereaux P.J., Marcucci M., Painter T.W., Conen D., Lomivorotov V., Sessler D.I. et al.; POISE-3 investigators. Tranexamic acid in patients undergoing noncardiac surgery. N. Engl. J. Med. 2022; 386(21): 1986-97. https://dx.doi.org/10.1056/NEJMoa2201171.
  44. Chornenki N.L.J., Um K.J., Mendoza P.A., Samienezhad A., Swarup V., Chai-Adisaksopha C. et al. Risk of venous and arterial thrombosis in non-surgical patients receiving systemic tranexamic acid: a systematic review and meta-analysis. Thromb. Res. 2019; 179: 81-6. https://dx.doi.org/10.1016/j.thromres.2019.05.003.
  45. Zakhari A., Sanders A.P., Solnik M.J. Tranexamic acid in gynecologic surgery. Curr. Med. Res. Opin. 2020; 36(3): 513-20. https://dx.doi.org/10.1080/03007995.2019.1708533.
  46. Leminen H., Hurskainen R. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int. J. Women Health. 2012; 4:413-21. https://dx.doi.org/10.2147/IJWH.S13840.
  47. Meaidi A., Kuhr Skals R., Alexander Gerds T., Lidegaard O., Torp-Pedersen C. Decline in Danish use of oral tranexamic acid with increasing use of the levonorgestrel-releasing intrauterine system: a nationwide drug utilization study. Contraception. 2020; 101(5): 321-6. https://dx.doi.org/10.1016/j.contraception.2019.12.013.
  48. Meaidi A., Mørch L., Torp-Pedersen C., Lidegaard O. Oral tranexamic acid and thrombosis risk in women. EClinicalMedicine. 2021; 35: 100882. https://dx.doi.org/10.1016/j.eclinm.2021.100882.
  49. Якушевская О.В., Юренева С.В. Венозная тромбоэмболия и комбинированная оральная контрацепция. Акушерство и гинекология. 2016; 9: 20-6. [Yakushevskaya O.V., Yureneva S.V. Venous thromboembolism and combined oral contraception. Obstetrics Gynecology. 2016; (9): 20-6. (in Russian)]. https://dx.doi.org/10.18565/aig.2016.9.20-6.
  50. Mihalache R.M., Ames P.R. Deep vein thrombosis, tranexamic acid, and a negative d-dimer. Clin. Appl. Thromb. Hemost. 2012; 18(6): 666-7. https://dx.doi.org/10.1177/1076029611435092.
  51. Yang X., Chai M., Xia L., He Z., Wu X., Zhang J. et al. Intraoperative use of tranexamic acid to reduce blood loss during cytoreductive surgery for advanced ovarian cancer: A randomized controlled clinical trial. Acta Obstet. Gynecol. Scand. 2023; 102(7): 950-9. https://dx.doi.org/10.1111/aogs.14567.
  52. Kietpeerakool C., Supoken A., Laopaiboon M., Lumbiganon P. Effectiveness of tranexamic acid in reducing blood loss during cytoreductive surgery for advanced ovarian cancer. Cochrane Database Syst. Rev. 2016; 2016(1): CD011732. https://dx.doi.org/10.1002/14651858.CD011732.pub2.
  53. Zec T., Di Napoli R., Fievez L., Ben Aziz M., Ottaiano A., Vittori A. et al. Efficacy and safety of tranexamic acid in cancer surgery. An update of cinical findings and ongoing research. J. Multidiscip. Healthc. 2022; 15: 1427-44. https://dx.doi.org/0.2147/JMDH.S337250.

Received 28.04.2023

Accepted 26.09.2023

About the Authors

Viktoriya A. Deryabina, 4th year student of the Pediatric Faculty, St. Petersburg State Pediatric Medical University, Ministry of Health of Russia, vika.deryabina@mail.ru,
194100, Russia, St. Petersburg, Litovskaya str., 2.
Valeriy I. Matukhin, Assistant at the Department of Obstetrics and Gynecology, St. Petersburg State Pediatric Medical University, Ministry of Health of Russia,
+7(981)737-04-72, val-matukhin@mail.ru, https://orcid.org/0000-0002-8906-8356, 194100, Russia, St. Petersburg, Litovskaya str., 2.
Nikolai N. Rukhliada, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, St. Petersburg State Pediatric Medical University, Ministry of Health
of Russia, +7(911)913-20-20, nickolasr@mail.ru, https://orcid.org/0000-0002-3548-0468, 194100, Russia, St. Petersburg, Litovskaya str., 2.
Victoria N. Abramova, obstetrician-gynecologist of the Gynecological Department, St. Petersburg State Pediatric Medical University, Ministry of Health of Russia,
abramova_vn@mail.ru, 194100, Russia, St. Petersburg, Litovskaya str., 2.
Elena E. Kuts, Assistant of the Department of Obstetrics and Gynecology, St. Petersburg State Pediatric Medical University, Ministry of Health of Russia,
elenakuts999@gmail.com, 194100, Russia, St. Petersburg, Litovskaya str., 2.
Corresponding author: Elena E. Kuts, elenakuts999@gmail.com

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