Skip to main content

Advertisement

SpringerLink
Log in

Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction: a systematic review and meta-analysis

  • Review
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Tamoxifen therapy is integral in the treatment of patients with hormone receptor-positive breast cancer. However, there is an association between tamoxifen and thromboembolic events. Flap and systemic thromboembolic events have devastating consequences in microvascular breast reconstruction. Currently, there are conflicting data on the association between tamoxifen therapy and thromboembolic complications for patients undergoing microvascular breast reconstruction. The objective of this study is to determine if perioperative tamoxifen therapy modifies the risk of complications and thromboembolic events for patients with breast cancer undergoing microvascular breast reconstruction.

Methods

A comprehensive literature search was performed across six databases from January 2003 to February 2016. Pooled estimates and relative risk (RR) were calculated using a random-effects model, confounding was examined with meta-regression, and risk of bias was evaluated. Primary outcomes were thrombotic flap complications and total flap loss. Study quality was assessed using Downs and Black criteria.

Results

Of 95 studies reviewed, 4 studies comprising 1700 patients and 2245 procedures were included for analysis. Compared to non-recipients, patients on tamoxifen were at increased risk of developing thrombotic flap complications (pooled RR 1.5; 95% CI 1.14–1.98) and total flap loss (pooled RR 3.35; 95% CI 0.95–11.91). There was no significant heterogeneity present in either outcome and no evidence of publication bias.

Conclusions

Perioperative tamoxifen therapy may increase the risk of thrombotic flap complications and flap loss for patients with breast cancer undergoing microvascular reconstruction. These findings further the ability of providers to make evidence-based recommendations in the perioperative management of patients with breast cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. American Cancer Society (2016) Cancer facts & figures 2016. http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf. Accessed 05 Feb 2016

  2. Riggs BL, Hartmann LC (2003) Selective estrogen-receptor modulators—mechanisms of action and application to clinical practice. N Engl J Med 348(7):618–629. doi:10.1056/NEJMra022219

    Article  CAS  PubMed  Google Scholar 

  3. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472):1687–1717. doi:10.1016/s0140-6736(05)66544-0

    Article  Google Scholar 

  4. Burstein HJ, Lacchetti C, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, Giordano SH, Hudis CA, Solky AJ, Stearns V, Winer EP, Griggs JJ (2016) Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American society of clinical oncology clinical practice guideline update on ovarian suppression. J Clin Oncol 34(14):1689–1701. doi:10.1200/jco.2015.65.9573

    Article  CAS  PubMed  Google Scholar 

  5. Davies C, Godwin J, Gray R, Clarke M, Cutter D, Darby S, McGale P, Pan HC, Taylor C, Wang YC, Dowsett M, Ingle J, Peto R (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 378(9793):771–784. doi:10.1016/s0140-6736(11)60993-8

    Article  CAS  PubMed  Google Scholar 

  6. Early Breast Cancer Trialists’ Collaborative Group (1998) Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 351(9114):1451–1467

    Article  Google Scholar 

  7. Deitcher SR, Gomes MP (2004) The risk of venous thromboembolic disease associated with adjuvant hormone therapy for breast carcinoma: a systematic review. Cancer 101(3):439–449. doi:10.1002/cncr.20347

    Article  PubMed  Google Scholar 

  8. Horsted F, West J, Grainge MJ (2012) Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med 9(7):e1001275. doi:10.1371/journal.pmed.1001275

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hernandez RK, Sorensen HT, Pedersen L, Jacobsen J, Lash TL (2009) Tamoxifen treatment and risk of deep venous thrombosis and pulmonary embolism: a Danish population-based cohort study. Cancer 115(19):4442–4449. doi:10.1002/cncr.24508

    Article  CAS  PubMed  Google Scholar 

  10. Eltahir Y, Werners LL, Dreise MM, van Emmichoven IA, Jansen L, Werker PM, de Bock GH (2013) Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg 132(2):201e–209e. doi:10.1097/PRS.0b013e31829586a7

    Article  CAS  PubMed  Google Scholar 

  11. Jagsi R, Jiang J, Momoh AO, Alderman A, Giordano SH, Buchholz TA, Pierce LJ, Kronowitz SJ, Smith BD (2016) Complications after mastectomy and immediate breast reconstruction for breast cancer: a claims-based analysis. Ann Surg 263(2):219–227. doi:10.1097/sla.0000000000001177

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lee KT, Mun GH (2015) Prosthetic breast reconstruction in previously irradiated breasts: a meta-analysis. J Surg Oncol 112(5):468–475. doi:10.1002/jso.24032

