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Jun 28, 2019 01:35PM
Thanks everyone for the wishes on feeling better. Today is indeed a better day, at least out of bed and on the couch, hoping to get a couple short puppy walks in later today.
Candy - That is so hilarious about your kitty and the light switch. Brilliant feline mind! I am sure I would have been creeped out too to discover the light on, all by itself with no one home!!! I guess that's a clear message that "Hey I'm home too, leave a light on for me so I don't have to hang out in the dark, would ya please?"! LOLOLOLOL.
I looked over those 2 studies that Marijen shared -- here's my take:
Basically the first one says blood thinners (enoxaparin (Lovenox) studied) are safe to take with brain METs/lesions. Blood Thinners OK For Cancers That Spread To Brain
The second one doesn't say this isn't true, instead says that there are other drugs that can interfere/block effectiveness of various blood thinners from the NOAC family (nonvitamin K oral anticoagulants), putting patients at increased risk of bleeding when this occurs. This includes drugs they looked at like abigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). So, this is something to be aware of and talk over with your drs if anti-coagulants are prescribed.
"NOACs alone DO NOT pose a significant risk of bleeding, BUT the concurrent use of NOACs with certain drugs that share the same metabolic pathways may cause increased risk of major bleeding," said study lead researcher Dr. Shang-Hung Chang, an associate professor of cardiology with Chang Gung Memorial Hospital in Taoyuan, Taiwan."
Drugs studied that INCREASE RISK OF BLEEDING while on a NOAC: "The investigators found that bleeding risk increased significantly when NOACs were used in combination with amiodarone, fluconazole, rifampin and phenytoin -- four drugs that treat widely different conditions.The researchers also found that other drugs dampened the effectiveness of NOACs, including atorvastatin, digoxin, and erythromycin or clarithromycin." blood-thinners-can-come-with-dangerous-side-effects from Health News
Anticoagulation Strategies in Cancer Patients (2019 Geoffrey D Barnes)
"The following are key points to remember from this review article about anticoagulation strategies in patients with cancer:
- Patients with active cancer are at increased risk of arterial and venous thromboembolism (VTE) and bleeding events. This results from cancer-specific impacts on all three elements of Virchow's triad (stasis, endothelial injury, and hypercoagulability).
- Certain cancers are associated with high or very high risk of thrombosis (especially VTE), including pancreatic, stomach, metastatic, gynecological, lung, brain, hematologic, and genitourinary cancers (excluding prostate).
- Certain cancer therapies are associated with a high risk of atrial arrhythmias (e.g., atrial fibrillation [AF]), including anthracyclines, alkylating agents, antimetabolites, interleukins, Bruton's tyrosine kinase TKIs, and immune checkpoint inhibitors.
- Historically, in patients with cancer, low molecular weight heparin (LMWH) has been the primary treatment choice for patients with VTE, while warfarin has been used for stroke prevention in AF.
- Recently completed studies in patients with cancer-associated VTE have demonstrated efficacy with edoxaban and rivaroxaban as compared to dalteparin. Subanalyses of the RE-COVER, EINSTEIN PE/DVT, AMPLIFY, and Hokusai-VTE studies also show efficacy of dabigatran, rivaroxaban, apixaban, and edoxaban as compared to warfarin. Bleeding rates with the direct oral anticoagulants (DOACs) have been variable across different studies.
- Several ongoing studies comparing DOACs to LMWH for treatment of cancer-associated VTE are ongoing and will provide further insight into both efficacy and safety of DOAC therapy.
- Use of DOAC therapy in cancer patients may be limited by potential drug-drug interactions. These include P-glycoprotein interactions (all DOACs) and CYP3A4 interactions (most strongly impacting rivaroxaban and apixaban).
- Renal impairment and thrombocytopenia are both common in patients with active cancer and may impact the safety of DOAC therapy. Using a DOAC with less renal clearance may be preferable. Avoiding anticoagulation when platelet counts are <50,000-70,000/μL is often recommended.
