Predicting and preventing thromboembolic events in patients receiving cisplatin-based chemotherapy for germ cell tumours

• Published in: European journal of cancer (1990) 2016-12, Vol.69, p.151-157
• Main Authors: Gizzi, Marco, Oberic, Lucie, Massard, Christophe, Poterie, Audrey, Gwenael, Le Teuff, Loriot, Yohann, Albiges, Laurence, Baciarello, Giulia, Michels, Judith, Bossi, Alberto, Blanchard, Pierre, Escudier, Bernard, Fizazi, Karim
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anticoagulants; Anticoagulants - therapeutic use; Antineoplastic Agents - therapeutic use; Body Surface Area; Chemoprevention; Chemotherapy; Cisplatin; Cisplatin - therapeutic use; Dehydrogenases; Germ cell tumours; Hematology, Oncology and Palliative Medicine; Heparin; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Incidence; L-Lactate dehydrogenase; L-Lactate Dehydrogenase - blood; Lactate dehydrogenase; Lactic acid; Logistic Models; Male; Medical treatment; Middle Aged; Molecular chains; Neoplasms, Germ Cell and Embryonal - drug therapy; Patients; Platinum; Prophylaxis; Retrospective Studies; Risk analysis; Risk Assessment; Risk Factors; Seminoma - drug therapy; Studies; Testicular Neoplasms - drug therapy; Thromboembolism; Thrombophlebitis; Thrombophlebitis - blood; Thrombophlebitis - epidemiology; Thrombophlebitis - prevention & control; Thrombosis; Thrombosis - blood; Thrombosis - epidemiology; Thrombosis - prevention & control; Tumors; Venous Thrombosis - blood; Venous Thrombosis - epidemiology; Venous Thrombosis - prevention & control; Young Adult
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2016.10.003

Abstract Background Patients with germ cell tumours (GCT) receiving cisplatin-based chemotherapy are at high risk of thromboembolic events (TEE). Previously, we identified serum lactate dehydrogenase (LDH) and body surface area (BSA) as independent predictive factors for TEE. The aim of this study was to validate these predictive factors and to assess the impact of thromboembolism prophylaxis in patients at risk of deep venous thrombosis (DVT). Methods Between 2001 and 2014, 295 patients received first-line cisplatin-based chemotherapy for GCT. Preventive anticoagulation with low-molecular-weight heparin (LMWH) was progressively implemented in patients with predictive factors. Sixteen patients with evidence of TEE before starting chemotherapy were excluded from the analysis. Results Among 279 eligible patients, a TEE occurred in 38 (14%) consisting of DVT (n = 26), arterial thrombosis (n = 2), and superficial thrombophlebitis (n = 10). DVT occurred in 26 (12.7%) of 204 patients with risk factors versus two (2.6%) of 75 patients with no risk factors (p = 0.01). After a prevention protocol was progressively implemented from 2005, primary thromboprophylaxis was administered to 104 patients (68%) with risk factors. Among patients at risk (n = 151), the incidence of DVT decreased by roughly half when they received a LMWH: 9/97 (9.2%) and 9/54 (16.6%), respectively (p = 0.23). Conclusion Patients with GCT who receive cisplatin-based chemotherapy are at risk of developing a TEE which can be predicted by elevated serum LDH. To our knowledge this is the first study exploring LMWH as thromboprophylaxis in GCT patients. A prospective trial testing prophylactic anticoagulation is warranted.