Anita Aggarwal

Pattern of Frequent But Nontargeted Pharmacologic Thromboprophylaxis for Hospitalized Patients With Cancer at Academic Medical Centers: A Prospective, Cross-Sectional, Multicenter Study

PURPOSE Hospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer. PATIENTS AND METHODS We conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization. RESULTS A total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9%) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2% (95% CI, 70.4% to 78.0%; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95% CI, 1.43 to 3.82; P=.007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95% CI, 0.22 to 0.61; P<.001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8% were considered to be high risk by the Padua Scoring System. CONCLUSION We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in hospitalized patients with cancer is commonly prescribed without regard to the presence or absence of concomitant risk factors for VTE.

A worldwide survey to assess the current approach to the treatment of patients with cancer and venous thromboembolism

Low-molecular-weight heparin (LWMH) is recommended as the preferred anticoagulant treatment over vitamin K antagonists (VKA) for venous thromboembolism (VTE) in patients with cancer. However, there is uncertainty about the duration and dose of LMWH treatment. Therefore, we designed this multinational survey to assess the current approach to the treatment of patients with cancer and VTE. An electronic survey tool was used to disseminate a survey containing 49 questions on different aspects of the treatment of patients with cancer and VTE, among both thrombosis and non-thrombosis specialists. A total of 229 invitations were sent, and 141 completed the survey (60% of the total). Fifty-eight percent of the respondents were from Europe, 35% from the US and the remaining 7% from other countries. Respondents specialties included haematology (23%), oncology (18%), pulmonology (15%) and general internal medicine (15%). LMWH was indicated as the first choice for the long-term treatment by 82% of the respondents, of whom 60% used full therapeutic doses and 40% chose a dose reduction. When continuing anticoagulants after the long-term treatment period, 44% of respondents preferred LMWH, 10% VKA, while the remaining 45% chose per individual patient for either LMWH or VKA. In conclusion, we observed a relatively high observance rate of the guidelines with respect to the use of LMWH for the long-term treatment of VTE in cancer. In contrast, the dose of LMWH and the type of anticoagulant chosen after the initial 3-12 months varied substantially, probably reflecting the limited available evidence.

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): Awareness and Prophylaxis Practices Reported by Patients with Cancer

Patients with cancer are at increased risk for venous thromboembolism (VTE). An online survey to measure PE/DVT terminology awareness and understanding of VTE risks revealed 24% and 15% of the 500 cancer patients surveyed had heard of term DVT/PE; 19% and 17% could name signs/ symptoms of DVT/PE; 3% recognized cancer treatments as risk factors for DVT/PE. Only 25% of the patients received prevention education from providers; <50% received VTE prophylaxis. Cancer patient awareness of VTE terminology and cancer and/or its treatment as risk for VTE is low. More effective patient/physician dialogue about VTE risk and thromboprophylaxis is needed.

Current management strategies and long-term clinical outcomes of upper extremity venous thrombosis.

Essentials Few data exist on outcome of upper extremity deep and superficial vein thrombosis (UEDVT and UESVT). We followed 102 and 55 patients with UEDVT or UESVT, respectively, for a median of 3.5 years. Risk of recurrent venous thromboembolism was low in both diseases, and the mortality high. Postthrombotic symptoms were infrequent and cancer patients had a higher risk of recurrent VTE.

Improving the diagnostic management of upper extremity deep vein thrombosis.

Essentials The Constans score and D‐dimer can rule out upper extremity deep vein thrombosis without imaging. We evaluated the performance of an extended Constans score and an age‐adjusted D‐dimer threshold. The extended Constans score did not increase the efficiency compared to the original score. Age‐adjusted D‐dimer testing safely increased the efficiency by 4%, but this needs validation.

A woman with rheumatoid arthritis, Sjögren's syndrome, leg ulcer, and significant weight loss.

A 46-year-old African American female presented with a 6-month history of swelling involving both hands and knees, with morning stiffness of 3 hours’ duration. She had difficulty extending both elbows and lifting her arms. She reported dryness of her eyes and mouth, but denied any dyspareunia. Despite a normal appetite, she reported a 49-pound weight loss over 6 months, but had no fever or night sweats and was without gastrointestinal symptoms. She had had a nonphotosensitive rash on her face for the past 3 months, but no alopecia or oral ulcers. Six weeks prior to presentation, she developed an enlarging painful ulcer over the right ankle.

Massive, rapidly growing cardiac lymphoma with rare valvular involvement showing excellent response to chemotherapy

Massive, Rapidly Growing Cardiac Lymphoma With Rare Valvular Involvement Showing Excellent Response to Chemotherapy Amr Mohsen, MD, Amir H. Najafi, MD, Louise Zhou, MD, Dalia A. Mobarek, MD, Anita Aggarwal, DO, PhD, Jehan El-Bayoumi, MD, Michael D. Greenberg, MD, and Federico E. Mordini, MD Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA Veterans Affairs Medical Center, Washington, District of Columbia, USA University of Florida, Jacksonville, Florida, USA George Washington University, Washington, District of Columbia, USA

A case report of T cell prolymphocytic leukemia and Kaposi sarcoma and a review of T cell prolymphocytic leukemia.

T cell prolymphocytic leukemia (T-PLL) is a rare mature T cell lymphoproliferative disease. It has been associated with an aggressive course, a poor response to conventional chemotherapy and a short median survival. Here we present a rare case of concurrent T-PLL and Kaposi sarcoma who achieved a complete hematologic and cytogenetic remission after a very short course of treatment with alemtuzumab. A review of T-PLL was done. In this review, clinical features, laboratory features and current therapeutic strategies of T-PLL are presented.

A worldwide survey to assess the treatment approach of cancer associated venous thromboembolism (CAT)

A1 The valuable influence of pharmacists in the anticoagulation clinic at the Veterans Affairs Medical Center of Washington, DC Zemzem Adem A2 A worldwide survey to assess the treatment approach of Cancer associated venous thromboembolism (CAT) Anita Aggarwal A3 Bridging for an Unintentional Subtherapeutic INR with Lowmolecular-weight heparin (LMWH): A Cost Analysis Tiffany W Chang A4 Patient satisfaction in an urban outpatient anticoagulation clinic after transitioning from a point-of-care device to venipuncture Christopher Malabanan A5 Contemporary Model for Clinical Thrombosis Management Christine P Rash