Anticoagulation in cancer

Thursday, March 7, 2019

Contact us: podcasts@mdedge.com

In this episode, Alok Khorana, MD, of the Cleveland Clinic joins David H. Henry, MD, to discuss results from the CASSINI trial and what it means for anticoagulation in cancer patients.

And Ilana Yurkiewicz, MD, begins part 1 of her look at informed consent.

Show notes
By Hitomi Hosoya, MD, PhD
Resident in the department of internal medicine, University of Pennsylvania Health System

- One in five cancer patients develops venous thromboembolism (VTE).

- The Khorana scoring system was developed and validated to stratify the VTE risk in cancer patients. The score is determined by the type of cancer, complete blood counts, and BMI.

- The CASSINI trial was aimed at determining the efficacy of oral factor Xa inhibitor for thromboprophylaxis in ambulatory patients with cancer who had a Khorana score of 2 or greater and were initiating chemotherapy.

- In total, 4.5% of the potential cohort had deep vein thrombosis (DVT) at screening ultrasound and were excluded from the study.

- The trial showed that rivaroxaban led to a substantially lower incidence of VTE, compared with the placebo group during the intervention period.

References:

  1. Blood. 2008 May 15;111(10):4902-7.
  2. Cancer. 2012 Jul 15;118(14):3468-76.
  3. N Engl J Med. 2019 Feb 21;380(8):720-8.

Podcast Participants

David Henry, MD
David Henry, MD, FACP, is a clinical professor of medicine at the University of Pennsylvania and vice chairman of the department of medicine at Pennsylvania Hospital in Philadelphia. He received his bachelor’s degree from Princeton University and his MD from the University of Pennsylvania, then completed his internship, residency, and fellowship at the Hospital of the University of Pennsylvania. After 2 years as an attending in the U.S. Air Force, he was drawn to practicing as a hem-onc because of the close patient contact and interaction, and his belief that, win or lose with each patient, one can always make a difference in their care and lives. Follow Dr. Henry on Twitter: @davidhenrymd.
Ilana Yurkiewicz, MD
Ilana Yurkiewicz, MD, is a fellow in hematology and oncology at Stanford University, where she also completed her internal medicine residency. Dr. Yurkiewicz holds an MD from Harvard Medical School and a BS from Yale University. She went into hematology and oncology because of the high-stakes decision-making, meaningful relationships with patients, and opportunity to help people through some of the toughest challenges of their lives. Dr. Yurkiewicz is also a medical journalist. She is a former AAAS Mass Media Fellow and Scientific American blog columnist, and her writing has appeared in numerous media outlets including Hematology News, where she writes the monthly column Hard Questions. Dr. Yurkiewicz is on Twitter: @ilanayurkiewicz.