    Article  PubMed  Google Scholar 

  13. Matros E, Albornoz CR, Razdan SN, Mehrara BJ, Macadam SA, Ro T, McCarthy CM, Disa JJ, Cordeiro PG, Pusic AL (2015) Cost-effectiveness analysis of implants versus autologous perforator flaps using the BREAST-Q. Plast Reconstr Surg 135(4):937–946. doi:10.1097/prs.0000000000001134

    Article  CAS  PubMed  Google Scholar 

  14. Winters ZE, Benson JR, Pusic AL (2010) A systematic review of the clinical evidence to guide treatment recommendations in breast reconstruction based on patient-reported outcome measures and health-related quality of life. Ann Surg 252(6):929–942. doi:10.1097/SLA.0b013e3181e623db

    Article  PubMed  Google Scholar 

  15. Pannucci CJ, Chang EY, Wilkins EG (2009) Venous thromboembolic disease in autogenous breast reconstruction. Ann Plast Surg 63(1):34–38. doi:10.1097/SAP.0b013e318188bedf

    Article  CAS  PubMed  Google Scholar 

  16. Pannucci CJ, MacDonald JK, Ariyan S, Gutowski KA, Kerrigan CL, Kim JY, Chung KC (2016) Benefits and risks of prophylaxis for deep venous thrombosis and pulmonary embolus in plastic surgery: a systematic review and meta-analysis of controlled trials and consensus conference. Plast Reconstr Surg 137(2):709–730. doi:10.1097/01.prs.0000475790.54231.28

    Article  CAS  PubMed  Google Scholar 

  17. Butz DR, Lapin B, Yao K, Wang E, Song DH, Johnson D, Sisco M (2015) Advanced age is a predictor of 30-day complications after autologous but not implant-based postmastectomy breast reconstruction. Plast Reconstr Surg 135(2):253e–261e. doi:10.1097/prs.0000000000000988

    Article  CAS  PubMed  Google Scholar 

  18. Jokuszies A, Radtke C, Betzler C, Branski L, Krämer R, Vogt PM (2013) Is tamoxifen associated with an increased risk for thromboembolic complications in patients undergoing microvascular breast reconstruction? Ger Med Sci 11:05

    Google Scholar 

  19. Kelley BP, Valero V, Yi M, Kronowitz SJ (2012) Tamoxifen increases the risk of microvascular flap complications in patients undergoing microvascular breast reconstruction. Plast Reconstr Surg 129(2):305–314. doi:10.1097/PRS.0b013e31823ae86c

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Mirzabeigi MN, Nelson JA, Fischer JP, Kovach SJ, Serletti JM, Wu LC, Kanchwala S (2015) Tamoxifen (selective estrogen-receptor modulators) and aromatase inhibitors as potential perioperative thrombotic risk factors in free flap breast reconstruction. Plast Reconstr Surg 135(4):670e–679e

    Article  CAS  PubMed  Google Scholar 

  21. Salibian A, Gu J, Lee Y, Wirth GA, Paydar KZ, Kobayashi MR, Evans G (2016) The Effects of perioperative tamoxifen therapy on microvascular flap complications in transverse rectus abdominis myocutaneous/deep inferior epigastric perforator flap breast reconstruction. Ann Plast Surg. doi:10.1097/SAP.0000000000000707

    Google Scholar 

  22. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. doi:10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  23. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012

    Article  CAS  PubMed  Google Scholar 

  24. Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52(6):377–384

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. doi:10.1002/sim.1186

    Article  PubMed  Google Scholar 

  26. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  CAS  PubMed  Google Scholar 

  27. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101

    Article  CAS  PubMed  Google Scholar 

  28. Harbord RM, Egger M, Sterne JA (2006) A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 25(20):3443–3457. doi:10.1002/sim.2380

    Article  PubMed  Google Scholar 

  29. Hallgren KA (2012) Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol 8(1):23–34

    Article  PubMed  PubMed Central  Google Scholar 

  30. Morrow M, Li Y, Alderman AK, Jagsi R, Hamilton AS, Graff JJ, Hawley ST, Katz SJ (2014) Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making. JAMA Surg 149(10):1015–1021. doi:10.1001/jamasurg.2014.548

    Article  PubMed  PubMed Central  Google Scholar 

  31. Amir E, Seruga B, Niraula S, Carlsson L, Ocana A (2011) Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. J Natl Cancer Inst 103(17):1299–1309. doi:10.1093/jnci/djr242

