Clinical research study
The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site

https://doi.org/10.1016/j.amjmed.2016.10.017Get rights and content

Abstract

Background

We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site.

Aim and Methods

We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer).

Results

As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal, and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95% confidence interval (CI), 3.8-8.1] vs 4.1 [95% CI, 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95% CI, 7.6-13] vs 12 [95% CI, 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95% CI, 4.4-10] vs 13 [95% CI, 9.2-17] events per 100 patient-years), whereas in those with lung cancer, the rate of thromboembolic recurrences was twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years).

Conclusions

Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.

Section snippets

Patients and Methods

Consecutive patients with symptomatic, acute deep vein thrombosis or pulmonary embolism, confirmed by objective tests (compression ultrasonography or contrast venography for deep vein thrombosis; helical computed tomography [CT] scan or high-probability ventilation/perfusion lung scintigraphy for pulmonary embolism), were enrolled in RIETE. We considered as having pulmonary embolism all those patients with symptomatic pulmonary embolism, either with or without concomitant deep vein thrombosis.

Patient Characteristics

Up to September 2014, 48,481 patients were recruited in RIETE, of whom 3947 had “active” cancer and were eligible for the present study, including 938 (24%) cases of breast cancer, 629 (16%) prostate, 1189 (30%) colorectal, and 1191 (30%) cases of lung cancer. The baseline characteristics of patients are summarized in Table 1. Besides sex and age, there were significant differences regarding the rate of metastatic disease (42%, 36%, 53% and 72%, respectively) and the proportion of patients for

Discussion

Current guidelines of antithrombotic therapy recommend that all cancer patients with venous thromboembolism receive long-term therapy with LMWH (at similar doses) for at least 3 months.4, 5, 6 Beyond the third month there is scarce information on the factors influencing outcome. Our findings, obtained from a large series of consecutive patients with active cancer and venous thromboembolism, reveal important differences in the rate of venous thromboembolic recurrences and major bleeding

Acknowledgment

We express our gratitude to Sanofi Spain for supporting this Registry with an unrestricted educational grant. We also express our gratitude to Bayer Pharma AG for supporting this Registry. Bayer Pharma AG's support was limited to the part of RIETE outside Spain, which accounts for a 22.7% of the total patients included in the RIETE Registry. We also thank the RIETE Registry Coordinating Center, S & H Medical Science Service, for their quality control data, logistic and administrative support.

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    Funding: This Registry was supported with an unrestricted educational grant from Sanofi Spain.

    Conflict of Interest: LB has participated in scientific meetings and advisory boards with Bayer, Leo-Pharma, and Pfizer; all other authors have no conflicts of interest.

    Authorship: IM designed research, performed research, contributed analytical tools, analyzed data, and wrote the paper; JC performed research, and wrote the paper; LB designed research, performed research, contributed analytical tools, analyzed data, and wrote the paper; CF contributed analytical tools, analyzed data, and wrote the paper; JT-S designed research, contributed vital analytical tools, analyzed data; MP analyzed data, and wrote the paper; CPD analyzed data and wrote the paper; SN analyzed data and wrote the paper; EG analyzed data and wrote the paper; MM designed research, performed research, contributed analytical tools, analyzed data, and wrote the paper.

    A full list of RIETE investigators is given in the Appendix.

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