Clinical research studyThe Clinical Course of Venous Thromboembolism May Differ According to Cancer Site
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.
References (27)
- et al.
Incidence of venous thromboembolism in patients with cancer - a cohort study using linked United Kingdom databases
Eur J Cancer
(2013) - et al.
Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report
Chest
(2016) - et al.
International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer
Lancet Oncol
(2016) - et al.
Epidemiology of cancer-associated venous thrombosis
Blood
(2013) - et al.
40-year trends in an index of survival for all cancers combined and survival adjusted for age and sex for each cancer in England and Wales, 1971-2011: a population-based study
Lancet
(2015) - et al.
The outcome after treatment of venous thromboembolism is different in surgical and acutely ill medical patients: findings from the RIETE registry
J Thromb Haemost
(2004) - et al.
Treatment of venous thromboembolism in cancer patients with dalteparin for up to 12 months: the DALTECAN Study
J Thromb Haemost
(2015) - et al.
Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer
Am J Med
(2006) - et al.
Factors influencing adherence to clinical guidelines in the management of cancer-associated thrombosis
J Thromb Haemost
(2016) - et al.
Cancer statistics, 2014
CA Cancer J Clin
(2014)
Bending the cost curve in cancer care
N Engl J Med
Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update
J Clin Oncol
Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis
PLoS One
Cited by (73)
Cancer-associated thrombosis: How many patients seen in clinical practice would be eligible for a direct oral anticoagulant randomized controlled trial?
2024, Respiratory Medicine and ResearchAnticoagulant treatment of cancer-associated thromboembolism
2024, Archives of Cardiovascular DiseasesFrench guidelines for the treatment of cancer-associated venous thromboembolism - 2023 update
2023, Respiratory Medicine and ResearchTraitement de la maladie veineuse thromboembolique au cours du cancer Mise à jour Avril 2023
2023, Revue des Maladies Respiratoires Actualites
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.