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Thromb Haemost 2007; 98(03): 656-661
DOI: 10.1160/TH07-04-0242
Cellular Proteolysis and Oncology
Schattauer GmbH

Venous thromboembolism in patients with active cancer

Ali Seddighzadeh
1   Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA
,
Ranjith Shetty
1   Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA
,
Samuel Z. Goldhaber
1   Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussetts, USA
› InstitutsangabenFinancial support:This study was funded, in part, by a research grant from Sanofi Aventis.
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Publikationsverlauf

Received 02. April 2007

Accepted after resubmission 04. Juni 2007

Publikationsdatum:
28. November 2017 (online)

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Summary

Patients with cancer have an increased risk of venous thromboembolism (VTE).To further define the demographics, comorbidities, and risk factors of VTE in these patients, we analyzed a prospective registry of 5,451 patients with ultrasound confirmed deep vein thrombosis (DVT) from 183 hospitals in the United States. Cancer was reported in 1,768 (39%), of whom 1,096 (62.0%) had active cancer. Of these, 599 (54.7%) were receiving chemotherapy, and 226 (20.6%) had metastases. Lung (18.5%), colorectal (11.8%), and breast cancer (9.0%) were among the most common cancer types. Cancer patients were younger (median age 66 years vs. 70 years; p<0.0001), were more likely to be male (50.4% vs. 44.5%; p=0.0005), and had a lower average body mass index (26.6 kg/m2 vs. 28.9 kg/m2; p<0.0001). Cancer patients less often received VTE prophylaxis prior to development of DVT compared to those with no cancer (308 of 1,096, 28.2% vs. 1,196 of 3,444, 34.6%; p<0.0001). For DVT therapy, low-molecular-weight heparin (LMWH) as monotherapy without warfarin (142 of 1,086, 13.1% vs. 300 of 3,429, 8.7%; p<0.0001) and inferior vena caval filters (234 of 1,086, 21.5% vs. 473 of 3,429, 13.8%; p<0.0001) were utilized more often in cancer patients than in DVT patients without cancer. Cancer patients with DVT and neurological disease were twice as likely to receive inferior vena caval filters than those with no cancer (odds ratio 2.17, p=0.005). In conclusion, cancer patients who develop DVT receive prophylaxis less often and more often receive filters than patients with no cancer who develop DVT. Future studies should focus on ways to improve implementation of prophylaxis in cancer patients and to further define the indications, efficacy, and safety of inferior vena caval filters in this population.

Keywords

Venous thrombosis - cancer - prophylaxis - low-molecular-weight heparin - inferior vena caval filter
 

