New study below.
Some might recall that I have written quite a bit about altered coagulation in PCa & its potential role in metastasis.
When I was diagnosed with a double DVT in my left calf, my doctor said that I would be on Warfarin for 6 months - 3 months for a first offender plus 3 months because I had cancer. He agreed to 3 months if I would get a repeat ultrasound scan. When only one DVT had cleared, he agreed to let me try nattokinase & monitor with periodic D-dimer tests.
The new study involved people with cancer-associated thrombosis (CAT) who were treated with "≥3 months of anticoagulation that was subsequently discontinued".
They monitored D-dimer & C-reactive protein (a measure of inflammation - another of my favorite topics).
D-dimer is elevated when a fibrin clot is being broken down by plasmin (or by nattokinase). It can be elevated for another reason, but zero means no clot.
"The DD and hs-CRP levels after 21 days were associated with VTE recurrence."
This is great news for those who wish to stop anticoagulation. It gives them a safe approach. Currently, most find out about VTE recurrence in the ER.
But, importantly for men with PCa, it may help prevent that first visit to the ER.
I posted a series on the importance of controlling inflammation. CRP should be brought as close to zero as possible. CRP has an impact on mortality risk even where there is no diagnosed disease.
With cancer, one should assume that an elevated D-dimer is due to a clot (that is the assumption in the ER if a clot is suspected.)
My own approach is to use nattokinase to reduce D-dimer to zero. I will never go back on Warfarin.
But in any case, the tests can give one a timely heads-up. Too many die on the way to the ER.
-Patrick
ncbi.nlm.nih.gov/pubmed/303...
Br J Cancer. 2018 Oct 15. doi: 10.1038/s41416-018-0269-5. [Epub ahead of print]
D-dimer and high-sensitivity C-reactive protein levels to predict venous thromboembolism recurrence after discontinuation of anticoagulation for cancer-associated thrombosis.
Jara-Palomares L1,2, Solier-Lopez A3, Elias-Hernandez T3, Asensio-Cruz MI3, Blasco-Esquivias I4, Sanchez-Lopez V5, de la Borbolla MR6, Arellano-Orden E5, Suarez-Valdivia L3, Marin-Romero S3, Marin-Barrera L3, Ruiz-Garcia A7, Montero-Romero E7, Navarro-Herrero S8, Lopez-Campos JL3,9, Serrano-Gotarredona MP8, Praena-Fernandez JM10, Sanchez-Diaz JM11, Otero-Candelera R3.
Author information
1
Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain. luisoneumo@hotmail.com.
2
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. luisoneumo@hotmail.com.
3
Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain.
4
Internal Medicine, Emergency Service, Virgen Macarena Hospital, Seville, Spain.
5
Institute of Biomedicine of Seville (IBIS), Virgen del Rocío Hospital, Seville, Spain.
6
Medical Oncology, Virgen de Valme Hospital, Seville, Spain.
7
UGC Emergency Service, Virgen del Rocío Hospital, Seville, Spain.
8
Diagnostic Imaging Unit, Radiology Service, Virgen del Rocío Hospital, Seville, Spain.
9
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
10
Methodology and Research Evaluation Unit, Hospital Virgen del Rocío, Seville, Spain.
11
Pharmacy, Hospital Virgen del Rocío, Seville, Spain.
Abstract
BACKGROUND:
Optimal duration of anticoagulation for cancer-associated thrombosis (CAT) remains unclear. This study assessed D-dimer (DD) and high-sensitivity C-reactive protein (hs-CRP) levels after the withdrawal of anticoagulation treatment to predict the risk of venous thromboembolism (VTE) recurrence among patients with CAT.
METHODS:
Prospective, multicentre study to evaluate CAT with ≥3 months of anticoagulation that was subsequently discontinued. Blood samples were taken when patients stopped the anticoagulation and 21 days later to determine the DD and hs-CRP levels. All patients were followed up for 6 months to detect VTE recurrence.
RESULTS:
Between 2013 and 2015, 325 patients were evaluated and 114 patients were ultimately enrolled in the study. The mean age was 62 ± 14 years and nearly 40% had metastasis. Ten patients developed VTE recurrence within 6 months (8.8%, 95% confidence interval [CI]: 4.3-15.5%). The DD and hs-CRP levels after 21 days were associated with VTE recurrence. The subdistribution hazard ratios were 9.82 for hs-CRP (95% CI: 19-52) and 5.81 for DD (95% CI: 1.1-31.7).
CONCLUSIONS:
This study identified that hs-CRP and DD were potential biomarkers of VTE recurrence after discontinuation of anticoagulation in CAT. A risk-adapted strategy could identify low-risk patients who may benefit from discontinuation of anticoagulation.
PMID: 30318508 DOI: 10.1038/s41416-018-0269-5