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Venous Thromboembolism Recurrence in Patients With Cancer

Deep vein thrombosis.

In patients with cancer who develop venous thromboembolism (VTE), cancer type plays a significant role in the risk of VTE recurrence after anticoagulation.

A condition involving the formation of a blood clot that starts in a vein, VTE can negatively impact the clinical outcomes of patients undergoing cancer treatment. While anticoagulation therapies, including apixaban and rivaroxaban, are mainstays of treatment, patients with cancer experience higher rates of anticoagulation failure and bleeding complications compared with patients without cancer. In the results of a study to be presented at the International Society on Thrombosis and Haemostasis (ISTH) Virtual Congress later this month, a team of researchers found that in patients with VTE and cancer, cancer type has a significant effect on VTE recurrence, mortality, and bleeding rates.

The study included patients who were enrolled in the Mayo Clinic VTE Registry between March 2013 and November 2019. Of the 2,798 patients, all of whom had acute VTE, 1,256 (44.9%) had active cancer. Cancer types were grouped into gastrointestinal, genitourinary and ovarian, pancreatic, hematologic, lung, brain, and other. The highest rate of treatment with direct oral anticoagulants was seen in patients with pancreatic cancer (63%), while patients with hematologic malignancies had the lowest rate (47%). Patient-reported outcomes were obtained in person, by phone, or by mailed questionnaire.

Among the cancer types, patients with pancreatic cancer experienced the highest rate of VTE recurrence, with an incidence rate of 9.70 per 100 person-years, followed by hematologic malignancies (7.24), lung cancer (6.74), other cancer types (5.99), gastrointestinal cancers (5.86), and genitourinary or ovarian cancers (2.02). Patients without cancer had a VTE recurrence rate of 2.95. No events were reported in patients with brain cancer.

Patients with pancreatic cancer also experienced the highest mortality rate (79.64 per 100 person-years), followed by lung cancer (77.48), genitourinary and ovarian cancers (55.91), brain cancer (55.23), gastrointestinal cancers (51.26), other cancer types (41.71), and hematologic malignancies (26.80). Patients without cancer had a mortality rate of 8.44.

The highest rates of major bleeding were seen in patients with lung cancer (11.44), genitourinary or ovarian cancers (11.18), other cancer types (9.06), brain cancer (8.05), gastrointestinal cancers (6.78), pancreatic cancer (3.47), and hematologic malignancies (2.08), compared with 2.62 for patients without cancer. Clinically relevant nonmajor bleeding was highest in patients with lung cancer (13.84), genitourinary/ovarian cancers (10.12), gastrointestinal cancer (7.25), other cancer types (6.40), pancreatic cancer (6.01), brain cancer (5.35) and hematologic malignancies (1.35), compared with 7.08 for patients without cancer.

"Significant differences in clinical outcomes of anticoagulation for VTE exist amongst patients with different cancers," conclude the investigators in their presentation abstract, led by first author Waldemar E. Wysokinski, MD, PhD, Professor in the Department of Cardiovascular Medicine at the Mayo Clinic in Rochester, Minnesota. "Pancreatic cancer is associated with the highest mortality and VTE recurrence, while major bleeding and clinically relevant nonmajor bleeding are not different compared to [patients without cancer]. Lung cancer has the highest rate of major bleeding and clinically relevant nonmajor bleeding, while VTE recurrence is not significantly different."

For More Information

Wysokinski W, Vlazny DT, McBane RD, et al (2020). Clinical outcome of anticoagulation for acute venous thromboembolism associated with different types of cancer. Res Pract Thromb Haemost (International Society on Thrombosis and Haemostasis Congress Abstracts): 4(suppl_1). Abstract PB2102.

Image credit: Patho. Licensed under CC BY-SA 3.0

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