Advertisement

Journal of Thrombosis and Thrombolysis

, Volume 47, Issue 1, pp 121–128 | Cite as

Thrombosis, anticoagulation and outcomes in malignant superior vena cava syndrome

  • Roy Ratzon
  • Shlomit Tamir
  • Tal Friehmann
  • Nir Livneh
  • Elizabeth Dudnik
  • Alon Rozental
  • Orly Hamburger-Avnery
  • David Pereg
  • Estela Derazne
  • Baruch Brenner
  • Pia Raanani
  • Hugo ten Cate
  • Galia Spectre
  • Avi LeaderEmail author
Article

Abstract

Anticoagulation is often used in superior vena cava syndrome (SVCS) associated with cancer (i.e malignant SVCS), even without thrombosis, but its effect on outcomes has not been reported. We aimed to determine factors and outcomes associated with thrombosis and anticoagulation in malignant SVCS. Patients with malignant SVCS diagnosed on computerized tomography (CT) were retrospectively included, indexed at diagnosis and followed for 6 months using medical records. The cohort included 183 patients with malignant SVCS of which 153 (84%) were symptomatic. Thirty of the 127 patients (24%) with a reviewable baseline CT had thrombosis of the SVC or tributaries at diagnosis. Patients with baseline thrombosis more often had symptomatic SVCS (p < 0.01). 70% (21/30) of patients with thrombosis and 52% (49/97) of those without thrombosis at baseline received anticoagulation, most often at therapeutic doses. Thrombosis occurred in 5/39 patients with anticoagulation (13%) compared to 2/18 (11%) of those without, during follow-up (p = 0.85). Anticoagulation was associated with a reduction in risk of SVC stent placement during follow-up that did not reach statistical significance (HR 0.47, 95% CI 0.2–1.13, p = 0.09). Major bleeding occurred in 7 (4%) patients, six of whom received anticoagulation (four therapeutic and two intermediate dose). Neither thrombosis nor anticoagulation affected survival. Anticoagulation is commonly used as primary prevention but its benefit remains to be proven. The role of reduced-dose anticoagulation in non-thrombotic malignant SVCS should be prospectively assessed.

Keywords

Superior vena cava syndrome Malignancy Thrombosis Anticoagulation 

Notes

Acknowledgements

The authors express their gratitude to Vincent ten Cate for his critical review of the manuscript.

Funding

This work was supported by the Paul Davidoff Foundation for the Ofek Program in collaboration with the Tel-Aviv University.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

11239_2018_1747_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 23 KB)
11239_2018_1747_MOESM2_ESM.docx (24 kb)
Supplementary material 2 (DOCX 23 KB)
11239_2018_1747_MOESM3_ESM.docx (29 kb)
Supplementary material 3 (DOCX 29 KB)
11239_2018_1747_MOESM4_ESM.docx (23 kb)
Supplementary material 4 (DOCX 22 KB)