    Article  CAS  PubMed  Google Scholar 

  32. Saphner T, Tormey DC, Gray R (1991) Venous and arterial thrombosis in patients who received adjuvant therapy for breast cancer. J Clin Oncol 9(2):286–294

    Article  CAS  PubMed  Google Scholar 

  33. Cuzick J, Forbes JF, Sestak I, Cawthorn S, Hamed H, Holli K, Howell A (2007) Long-term results of tamoxifen prophylaxis for breast cancer—96-month follow-up of the randomized IBIS-I trial. J Natl Cancer Inst 99(4):272–282. doi:10.1093/jnci/djk049

    Article  CAS  PubMed  Google Scholar 

  34. Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, Vogel V, Robidoux A, Dimitrov N, Atkins J, Daly M, Wieand S, Tan-Chiu E, Ford L, Wolmark N (1998) Tamoxifen for prevention of breast cancer: report of the national surgical adjuvant breast and bowel project P-1 study. J Natl Cancer Inst 90(18):1371–1388

    Article  CAS  PubMed  Google Scholar 

  35. Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, Hoctin-Boes G, Houghton J, Locker GY, Tobias JS (2005) Results of the ATAC (arimidex, tamoxifen, alone or in combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 365(9453):60–62. doi:10.1016/s0140-6736(04)17666-6

    Article  CAS  PubMed  Google Scholar 

  36. Margolese RG, Cecchini RS, Julian TB, Ganz PA, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky AM, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N (2016) Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet 387(10021):849–856. doi:10.1016/s0140-6736(15)01168-x

    Article  CAS  PubMed  Google Scholar 

  37. Walker AJ, West J, Card TR, Crooks C, Kirwan CC, Grainge MJ (2016) When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data. Blood 127(7):849–857. doi:10.1182/blood-2015-01-625582

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara BJ (2007) Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 119(7):2092–2100. doi:10.1097/01.prs.0000260598.24376.e1

    Article  CAS  PubMed  Google Scholar 

  39. Khansa I, Chao AH, Taghizadeh M, Nagel T, Wang D, Tiwari P (2013) A systematic approach to emergent breast free flap takeback: clinical outcomes, algorithm, and review of the literature. Microsurgery 33(7):505–513. doi:10.1002/micr.22151

    Article  PubMed  Google Scholar 

  40. Khouri RK, Cooley BC, Kunselman AR, Landis JR, Yeramian P, Ingram D, Natarajan N, Benes CO, Wallemark C (1998) A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 102(3):711–721

    Article  CAS  PubMed  Google Scholar 

  41. Hanasono MM, Butler CE (2008) Prevention and treatment of thrombosis in microvascular surgery. J Reconstr Microsurg 24(5):305–314. doi:10.1055/s-2008-1080530

    Article  PubMed  Google Scholar 

  42. Adam HK, Patterson JS, Kemp JV (1980) Studies on the metabolism and pharmacokinetics of tamoxifen in normal volunteers. Cancer Treat Rep 64(6–7):761–764

    CAS  PubMed  Google Scholar 

  43. Hoskins JM, Carey LA, McLeod HL (2009) CYP2D6 and tamoxifen: DNA matters in breast cancer. Nat Rev Cancer 9(8):576–586. doi:10.1038/nrc2683

    Article  CAS  PubMed  Google Scholar 

  44. Johnson MD, Zuo H, Lee KH, Trebley JP, Rae JM, Weatherman RV, Desta Z, Flockhart DA, Skaar TC (2004) Pharmacological characterization of 4-hydroxy-N-desmethyl tamoxifen, a novel active metabolite of tamoxifen. Breast Cancer Res Treat 85(2):151–159. doi:10.1023/B:BREA.0000025406.31193.e8

    Article  CAS  PubMed  Google Scholar 

  45. Desta Z, Ward BA, Soukhova NV, Flockhart DA (2004) Comprehensive evaluation of tamoxifen sequential biotransformation by the human cytochrome P450 system in vitro: prominent roles for CYP3A and CYP2D6. J Pharmacol Exp Ther 310(3):1062–1075. doi:10.1124/jpet.104.065607

