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Medical Oncology

, Volume 27, Issue 3, pp 807–814 | Cite as

Management of venous thromboembolism in colorectal cancer patients treated with bevacizumab

  • Mitsukuni Suenaga
  • Nobuyuki Mizunuma
  • Kokoro Kobayashi
  • Eiji Shinozaki
  • Satoshi Matsusaka
  • Keisho Chin
  • Yasutoshi Kuboki
  • Takashi Ichimura
  • Masato Ozaka
  • Mariko Ogura
  • Yoshimasa Fujiwara
  • Kiyoshi Matsueda
  • Fumio Konishi
  • Kiyohiko HatakeEmail author
Original Paper

Abstract

Venous thromboembolism associated with use of a central venous access system is an urgent problem in patients treated with bevacizumab (bev). We investigated the effectiveness of Doppler ultrasound imaging (DUS) in the early detection of catheter-related thrombosis for avoidance of severe venous thromboembolism. Patients with metastatic colorectal cancer received either FOLFOX-4 + bev or FOLFIRI + bev. DUS was performed on the deep venous system for detection of thrombus formation during the initial cycle of treatment, followed by re-evaluation after the third cycle in patients with asymptomatic thrombus formation. All patients were followed up until treatment was interrupted. Median duration of follow-up was 484 days (range 72–574). Among 41 enrolled patients, curable symptomatic thrombosis occurred in one, and asymptomatic thrombosis in 21 (51.2%). Of 21 patients undergoing re-evaluation, thrombi remained without progression in 17 patients, and enlargement in 4 patients. In two of the patients in whom there was progression, pulmonary embolism occurred after the sixth cycle. In the asymptomatic group, no thrombi developed as far as the superior vena cava in any patient. In the cases of progression, thrombotic enlargement was observed in all the 4 patients, with decreased vascular flow in 2. Using DUS, we were able to detect asymptomatic thrombosis in the early cycles of treatment, indicating its potential in the monitoring of venous thrombi. In the event of an enlarging asymptomatic thrombosis developing into the superior vena cava along with decreased vascular flow, careful follow-up and appropriate anticoagulant therapy may be recommended without increased risk of bleeding.

Keywords

Venous thromboembolism Bevacizumab Colorectal cancer 

Notes

Acknowledgments

We would like to thank Dr. Madoiwa (Department of Hematology, Jichi Medical University) for excellent pathophysiological advice on the blood coagulation system and Dr. Furuya (Department of Circulatory Organ Internal Medicine, Tokyo Rinkai Hospital) for technical advice on treatment of thromboembolism.

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Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Mitsukuni Suenaga
    • 1
  • Nobuyuki Mizunuma
    • 1
  • Kokoro Kobayashi
    • 1
  • Eiji Shinozaki
    • 1
  • Satoshi Matsusaka
    • 1
  • Keisho Chin
    • 1
  • Yasutoshi Kuboki
    • 1
  • Takashi Ichimura
    • 1
  • Masato Ozaka
    • 1
  • Mariko Ogura
    • 1
  • Yoshimasa Fujiwara
    • 2
  • Kiyoshi Matsueda
    • 2
  • Fumio Konishi
    • 3
  • Kiyohiko Hatake
    • 1
    Email author
  1. 1.Department of Medical OncologyCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
  2. 2.Department of RadiologyCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
  3. 3.Department of SurgeryOmiya Medical Center, Jichi Medical UniversityAmanuma cho, Omiya-ku, Saitama CityJapan

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