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Outcomes of anticoagulation treatment for renal cell carcinoma tumor thrombi: a systematic review.

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Τίτλος: Outcomes of anticoagulation treatment for renal cell carcinoma tumor thrombi: a systematic review.
Συγγραφείς: Akerboom B; Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Martens ESL; Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Kaptein FHJ; Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Kondo T; Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan., van der Hulle T; Department of Medicine-Oncology, Leiden University Medical Center, Leiden, the Netherlands., van Gennep EJ; Department of Urology, Leiden University Medical Center, Leiden, the Netherlands., Versteeg HH; Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., van Mens TE; Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Klok FA; Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: f.a.klok@LUMC.nl.
Πηγή: Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2026 Feb; Vol. 24 (2), pp. 654-661. Date of Electronic Publication: 2025 Nov 04.
Τύπος έκδοσης: Journal Article; Systematic Review; Research Support, Non-U.S. Gov't
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier Country of Publication: England NLM ID: 101170508 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1538-7836 (Electronic) Linking ISSN: 15387836 NLM ISO Abbreviation: J Thromb Haemost Subsets: MEDLINE
Imprint Name(s): Publication: 2023- : [New York] : Elsevier
Original Publication: Oxford : Blackwell Pub.
Ιατρικοί όροι (MeSH): Carcinoma, Renal Cell*/drug therapy , Carcinoma, Renal Cell*/complications , Carcinoma, Renal Cell*/blood , Carcinoma, Renal Cell*/epidemiology , Anticoagulants*/therapeutic use , Anticoagulants*/adverse effects , Kidney Neoplasms*/drug therapy , Kidney Neoplasms*/complications , Kidney Neoplasms*/blood , Venous Thromboembolism*/epidemiology , Venous Thromboembolism*/diagnosis , Venous Thromboembolism*/drug therapy , Venous Thromboembolism*/prevention & control , Venous Thromboembolism*/blood , Thrombosis*/drug therapy , Thrombosis*/diagnosis , Thrombosis*/epidemiology , Blood Coagulation*/drug effects, Hemorrhage/chemically induced ; Hemorrhage/epidemiology ; Humans ; Risk Factors ; Treatment Outcome ; Incidence ; Observational Studies as Topic ; Risk Assessment ; Time Factors ; Male
Περίληψη: Background: Patients with renal cell carcinoma (RCC) and tumor thrombus (TT) are at significant risk of venous thromboembolism (VTE).
Objectives: This systematic review aimed to assess the role of anticoagulation in ambulatory patients with RCC and TT.
Methods: Inclusion criteria were diagnosis of RCC with TT, reporting of VTE, major bleeding and/or arterial thromboembolism, as well as exposure to anticoagulation. Studies with <30 patients were excluded. Studies were also excluded if anticoagulation status was not reported per outcome stratum. A comprehensive search was conducted in PubMed and other databases. Risk of bias was assessed in accordance with the Scottish Intercollegiate Guidelines Network bias quality assessment tool.
Results: Six observational studies containing 659 patients were included. All studies had considerable risk of bias. Anticoagulation use ranged from 3.9% to 50%. Two studies reported a lower VTE incidence in anticoagulated patients than in non-anticoagulated patients: 7.3% (1.2-21) vs 20% (6.9-37) after 1 year, and 18% (1.5-49) vs 24% (14-36) after 2 years. In anticoagulated patients, major bleeding incidence was 12% (2.8-27) after 1 year and 33% (8.2-60) after 2 years. For non-anticoagulated patients the incidence was 19% (6.6-36) after 1 year and 12% (5.1-22) after 2 years. Importantly, none of the studies were management studies, and confidence intervals of our outcomes were wide.
Conclusion: Anticoagulation in patients with RCC with TT may lower VTE risk. Bleeding risk is high in both anticoagulated as well as non-anticoagulated patients. Current evidence remains inconclusive due to study heterogeneity and risk of bias.
(Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)
Competing Interests: Declaration of competing interests F.A.K. received research funding from Bayer, BMS, BSCI, AstraZeneca, angiodynamics, MSD, Leo Pharma, Actelion, Varm-X, The Netherlands Organisation for Health Research and Development, The Dutch Heart Foundation, and the Horizon Europe Program, all outside this work and paid to his institution. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Contributed Indexing: Keywords: anticoagulants; hemorrhage; kidney neoplasms; pulmonary embolism; venous thrombosis
Substance Nomenclature: 0 (Anticoagulants)
Entry Date(s): Date Created: 20251106 Date Completed: 20260205 Latest Revision: 20260804
Update Code: 20260805
DOI: 10.1016/j.jtha.2025.10.020
PMID: 41197810
Βάση Δεδομένων: MEDLINE
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  Data: Outcomes of anticoagulation treatment for renal cell carcinoma tumor thrombi: a systematic review.
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Patients with renal cell carcinoma (RCC) and tumor thrombus (TT) are at significant risk of venous thromboembolism (VTE).&lt;br /&gt;Objectives: This systematic review aimed to assess the role of anticoagulation in ambulatory patients with RCC and TT.&lt;br /&gt;Methods: Inclusion criteria were diagnosis of RCC with TT, reporting of VTE, major bleeding and/or arterial thromboembolism, as well as exposure to anticoagulation. Studies with &amp;lt;30 patients were excluded. Studies were also excluded if anticoagulation status was not reported per outcome stratum. A comprehensive search was conducted in PubMed and other databases. Risk of bias was assessed in accordance with the Scottish Intercollegiate Guidelines Network bias quality assessment tool.&lt;br /&gt;Results: Six observational studies containing 659 patients were included. All studies had considerable risk of bias. Anticoagulation use ranged from 3.9% to 50%. Two studies reported a lower VTE incidence in anticoagulated patients than in non-anticoagulated patients: 7.3% (1.2-21) vs 20% (6.9-37) after 1 year, and 18% (1.5-49) vs 24% (14-36) after 2 years. In anticoagulated patients, major bleeding incidence was 12% (2.8-27) after 1 year and 33% (8.2-60) after 2 years. For non-anticoagulated patients the incidence was 19% (6.6-36) after 1 year and 12% (5.1-22) after 2 years. Importantly, none of the studies were management studies, and confidence intervals of our outcomes were wide.&lt;br /&gt;Conclusion: Anticoagulation in patients with RCC with TT may lower VTE risk. Bleeding risk is high in both anticoagulated as well as non-anticoagulated patients. Current evidence remains inconclusive due to study heterogeneity and risk of bias.&lt;br /&gt; (Copyright &#169; 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: Declaration of competing interests F.A.K. received research funding from Bayer, BMS, BSCI, AstraZeneca, angiodynamics, MSD, Leo Pharma, Actelion, Varm-X, The Netherlands Organisation for Health Research and Development, The Dutch Heart Foundation, and the Horizon Europe Program, all outside this work and paid to his institution. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
– Name: SubjectMinor
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  Data: &lt;i&gt;Keywords: &lt;/i&gt;anticoagulants; hemorrhage; kidney neoplasms; pulmonary embolism; venous thrombosis
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  Data: 0 (Anticoagulants)
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  Data: &lt;i&gt;Date Created: &lt;/i&gt;20251106 &lt;i&gt;Date Completed: &lt;/i&gt;20260205 &lt;i&gt;Latest Revision: &lt;/i&gt;20260804
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  Data: 20260805
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  Data: 10.1016/j.jtha.2025.10.020
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  Data: 41197810
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        StartPage: 654
    Subjects:
      – SubjectFull: Hemorrhage chemically induced
        Type: general
      – SubjectFull: Hemorrhage epidemiology
        Type: general
      – SubjectFull: Humans
        Type: general
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      – SubjectFull: Thrombosis epidemiology
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      – SubjectFull: Blood Coagulation drug effects
        Type: general
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      – TitleFull: Outcomes of anticoagulation treatment for renal cell carcinoma tumor thrombi: a systematic review.
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            – Type: issn-electronic
              Value: 1538-7836
          Numbering:
            – Type: volume
              Value: 24
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Journal of thrombosis and haemostasis : JTH
              Type: main
ResultId 1