    Article  CAS  PubMed  Google Scholar 

  46. Gjerde J, Gandini S, Guerrieri-Gonzaga A, Haugan Moi LL, Aristarco V, Mellgren G, Decensi A, Lien EA (2012) Tissue distribution of 4-hydroxy-N-desmethyltamoxifen and tamoxifen-N-oxide. Breast Cancer Res Treat 134(2):693–700. doi:10.1007/s10549-012-2074-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Lien EA, Solheim E, Ueland PM (1991) Distribution of tamoxifen and its metabolites in rat and human tissues during steady-state treatment. Cancer Res 51(18):4837–4844

    CAS  PubMed  Google Scholar 

  48. Kisanga ER, Gjerde J, Guerrieri-Gonzaga A, Pigatto F, Pesci-Feltri A, Robertson C, Serrano D, Pelosi G, Decensi A, Lien EA (2004) Tamoxifen and metabolite concentrations in serum and breast cancer tissue during three dose regimens in a randomized preoperative trial. Clin Cancer Res 10(7):2336–2343

    Article  CAS  PubMed  Google Scholar 

  49. Lien EA, Solheim E, Lea OA, Lundgren S, Kvinnsland S, Ueland PM (1989) Distribution of 4-hydroxy-N-desmethyltamoxifen and other tamoxifen metabolites in human biological fluids during tamoxifen treatment. Cancer Res 49(8):2175–2183

    CAS  PubMed  Google Scholar 

  50. Stearns V, Johnson MD, Rae JM, Morocho A, Novielli A, Bhargava P, Hayes DF, Desta Z, Flockhart DA (2003) Active tamoxifen metabolite plasma concentrations after coadministration of tamoxifen and the selective serotonin reuptake inhibitor paroxetine. J Natl Cancer Inst 95(23):1758–1764

    Article  CAS  PubMed  Google Scholar 

  51. Chen KT, Mardini S, Chuang DC, Lin CH, Cheng MH, Lin YT, Huang WC, Tsao CK, Wei FC (2007) Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg 120(1):187–195. doi:10.1097/01.prs.0000264077.07779.50

    Article  CAS  PubMed  Google Scholar 

  52. Kroll SS, Schusterman MA, Reece GP, Miller MJ, Evans GR, Robb GL, Baldwin BJ (1996) Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg 98(7):1230–1233

    Article  CAS  PubMed  Google Scholar 

  53. Nelson JA, Kim EM, Eftekhari K, Low DW, Kovach SJ, Wu LC, Serletti JM (2012) Late venous thrombosis in free flap breast reconstruction: strategies for salvage after this real entity. Plast Reconstr Surg 129(1):8e–15e. doi:10.1097/PRS.0b013e3182361f7f

    Article  PubMed  Google Scholar 

  54. Serletti JM, Moran SL, Orlando GS, O’Connor T, Herrera HR (1998) Urokinase protocol for free-flap salvage following prolonged venous thrombosis. Plast Reconstr Surg 102(6):1947–1953

    Article  CAS  PubMed  Google Scholar 

  55. Noble S, Pasi J (2010) Epidemiology and pathophysiology of cancer-associated thrombosis. Br J Cancer 102(Suppl 1):S2–S9. doi:10.1038/sj.bjc.6605599

    Article  PubMed  PubMed Central  Google Scholar 

  56. Falati S, Gross P, Merrill-Skoloff G, Furie BC, Furie B (2002) Real-time in vivo imaging of platelets, tissue factor and fibrin during arterial thrombus formation in the mouse. Nat Med 8(10):1175–1181. doi:10.1038/nm782

    Article  CAS  PubMed  Google Scholar 

  57. Seo MH, Kim SM, Huan F, Myoung H, Lee JH, Lee SK (2015) Analysis of microvascular free flap failure focusing on the microscopic findings of the anastomosed vessels. J Cranio-fac Surg 26(7):2047–2051. doi:10.1097/scs.0000000000002111

    Article  Google Scholar 

  58. Johnson PC (1990) Platelet-mediated thrombosis in microvascular surgery: new knowledge and strategies. Plast Reconstr Surg 86(2):359–367

    Article  CAS  PubMed  Google Scholar 

  59. Cho EH, Ligh C, Hodulik KL, Hollenbeck ST (2014) Role of platelet inhibition in microvascular surgery. J Reconstr Microsurg 30(9):589–598. doi:10.1055/s-0034-1381955

    Article  PubMed  Google Scholar 

  60. Khouri RK, Cooley BC, Kenna DM, Edstrom LE (1990) Thrombosis of microvascular anastomoses in traumatized vessels: fibrin versus platelets. Plast Reconstr Surg 86(1):110–117

