Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

David Spirk; Tim Sebastian; Stefano Barco; Martin Banyai; Jürg H. Beer; Lucia Mazzolai; Thomas Baldi; Drahomir Aujesky; Daniel Hayoz; Rolf P. Engelberger; Thomas Kaeslin; Wolfgang Korte; Robert Escher; Marc Husmann; Marc Blondon; Nils Kucher

doi:10.1055/s-0040-1720977

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2021; 121(05): 641-649
DOI: 10.1055/s-0040-1720977

Stroke, Systemic or Venous Thromboembolism

Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

David Spirk

¹Institute of Pharmacology, University of Bern, Bern, Switzerland

,

Tim Sebastian

²Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland

,

Stefano Barco

²Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland

³Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany

,

Martin Banyai

²Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland

,

Jürg H. Beer

⁴Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland

,

Lucia Mazzolai

⁵Clinic of Angiology, Lausanne University Hospital, Lausanne, Switzerland

,

Thomas Baldi

⁶Department of Internal Medicine, University Hospital Basel, Basel, Switzerland

⁷Department of Internal Medicine, Limmattal Hospital, Schlieren, Switzerland

,

Drahomir Aujesky

⁸Division of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland

,

Daniel Hayoz

⁹Division of Angiology, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland

,

Rolf P. Engelberger

⁹Division of Angiology, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland

,

Thomas Kaeslin

¹⁰Department of Internal Medicine, Cantonal Hospital Obwalden, Sarnen, Switzerland

,

Wolfgang Korte

¹¹Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

,

Robert Escher

¹²Department of Internal Medicine, Regional Hospital Burgdorf, Burgdorf, Switzerland

,

Marc Husmann

²Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland

,

Marc Blondon

¹³Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland

,

Nils Kucher

²Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland

› Institutsangaben

Abstract

Objective In patients with cancer-associated venous thromboembolism (VTE), the risk of recurrence is similar after incidental and symptomatic events. It is unknown whether the same applies to incidental VTE not associated with cancer.

Methods and Results We compared baseline characteristics, anticoagulation therapy, all-cause mortality, and VTE recurrence rates at 90 days between patients with incidental (n = 131; 52% without cancer) and symptomatic (n = 1,931) VTE included in the SWIss Venous ThromboEmbolism Registry (SWIVTER). After incidental VTE, 114 (87%) patients received anticoagulation therapy for at least 3 months. The mortality rate was 9.2% after incidental and 8.4% after symptomatic VTE for hazard ratio (HR) 1.10 (95% confidence interval [CI] 0.49–2.50). After adjustment for competing risk of death, recurrence rate was 3.1 versus 2.8%, respectively, for sub-HR 1.07 (95% CI 0.39–2.93). These results were consistent among cancer (mortality: 15.9% vs. 12.6%; HR 1.32, 95% CI 0.67–2.59; recurrence: 4.8% vs. 4.7%; HR 1.02, 95% CI 0.30–3.42) and noncancer patients (mortality: 2.9% vs. 2.1%; HR 1.37, 95% CI 0.33–5.73; recurrence: 1.5% vs. 2.3%; HR 0.63, 95% CI 0.09–4.58). Patients with incidental VTE who received anticoagulation therapy for at least 3 months had lower mortality (4% vs. 41%) and recurrence rate (1% vs. 18%) compared with those who did not.

Conclusion In SWIVTER, more than half of incidental VTE events occurred in noncancer patients who often received anticoagulation therapy. Among noncancer patients, early mortality and recurrence rates were similar after incidental versus symptomatic VTE. Our findings suggest that anticoagulation therapy for incidental VTE may be beneficial regardless of the presence of cancer.

Keywords

anticoagulation - incidental diagnosis - mortality - venous thromboembolism

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Referenzen

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