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Thromb Haemost 2012; 108(02): 225-235
DOI: 10.1160/TH12-01-0010
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

A nation-wide analysis of venous thromboembolism in 497,180 cancer patients with the development and validation of a risk-stratification scoring system

Yuan-Bin Yu   *
1   Institutes of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Jyh-Pyng Gau   *
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Chun-Yu Liu
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Muh-Hwa Yang
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Shu-Chiung Chiang
5   Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan
,
Hui-Chi Hsu
1   Institutes of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Ying-Chung Hong
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Liang-Tsai Hsiao
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Jin-Hwang Liu
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Tzeon-Jye Chiou
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Po-Min Chen
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Tzong-Shyuan Lee
1   Institutes of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
,
Li-Fang Chou
7   Department of Public Finance, National Chengchi University, Taipei, Taiwan
,
Cheng-Hwai Tzeng
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
4   Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Tzeng-Ji Chen
2   Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
3   Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
6   Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
› Author Affiliations Financial support: This work was supported by grants from National Science Council Grant No. NSC 98–2410-H-010–003-MY2 & NSC 96–2416-H-004–007-MY2, Taipei Veterans Gener Hospital Grant No. V97A-113 & V98B1–011, and Taiwan Clinical Oncology Research Foundation.
Further Information

Publication History

Received: 10 January 2012

Accepted after major revision: 12 April 2012

Publication Date:
25 November 2017 (online)

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Summary

The Asian population is thought to have a low risk of venous thromboembolism (VTE), but the epidemiology of VTE in cancer patients remains unclear. The National Health Insurance Research Database of Taiwan was used to find hospitalised patients newly-diagnosed with cancer to determine the incidence of VTE in cancer patients and to identify the risk factors for VTE. Between 1997 and 2005, 497,180 cancer patients were identified. During a median follow-up of 21.3 months (range 0–119.9 months), 5,296 patients developed VTE. The estimated incidence was 185 events per 100,000 person-years. Patients with a prior history of VTE and female patients between the ages of 40 and 80 carried high risk of VTE. The rate of VTE was relatively high in patients with myeloma, prostate cancer, lung cancer, gynaecologic cancers, sarcoma, and metastasis of unknown origin. We developed a risk-stratification scoring system to divide the cancer patients into four discrete risk groups (very low risk, low risk, intermediate, and high risk). The incidence of VTE in each group was 0.5%, 0.9%, 1.5%, and 8.7%, respectively (p < 0.001). This scoring system was validated in a separate patient cohort. In conclusion, VTE is a distinct burden for cancer patients in Taiwan. The risk scoring system could prove helpful in decision-making concerning thromboprophylaxis in cancer patients.

Note: The results of this paper were presented as an Asian-Pacific Scholarship Award at the 23rd Congress of the International Society on Thrombosis and Haemostasis, Kyoto, Japan, 23–28 July 2011.

Keywords

Cancer - epidemiology - scoring system - venous thromboembolism

* Y-B. Yu and J-P. Gau contributed equally to this work.


 

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