Incidental Pulmonary Embolism in Oncologic Patients

[pjoshea13]

New meta-analysis below [1].

I have a number of posts on abnormal coagulation & the need to monitor with D-dimer tests - & the use of nattokinase to speed clot elimination. Currently, doctors wait until cancer patients get a DVT or pulmonary embolism, etc. Those who do not die on the way to the ER are then put on anticoagulants.

In other words, there are no prophylactic meds, so docs do not screen for patients at risk - or even look for active clots.

"Incidental pulmonary embolism (IPE) is a common finding on computed tomography (CT). IPE is frequent in oncologic patients undergoing staging CT."

You can't really ignore a pulmonary embolism when it is accidentally found.

"The overall frequency of {incidental pulmonary embolism} in oncologic patients was 3.36%" However, "The highest frequency was found in prostate cancer (8.59% ...)" Wow!

"The highest frequency of IPE {incidental pulmonary embolism} was identified in prostate cancer patients. It has been shown previously that patients with prostate cancer are at higher risk of thromboembolic diseases, with the highest risk for those receiving endocrine therapy. Moreover, it was stated that prostate cancer itself, prostate cancer treatments, and selection mechanisms all contribute to an increased risk of thromboembolic events. Beyond that, the high frequency of IPE in the present study might be caused by the fact that prostate cancer staging CTs are mainly performed at the metastasized tumor stage compared to other tumor entities, which harbors in itself a higher risk of IPE."

As I say, a D-dimer test may identify a growing clot. If the number is zero, there is no clot. D-dimer may be elevated for other reasons, but where there is high risk of a clot, one should consider taking nattokinase. In my opinion. I'm not a doctor, etc, etc."

-Patrick

[1] link.springer.com/article/1...

[cesces]

"but where there is high risk of a clot, one should consider taking nattokinase"

Is there any reason to treat nattokinase different from other moderate readily available blood thinning agents like aspirin or fish oil supplements?

[pjoshea13 in reply to cesces]

One might take a daily 2,000 FU cap & hope for the best, or double up, but sometimes a therapeutic dose has to be much higher. I have to take 6 caps to keep D-dimer in check. i.e. that is my maintenance dose.

Nattokinase is not a "blood thinner" (nor are aspirin & omega-3). It is similar to the plasmin enzyme that (very slowly) dissolves fibrin. Nattokinase speeds up the process & the aim is to outpace the accretion of fibrin.

Aspirin inhibits the aggregation of platelets. It does this at the lowest dose & there is no point in taking a higher dose. There is nothing to monitor. It is not guaranteed to prevent clots - i.e. an accumulation of fibrin. The clumping together of platelets at the site of a clot is the first step. It is followed-up by the conversion of fibrinogen to fibrin, & accumulation, at the site.

Omega-3 [DHA/EPA] are important in that they compete for space in the lipid rafts of cells. As such, they create a more favorable omega-3:6 ratio. Arachidonic acid [AA] (an omega-6) is pro-coagulation & pro-inflammation. EPA/DHA are the reverse. It's good to have a favorable EPA/DHA:AA ratio in the raft, but that will not necassarily prevent clots. One should not take more than the highest recommended dose. Once again, there is nothing to monitor.

With nattokinase, one should monitor D-dimer. IMO

Cancers want & probably need coagulation.

-Patrick

[GreenStreet in reply to pjoshea13]

Patrick thanks for this. Do you think it is a good idea to take lowest dose aspirin and Natto because they work differently or Natto only. I can’t get a regular d dimer test in UK so am flying blind but taking 4000 FU Natto

[pjoshea13 in reply to GreenStreet]

Personally, I do not use aspirin since it can be a problem for the stomach & kidneys. Would the FDA approve it today? It's grandfathered because it has been around for over 120 years. That is half the time that the U.S. has been a country!

For those who tolerate low-dose aspirin, I believe it to be useful,

Nattokinase does not stop coagulation. It cleans it up after the fact. I'm OK with that. But it does mean having to to know that clotting has occurred. Hence the D-dimer test.

I was wondering how in these Covid times or for those otherwise unable to get D-dimer tested, what would be a good strategy? You are doubling-up. Fair enough for maintenance. But what about an initial washout period? A month at quadruple the dose? I couldn't say.

Be on the lookout for leg discomfort. Warmth at the affected area. Perhaps a hint of water retention. & of course, breathing issues. Note that anticoagulants do not dissolve clots. They simply give plasmin a chance to dissolve the clot by slowing down coagulation. Speeding-up the destruction of the clot is a better strategy IMO.

Once again, I'm not a doc. I don't want anyone in the ER saying: "But Patrick said ... " LOL

-Patrick

[GreenStreet in reply to pjoshea13]

Thanks I’ ll be sure to shop you in ER in the UK !! Lol

[PhilipSZacarias in reply to pjoshea13]

You know more about this topic than my oncologist and family doctor. 😉

[cesanon in reply to pjoshea13]

Thank you Patrick, very educational.

[pjoshea13]

Nala,

It's a dismal prospect to be on Warfarin for the rest of one's life, with the attendant bone loss & arterial calcification. Your friend was lucky to avoid that.

Best, -Patrick

[Hidden]

I wonder what the age adjusted risk would be? Avg PCa patient is in his 60s or 70s? What is the general population risk for that age? And what is the oncology patient risk at that age?

Is the risk normal if you are NED and much higher if on chemo or ADT or?

[pjoshea13 in reply to Hidden]

One can study the probability distributions & assess one's risk - or monitor D-dimer.

What concerns me as much as the possibility of a lethal clot to the lungs, is that micro-clots may facilitate the migration of cancer cells to favorable sites. One may already have metastatic cancer, but I think it a good idea to inhibit further mets & tumor burden.

-Patrick

[cesanon in reply to pjoshea13]

As you get older doesn't your risk for a Hemorrhagic (as opposed to ischemic) stroke increase?

Might that caution some care in erroring on the side of a moderate dose of Nattokinase?

[pjoshea13 in reply to cesanon]

Nattokinase does not stop coagulation.

We take it to eliminate unwanted clots ...

and it should be stopped when clots are required.

-Patrick

[PhilipSZacarias]

Very helpful. Thank you as always.

[DrFeeelgood]

I am currently on Eliquis for this. Started having problems breathing after 8th chemo round. Did a CT of lungs and was diagnosed with multiple bilateral PE. After a month and a half of blood thinners I am getting back to normal. Dr. First though it was Anemia causing the breathing problems. Be safe fellow members!!

[maley2711]

Patrick - I'm fairly new here. Do you have formal medical training, or just inquisitive and lots of research, Google and otherwise?

[pjoshea13 in reply to maley2711]

Just 16 years of daily post-diagnosis PubMed papers. Nothing more - except some very informative discussions with doctors.

pubmed.ncbi.nlm.nih.gov

-Patrick