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; Jyh-Pyng Gau; Chun-Yu Liu; Muh-Hwa Yang; Shu-Chiung Chiang; Hui-Chi Hsu; Ying-Chung Hong; Liang-Tsai Hsiao; Jin-Hwang Liu; Tzeon-Jye Chiou; Po-Min Chen; Tzong-Shyuan Lee; Li-Fang Chou; Cheng-Hwai Tzeng; Tzeng-Ji Chen

doi:10.1160/TH12-01-0010

Thrombosis and Haemostasis, Table of Contents

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^*

¹Institutes of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Jyh-Pyng Gau^*

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Chun-Yu Liu

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Muh-Hwa Yang

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Shu-Chiung Chiang

⁵Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan

,

Hui-Chi Hsu

¹Institutes of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Ying-Chung Hong

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Liang-Tsai Hsiao

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Jin-Hwang Liu

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Tzeon-Jye Chiou

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Po-Min Chen

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Tzong-Shyuan Lee

¹Institutes of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

,

Li-Fang Chou

⁷Department of Public Finance, National Chengchi University, Taipei, Taiwan

,

Cheng-Hwai Tzeng

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁴Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

,

Tzeng-Ji Chen

²Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

³Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan

⁶Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

› Author Affiliations

Abstract

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 23^rd Congress of the International Society on Thrombosis and Haemostasis, Kyoto, Japan, 23–28 July 2011.

Keywords

Cancer - epidemiology - scoring system - venous thromboembolism

Full Text

References

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