- Although one retrospective study of patients with brain metastases showed no increased risk of intracranial hemorrhage risk with LMWH versus no anticoagulation, it is not clear if this is generalizable to all patients with brain metastases. Nonetheless, DOAC therapy is associated with lower intracranial hemorrhage risk than warfarin broadly, and availability of reversal agents may swing the risk:benefit ratio in favor of treatment for many patients.
- Most patients with cancer-associated thrombosis will require treatment as long as the cancer is active (until remission or resection). Extended treatment may be considered based on overall risk:benefit assessment.
- Hospitalized patients with active cancer are at high risk for thrombosis and should receive aggressive thromboprophylaxis as long as there is not a prohibitively high risk of bleeding.
- Patients with cancer and AF should be treated according to standardized risk stratification scores (e.g., CHA2DS2-VASc)."
Anticoagulation Strategies in Patients With Cancer (Journal of the American College of Cardiology 2019)
**there's a pay wall I couldn't get past, but here's the abstract and chart***
- "Patients with active cancer face higher risks of arterial and venous thromboembolism (VTE), atrial arrhythmias, and bleeding events.
- Historically, in patients with cancer, low-molecular weight heparins have been preferred for treatment of VTE, while warfarin has been the standard anticoagulant for stroke prevention in atrial fibrillation.
- Select direct oral anticoagulants have now been shown to safely prevent thrombotic events in recent clinical trials, and present an attractive oral dosing option for patients with cancer.
- Multidisciplinary care that accounts for individualized bleeding and thrombotic risks, drug-drug interactions, patient preferences, and periodic clinical reassessment is warranted to identify the optimal anticoagulation strategy for patients with cancer.
Patients with active cancer are at an increased risk of arterial and venous thromboembolism (VTE) and bleeding events. Historically, in patients with cancer, low molecular weight heparins have been preferred for treatment of VTE, whereas warfarin has been the standard anticoagulant for stroke prevention in patients with atrial fibrillation (AF). More recently, direct oral anticoagulants (DOACs) have been demonstrated to reduce the risk of venous and arterial thromboembolism in large randomized clinical trials of patients with VTE and AF, respectively, thus providing an attractive oral dosing option that does not require routine laboratory monitoring. In this review, we summarize available clinical trial data and guideline recommendations, and outline a practical approach to anticoagulation management of VTE and AF in cancer."
Strategies for Using Anticoagulation Therapy in Patients With Cancer (Doyle 2018)"What Anticoagulant Should Be Used for Patients With Cancer?
As Dr. Kempton reported, the long-standing CLOT trial established the superiority of low–molecular-weight heparin over warfarin for the treatment of cancer-associated thrombosis, with a nearly 50% relative risk reduction with the use of dalteparin vs warfarin.6 The CATCH trial showed a similar benefit of tinzaparin (Innohep) over warfarin with associated reduction in the risk for bleeding.7 According to Dr. Kempton, however, the recent introduction of direct-acting oral anticoagulants has generated a great deal of clinical interest because "they are much simpler than the use of subcutaneous injection."
"Overall, in patients without cancer, direct-acting oral anticoagulants have been shown to be slightly safer than warfarin for the treatment of VTE," said Dr. Kempton. "For select patients, warfarin may still be more appropriate, but direct-acting oral anticoagulants are becoming the standard of care in this space."
"Spoonie" who entered BC World @ 41. DXd w/MS & Thyroid Cancer @42. Treatment: LX/SLNB/RADs. Plan A: 5mg Tamox = 0 QOL. Plan B: OS/AI = Rare allergy to OS meds. Plan C: Only option left, Diet & Exercise. PS: Not a dr, just a Googler.
7/20/2018, IDC, Left, 3cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH)
8/30/2018, DCIS, Left, 1cm, Stage 0, Grade 2
8/30/2018 Lumpectomy: Left; Lymph node removal: Left, Sentinel
10/1/2018 Whole-breast: Breast, Lymph nodes, Chest wall
3/30/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
7/2/2019 Zoladex (goserelin)