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Thromb Haemost 2019; 119(03): 490-495
DOI: 10.1055/s-0039-1677745
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Incidence of Cancer after a Second Unprovoked Venous Thromboembolic Event

Shéhérazade Rézig
1   EA 3878 (GETBO), Brest University Hospital, Brest University, Brest, France
,
Raphael Le Mao
1   EA 3878 (GETBO), Brest University Hospital, Brest University, Brest, France
2   Department of Chest Diseases and Internal Medicine, Hôpital de la Cavale Blanche, Brest Cedex, France
,
Francis Couturaud
1   EA 3878 (GETBO), Brest University Hospital, Brest University, Brest, France
2   Department of Chest Diseases and Internal Medicine, Hôpital de la Cavale Blanche, Brest Cedex, France
3   CIC INSERM 1412, Hôpital de la Cavale Blanche, Brest Cedex, France
,
Karine Lacut
1   EA 3878 (GETBO), Brest University Hospital, Brest University, Brest, France
2   Department of Chest Diseases and Internal Medicine, Hôpital de la Cavale Blanche, Brest Cedex, France
,
Aurélien Delluc
1   EA 3878 (GETBO), Brest University Hospital, Brest University, Brest, France
4   Division of Hematology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
› Author Affiliations Funding The study was supported by grants from INSERM (Contrat de Recherche Stratégique 2001, CRES No. 4CR05G), from Région Bretagne (Programme 1044–04013235 no. 1440) and Programme Hospitalier de Recherche Clinique 2000. The Centre Hospitalier Régional et Universitaire de Brest promoted the study. The funders of this study had no role in the design or conduct of the study; in the collection, analysis or interpretation of the data; or in the preparation, review or approval of the manuscript.
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Publication History

20 July 2018

09 December 2018

Publication Date:
27 January 2019 (online)

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Abstract

Patients with two unprovoked venous thromboembolism (VTE) events could be at high risk for cancer diagnosis and may therefore benefit from extended cancer screening strategies. However, accurate data on the incidence of cancer in this population is lacking. In a prospective cohort study, we followed-up with all patients who experienced two unprovoked symptomatic VTE events that occurred in less than 2 years apart. We estimated the 1-year incidence rate of cancer following the second unprovoked VTE event using the Kaplan–Meier method. Potential predictors for cancer diagnosis were assessed using a Cox proportional hazard regression model. Between May 2000 and December 2013, we included 197 patients with two episodes of symptomatic unprovoked VTE that occurred in less than 2 years apart. Their mean age was 66.2 ± 16.3 years, and 122 (51.8%) were male. Seventeen patients were diagnosed with cancer during the year following the second episode of unprovoked VTE, corresponding to a cumulative incidence rate of 9.19% (95% confidence interval [CI]: 5.81–14.37). The 1-year cumulative incidence rate of cancer was 35.88% (95% CI: 19.75–59.25) in patients with VTE recurrence on anticoagulation, 5.51% (95% CI: 2.9–10.32) among patients with a second episode of unprovoked VTE occurring after stopping anticoagulation and 1.15% (95% CI: 0.16–7.88) when time elapsed between the first and recurrent VTE was > 1 year. Our study suggests that the incidence of cancer in patients with a second episode of unprovoked VTE that occurs off anticoagulation, or > 1 year after the first event, is similar to that of patients with a first unprovoked VTE event.

Keywords

unprovoked venous thromboembolism - occult cancer - symptomatic VTE events
 

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