  • References

  • 1 Prandoni P, Falanga A, Piccioli A. Cancer and venous thromboembolism. Lancet Oncol 2005; 6: 401-410.
    CrossrefPubMedSuche in Google Scholar
  • 2 Lee AY, Levine MN. Venous thromboembolism and cancer: risks and outcomes. Circulation 2003; 107 (Suppl. 01) I17-21.
    PubMedSuche in Google Scholar
  • 3 Silverstein MD, Heit JA, Mohr DN. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158: 585-593.
    CrossrefPubMedSuche in Google Scholar
  • 4 Lee AY. Epidemiology and management of venous thromboembolism in patients with cancer. Thromb Res 2003; 110: 167-172.
    CrossrefPubMedSuche in Google Scholar
  • 5 Prandoni P, Lensing AW, Cogo A. et al. The longterm clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125: 1-7.
    CrossrefPubMedSuche in Google Scholar
  • 6 Sorensen HT, Mellemkjaer L, Olsen JH. et al. Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000; 343: 1846-1850.
    CrossrefPubMedSuche in Google Scholar
  • 7 Levitan N, Dowlati A, Remick SC. et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine (Baltimore) 1999; 78: 285-291.
    CrossrefPubMedSuche in Google Scholar
  • 8 Hutten BA, Prins MH, Gent M. et al. Incidence of recurrent thromboembolic and bleeding complications among patients with venous thromboembolism in relation to both malignancy and achieved international normalized ratio: a retrospective analysis. J Clin Oncol 2000; 18: 3078-3083.
    CrossrefPubMedSuche in Google Scholar
  • 9 Prandoni P, Lensing AW, Piccioli A. et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100: 3484-3488.
    CrossrefPubMedSuche in Google Scholar
  • 10 Goldhaber SZ, Tapson VF. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 2004; 93: 259-262.
    CrossrefPubMedSuche in Google Scholar
  • 11 Gocke J. Lower extremity venous ultrasonography. In: Essentials of vascular laboratory diagnosis. Blackwell Publishing; 2005: 184-206.
    CrossrefSuche in Google Scholar
  • 12 Haddad TC, Greeno EW. Chemotherapy-induced thrombosis. Thromb Res 2006; 118: 555-568.
    CrossrefPubMedSuche in Google Scholar
  • 13 Winter PC. The pathogenesis of venous thromboembolism in cancer: emerging links with tumour biology. Hematol Oncol 2006; 24: 126-133.
    CrossrefPubMedSuche in Google Scholar
  • 14 Rickles FR, Falanga A. Molecular basis for the relationship between thrombosis and cancer. Thromb Res 2001; 102: V215-224.
    CrossrefPubMedSuche in Google Scholar
  • 15 Bick RL. Cancer-associated thrombosis. N Engl J Med 2003; 349: 109-111.
    CrossrefPubMedSuche in Google Scholar
  • 16 Heit JA, Silverstein MD, Mohr DN. et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160: 809-815.
    CrossrefPubMedSuche in Google Scholar
  • 17 Bergqvist D, Agnelli G, Cohen AT. et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002; 346: 975-980.
    CrossrefPubMedSuche in Google Scholar
  • 18 Flordal PA, Berggvist D, Burmark US. et al. Risk factors for major thromboembolism and bleeding tendency after elective general surgical operations. The Fragmin Multicentre Study Group. Eur J Surg 1996; 162: 783-789.
    PubMedSuche in Google Scholar
  • 19 Geerts WH, Heit JA, Clagett GP. et al. Prevention of venous thromboembolism. Chest 2001; 119 Suppl 132S-175S.
    CrossrefPubMedSuche in Google Scholar
  • 20 Levine M, Hirsh J, Gent M. et al. Double-blind randomised trial of a very-low-dose warfarin for prevention of thromboembolism in stage IV breast cancer. Lancet 1994; 343: 886-889.
    CrossrefPubMedSuche in Google Scholar
  • 21 Kucher N, Koo S, Quiroz R. et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005; 352: 969-977.
    CrossrefPubMedSuche in Google Scholar
  • 22 Meyer G, Marjanovic Z, Valcke J. et al. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 2002; 162: 1729-1735.
    CrossrefPubMedSuche in Google Scholar
  • 23 Iorio A, Guercini F, Pini M. Low-molecular-weight heparin for the long-term treatment of symptomatic venous thromboembolism: meta-analysis of the randomized comparisons with oral anticoagulants. J Thromb Haemost 2003; 1: 1906-1913.
    CrossrefPubMedSuche in Google Scholar
  • 24 Kucher N, Quiroz R, McKean S. et al. Extended enoxaparin monotherapy for acute symptomatic pulmonary embolism. Vasc Med 2005; 10: 251-256.
    CrossrefPubMedSuche in Google Scholar
  • 25 Beckman JA, Dunn K, Sasahara AA. et al. Enoxaparin monotherapy without oral anticoagulation to treat acute symptomatic pulmonary embolism. Thromb Haemost 2003; 89: 953-958.
    Thieme ConnectPubMedSuche in Google Scholar
  • 26 Lee AY, Levine MN, Baker RI. et al. Low-molecular- weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349: 146-153.
    CrossrefPubMedSuche in Google Scholar
  • 27 Hann CL, Streiff MB. The role of vena caval filters in the management of venous thromboembolism. Blood Rev 2005; 19: 179-202.
    CrossrefPubMedSuche in Google Scholar
  • 28 Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 2005; 112: 416-422.
    PubMedSuche in Google Scholar
  • 29 Alpert JS. Are data from clinical registries of any value?. Eur Heart J 2000; 21: 1399-1401.
    CrossrefPubMedSuche in Google Scholar