References

  1. 1.
    Rice TW, Rodriguez RM, Light RW (2006) The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore) 85:37–42.  https://doi.org/10.1097/01.md.0000198474.99876.f0 CrossRefGoogle Scholar
  2. 2.
    Abner A (1993) Approach to the patient who presents whh superior vena cava obstruction. Chest 103:394S–397S.  https://doi.org/10.1378/chest.103.4 CrossRefGoogle Scholar
  3. 3.
    Perez-Soler R, McLaughlin P, Velasquez WS et al (1984) Clinical features and results of management of superior vena cava syndrome secondary to lymphoma. J Clin Oncol 2:260–266.  https://doi.org/10.1200/JCO.1984.2.4.260 CrossRefGoogle Scholar
  4. 4.
    Armstrong BA, Perez CA, Simpson JR, Hederman MA (1987) Role of irradiation in the management of superior vena cava syndrome. Int J Radiat Oncol Biol Phys 13:531–539.  https://doi.org/10.1016/0360-3016(87)90068-X CrossRefGoogle Scholar
  5. 5.
    Schraufnagel DE, Hill R, Leech JA, Pare JA (1981) Superior vena caval obstruction. Is it a medical emergency? Am J Med 70:1169–1174CrossRefGoogle Scholar
  6. 6.
    Kim Y-I (2004) Endovascular stenting as a first choice for the palliation of superior vena cava syndrome. J Korean Med Sci 19:519–522CrossRefGoogle Scholar
  7. 7.
    Marcy PY, Magné N, Bentolila F et al (2001) Superior vena cava obstruction: is stenting necessary? Support Care Cancer 9:103–107CrossRefGoogle Scholar
  8. 8.
    Lanciego C, Pangua C, Chacon JI, Velasco J, Boy RC, Viana A, Cerezo S, Garcia LG (2009) Endovascular stenting as the first step in the overall management of malignant superior vena cava syndrome. Am J Roentgenol 193:549–558CrossRefGoogle Scholar
  9. 9.
    Lepper PM, Ott SR, Hoppe H et al (2011) Superior vena cava syndrome in thoracic malignancies. Respir Care 56:653–666.  https://doi.org/10.4187/respcare.00947 CrossRefGoogle Scholar
  10. 10.
    Wilson LD, Detterbeck FC, Yahalom J (2007) Superior vena cava syndrome with malignant causes. N Engl J Med 356:1862–1869CrossRefGoogle Scholar
  11. 11.
    Yu JB, Wilson LD, Detterbeck FC (2008) Superior vena cava syndrome—a proposed classification system and algorithm for management. J Thorac Oncol 3:811–814.  https://doi.org/10.1097/JTO.0b013e3181804791 CrossRefGoogle Scholar
  12. 12.
    Schulman S, Anger SU, Bergqvist D et al (2010) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J Thromb Haemost 8:202–204.  https://doi.org/10.1111/j.1538-7836.2009.03678.x CrossRefGoogle Scholar
  13. 13.
    Mónaco RG, Bertoni H, Pallota G et al (2003) Use of self-expanding vascular endoprostheses in superior vena cava syndrome. Eur J Cardio-thoracic Surg 24:208–211.  https://doi.org/10.1016/S1010-7940(03)00293-8 CrossRefGoogle Scholar
  14. 14.
    Morin S, Grateau A, Reuter D et al (2017) Management of superior vena cava syndrome in critically ill cancer patients. Support Care Cancer.  https://doi.org/10.1007/s00520-017-3860-z Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Roy Ratzon
    • 1
    • 2
  • Shlomit Tamir
    • 2
    • 3
  • Tal Friehmann
    • 2
    • 3
  • Nir Livneh
    • 1
    • 2
  • Elizabeth Dudnik
    • 4
    • 5
  • Alon Rozental
    • 1
    • 2
  • Orly Hamburger-Avnery
    • 2
    • 6
  • David Pereg
    • 2
    • 7
  • Estela Derazne
    • 2
  • Baruch Brenner
    • 2
    • 5
  • Pia Raanani
    • 1
    • 2
  • Hugo ten Cate
    • 8
    • 9
  • Galia Spectre
    • 1
    • 2
  • Avi Leader
    • 1
    • 2
    • 8
    Email author
  1. 1.Institute of Hematology, Davidoff Cancer CenterRabin Medical CenterPetah TikvaIsrael
  2. 2.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Radiology DepartmentRabin Medical CenterPetah TikvaIsrael
  4. 4.Thoracic Oncology UnitRabin Medical CenterPetah TikvaIsrael
  5. 5.Institute of Oncology, Davidoff Cancer CenterRabin Medical CenterPetah TikvaIsrael
  6. 6.Institute of HematologyMeir Medical CenterKfar SabaIsrael
  7. 7.Cardiology DepartmentMeir Medical CenterKfar SabaIsrael
  8. 8.Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
  9. 9.Thrombosis Expert CenterMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands

Personalised recommendations