Potentially Dangerous Complementary and Alternative Medicine (CAM) Use by Ovarian Cancer Patients | Abstract

Potentially Dangerous Complementary and Alternative Medicine (CAM) Use by Ovarian Cancer Patients

Abstract

Objective: 

The use of complementary or alternative medicine (CAM) has increased greatly over the last decade. Although many CAM activities are unlikely to increase a patient's risk for adverse events with conventional treatment for cancer, this is not necessarily true of ingestible CAM treatments such as herbal remedies, teas, and other supplements. This study surveyed women with ovarian cancer in order to evaluate the use of herbs and supplements that might place them at increased risk at the time of their surgery for ovarian cancer.  

Methods: 

A total of 219 women with ovarian cancer, who had received care from one of two participating oncology practices, were surveyed. 

Results: 

Of the women who reported having had surgery to treat their ovarian cancer (n=209), 65 (31%) reporting using one or more herbs or supplements that have been hypothesized to increase their risk for adverse outcomes. In almost all cases the risks associated with these substances were elevated risks for excessive bleeding.  

Conclusions: 

The use of herbs and supplements that might increase risks associated with excessive bleeding during gynecologic cancer surgery is common. Further research is needed to better understand the risks associated with use of herbs and supplements among women approaching surgery

. (J GYNECOL SURG 28:1)

Cancer effect on periprocedural thromboembolism and bleeding in anticoagulated patients

Cancer effect on periprocedural thromboembolism and bleeding in anticoagulated patients:

Background:
Patients with active cancer are often on chronic anticoagulation and frequently require interruption of this treatment for invasive procedures. The impact of cancer on periprocedural thromboembolism (TE) and major bleeding is not known.

Patients and methods:
Two thousand one hundred and eighty-two consecutive patients referred for periprocedural anticoagulation (2484 procedures) using a standardized protocol were followed forward in time to estimate the 3-month incidence of TE, major bleeding and survival stratified by anticoagulation indication. For each indication, we tested active cancer and bridging heparin therapy as potential predictors of TE and major bleeding.

Results:
Compared with patients without cancer, active cancer patients (n = 493) had more venous thromboembolism (VTE) complications (1.2% versus 0.2%), major bleeding (3.4% versus 1.7%) and reduced survival (95% versus 99%). Among active cancer patients, only those chronically anticoagulated for VTE had higher rates of periprocedural VTE (2% versus 0.16%;) and major bleeding (3.7% versus 0.6%). Bridging with heparin increased the rate of major bleeding in cancer patients (5% versus 1%;) without impacting the VTE rate (0.7% versus 1.4%,).

Conclusions:
Cancer patients anticoagulated for VTE experience higher rates of periprocedural VTE and major bleeding. Periprocedural anticoagulation for these patients requires particular attention to reduce these complications.

Medscape: Bleeding Rates and Medical Costs of New Oral Anticoagulants (warfarin, dabigatran...)

Bleeding Rates and Medical Costs of New Oral Anticoagulants

April 2, 2012 (Chicago, Illinois) — Firsthand experience with the new oral anticoagulants, coupled with excitement over those yet to be widely in use, has inspired a range of studies examining real-world risk/benefits, as well as the potential costs of replacing warfarin with the new agents.

In a poster session at last week's American College of Cardiology 2012 Scientific Sessions, investigators presented two separate experiences with dabigatran from different US centers--showing very different results--while others presented new cost analyses comparing different oral agents with warfarin.

One US report of patients switched to dabigatran showed a much higher rate of major bleeding than in the RE-LY trial, but a lower rate of dyspepsia, while a second report showed a lower rate of both major and minor bleeding compared with RE-LY trial.

Thirty-day mortality rate in women with cancer and venous thromboembolism. Findings from the RIETE Registry (abstract)

Note: different adverse events depending on cancer site

abstract: Bleeding events in (Avastin) bevacizumab-treated cancer patients who received full-dose anticoagulation and remained on study

Conclusions:
These data suggest that bevacizumab did not increase the risk of severe bleeding in cancer patients who received

GI Topics, 2010 - Commonly used antidepressants are associated with increased risk of upper GI bleeds