    Article  CAS  PubMed  Google Scholar 

  61. Shah VP, Chegini HA, Vishneski SR, Weatherman RV, Blackmore PF, Dobrydneva Y (2012) Tamoxifen promotes superoxide production in platelets by activation of PI3-kinase and NADPH oxidase pathways. Thromb Res 129(1):36–42. doi:10.1016/j.thromres.2011.08.010

    Article  CAS  PubMed  Google Scholar 

  62. Dobrydneva Y, Weatherman RV, Trebley JP, Morrell MM, Fitzgerald MC, Fichandler CE, Chatterjie N, Blackmore PF (2007) Tamoxifen stimulates calcium entry into human platelets. J Cardiovasc Pharmacol 50(4):380–390. doi:10.1097/FJC.0b013e31811ec748

    Article  CAS  PubMed  Google Scholar 

  63. Vitseva O, Flockhart DA, Jin Y, Varghese S, Freedman JE (2005) The effects of tamoxifen and its metabolites on platelet function and release of reactive oxygen intermediates. J Pharmacol Exp Ther 312(3):1144–1150. doi:10.1124/jpet.104.076315

    Article  CAS  PubMed  Google Scholar 

  64. Vemana HP, Karim ZA, Conlon C, Khasawneh FT (2015) A critical role for the transient receptor potential channel type 6 in human platelet activation. PLoS ONE 10(4):e0125764. doi:10.1371/journal.pone.0125764

    Article  PubMed  PubMed Central  Google Scholar 

  65. Varga-Szabo D, Braun A, Nieswandt B (2009) Calcium signaling in platelets. J Throm Haemost 7(7):1057–1066. doi:10.1111/j.1538-7836.2009.03455.x

    Article  CAS  Google Scholar 

  66. Mackman N, Tilley RE, Key NS (2007) Role of the extrinsic pathway of blood coagulation in hemostasis and thrombosis. Arterioscler Thromb Vasc Biol 27(8):1687–1693. doi:10.1161/atvbaha.107.141911

    Article  CAS  PubMed  Google Scholar 

  67. Tesselaar ME, Romijn FP, Van Der Linden IK, Prins FA, Bertina RM, Osanto S (2007) Microparticle-associated tissue factor activity: a link between cancer and thrombosis? J Throm Haemost 5(3):520–527. doi:10.1111/j.1538-7836.2007.02369.x

    Article  CAS  Google Scholar 

  68. Toth B, Liebhardt S, Steinig K, Ditsch N, Rank A, Bauerfeind I, Spannagl M, Friese K, Reininger AJ (2008) Platelet-derived microparticles and coagulation activation in breast cancer patients. Thromb Haemost 100(4):663–669

    CAS  PubMed  Google Scholar 

  69. Trappenburg MC, van Schilfgaarde M, Bredewold EO, van Aalderen MC, Spronk HM, Ten Cate H, Leyte A, Terpstra WE (2011) Elevated numbers and altered subsets of procoagulant microparticles in breast cancer patients using endocrine therapy. Thromb Res 127(4):363–369. doi:10.1016/j.thromres.2010.12.015

    Article  CAS  PubMed  Google Scholar 

  70. Pritchard KI, Paterson AH, Paul NA, Zee B, Fine S, Pater J, National Cancer Institute of Canada Clinical Trials Group Breast Cancer Site Group (1996) Increased thromboembolic complications with concurrent tamoxifen and chemotherapy in a randomized trial of adjuvant therapy for women with breast cancer. J Clin Oncol 14(10):2731–2737

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

RPP and EBO are supported by a National Institutes of Health (NIH) Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant (T32CA190194, PI Colditz). No funding was provided directly for this study. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.

Author information

Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Rajiv P. Parikh, Elizabeth B. Odom & Terence M. Myckatyn

  2. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Rajiv P. Parikh, Elizabeth B. Odom, Liyang Yu & Graham A. Colditz

  3. Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Suite 1150 NW Tower, Box 8238, St. Louis, MO, 63110, USA

    Rajiv P. Parikh

Authors
  1. Rajiv P. Parikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth B. Odom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liyang Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Graham A. Colditz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Terence M. Myckatyn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rajiv P. Parikh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Research involving human participants and/or animals and informed consent

Not applicable—this article does not contain any studies with human participants performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parikh, R.P., Odom, E.B., Yu, L. et al. Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction: a systematic review and meta-analysis. Breast Cancer Res Treat 163, 1–10 (2017). https://doi.org/10.1007/s10549-017-4146-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-017-4146-3

Keywords

Search

Navigation