Hamadi, Omar

e15520 Background: Fruquintinib is a highly selective tyrosine kinase inhibitor that targets vascular endothelial growth factor receptors (VEGFR) 1, 2, and 3, which play a critical role in angiogenesis and tumor growth. As a novel anti-angiogenic agent, Fruquintinib has demonstrated promising efficacy in the treatment of various advanced malignancies, including metastatic colorectal cancer. However, concerns about its cardiovascular safety have emerged, given that VEGFR inhibition is often associated with cardiovascular adverse events. Methods: We conducted a systematic search through PubMed, Scopus, Embase, and Web of Science to identify randomized controlled trials and cohort studies that assessed the safety of Fruquintinib compared with placebo in patients with metastatic colorectal and other cancers. The evaluated outcomes included hypertension, coronary artery disease, cerebrovascular accidents, peripheral artery disease, heart failure, thromboembolism, arrhythmias, aortic dissection, and superior vena cava syndrome. Two independent reviewers screened the titles/abstracts based on predefined inclusion and exclusion criteria, followed by a full-text review of potentially relevant studies. Any disagreements between the reviewers were resolved through consultation with a third reviewer to ensure the accuracy and consistency of the study selection. Results: Fifteen reports were included in our study. Out of 3832 patients taking Fruquintinib monotherapy, a total of 997 developed hypertension with a pooled estimate incidence of 0.329 (95% CI: 0.248, 0.410; P < 0.001). In comparison to placebo, Fruquintinib was associated with significantly higher odds of developing hypertension (OR: 6.856; 95% CI: 5.071, 9.268; P < 0.001). Compared to Regorafenib, Fruquintinib demonstrated an OR of 1.549 (95% CI: 0.804, 2.983; P = 0.191) for the development of hypertension. Additionally, patients taking Fruquintinib had a pooled estimate incidence of 0.041 (95% CI: 0.021, 0.060, P < 0.001) for thromboembolism development with an OR of 2.092 (95% CI: 0.813, 5.385; P = 0.126) compared to placebo. Other reported cardiovascular side effects included sinus tachycardia, superior vena cava syndrome, peripheral edema, heart failure, myocardial enzymes elevation, and vascular access complications. Conclusions: Our study found that Fruquintinib is associated with significant cardiovascular risks, with hypertension being the most common adverse event, while thromboembolism did not reach statistical significance. Therefore, close monitoring for treatment-related cardiovascular events should be considered in these patients.

Background: Clinical outcomes of catheter-based thrombectomy (CBT) compared with surgical embolectomy (SE) in patients with massive pulmonary embolism (mPE) have not been previously examined. Methods: We conducted a retrospective cohort study using the 2016-2020 National Inpatient Sample database to compare the outcomes of CBT versus SE in patients with mPE. Outcomes of interest included risk-adjusted in-hospital mortality, major bleeding, stroke, acute kidney injury (AKI), hospital length of stay (LOS), and total cost. Results: The total cohort included 5,845 patients with mPE, of which 5,490 (93.9%) underwent CBT and 215 (3.7%) underwent SE. After risk-adjustment, CBT had similar odds of in-hospital mortality (adjusted odds ratio [aOR] 1.49, 95% confidence interval [CI] 0.60-3.66, p=0.37) and stroke (aOR 1.49, 95% CI 0.30-7.38, p=0.62), lower odds of major bleeding (aOR 0.28, 95% CI 0.13-0.63, p<0.01), and higher odds of AKI (aOR 2.40, 95% CI 1.11-5.17, p=0.02) compared with SE. CBT had a similar LOS (p=0.58) and total cost (p=0.23) compared with SE. Between 2016 and 2020, there was a temporal increase in the performance of CBT in patients with mPE (p trend <0.01). Conclusions: In patients with massive PE, CBT was associated with similar in-hospital mortality, stroke, LOS, and total cost, lower major bleeding, and higher AKI compared with SE. Randomized controlled trials are indicated to confirm our findings.