Comparison of Long-term Complications in Cancer Patients with Incidental and Acute Symptomatic Venous Thromboembolism

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Jun 5

PMID 37273873

Authors

Maria Barca-Hernando

Sergio Lopez-Ruz

Samira Marin-Romero

Teresa Elias-Hernandez

Remedios Otero-Candelera

Luis Jara-Palomares

Affiliations

Soon will be listed here.

Abstract

Background: Clinical practice guidelines recommend that patients with incidental venous thromboembolism (VTE) receive the same anticoagulant therapy as those with symptomatic VTE. We aimed to compare the rate of complications between cancer patients with incidental and symptomatic VTE through a long-term follow-up cohort.

Methods: We performed a analysis of prospective studies of cancer patients with VTE between 2008 and 2019, with the primary outcome of rates of recurrent VTE and clinically relevant bleeding (CRB) in incidental and symptomatic VTE groups.

Results: In total, 796 patients were included, of which 42.8% had incidental VTE. No significant differences were noted in the rate of recurrent VTE (0.4 per 100 patients/month vs. 0.5 per 100 patients/month; = 0.313) and in the rate of CRB (0.6 per 100 patients/month vs. 0.5 per 100 patients/month; = 0.128) between patients with incidental VTE and symptomatic VTE, respectively. At six-month follow-ups, the cumulative incidence of CRB was significantly higher in patients with incidental VTE than that in those with symptomatic VTE (7.9% vs. 4.4%, respectively; OR: 1.8; 95% CI: 1.01-3.2).

Conclusion: Cancer patients with incidental VTE had similar rates of CRB and VTE recurrence in long-term follow-up compared with patients with symptomatic VTE. At six-month follow-ups, patients with incidental VTE had a higher cumulative incidence of CRB than those with symptomatic VTE.

Citing Articles

SEOM clinical guidelines on venous thromboembolism (VTE) and cancer (2023).

Ortega Moran L, Mateo F, Balanya R, Rogado Revuelta J, Martinez S, Fombella J Clin Transl Oncol. 2024; 26(11):2877-2901.

PMID: 39110395 PMC: 11467034. DOI: 10.1007/s12094-024-03605-2.

References

Marshall A, Levine M, Hill C, Hale D, Thirlwall J, Wilkie V . Treatment of cancer-associated venous thromboembolism: 12-month outcomes of the placebo versus rivaroxaban randomization of the SELECT-D Trial (SELECT-D: 12m). J Thromb Haemost. 2020; 18(4):905-915. DOI: 10.1111/jth.14752. View

Young A, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C . Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT-D). J Clin Oncol. 2018; 36(20):2017-2023. DOI: 10.1200/JCO.2018.78.8034. View

Prandoni P, Falanga A, Piccioli A . Cancer and venous thromboembolism. Lancet Oncol. 2005; 6(6):401-10. DOI: 10.1016/S1470-2045(05)70207-2. View

Konstantinides S, Meyer G, Becattini C, Bueno H, Geersing G, Harjola V . 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2019; 41(4):543-603. DOI: 10.1093/eurheartj/ehz405. View

Francis C, Kessler C, Goldhaber S, Kovacs M, Monreal M, Huisman M . Treatment of venous thromboembolism in cancer patients with dalteparin for up to 12 months: the DALTECAN Study. J Thromb Haemost. 2015; 13(6):1028-35. DOI: 10.1111/jth.12923. View

Dentali F, Ageno W, Becattini C, Galli L, Gianni M, Riva N . Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: a meta-analysis. Thromb Res. 2010; 125(6):518-22. DOI: 10.1016/j.thromres.2010.03.016. View

Lobo J, Alonso S, Arenas J, Domenech P, Escribano P, Fernandez-Capitan C . Multidisciplinary Consensus for the Management of Pulmonary Thromboembolism. Arch Bronconeumol. 2021; 58(3):246-254. DOI: 10.1016/j.arbres.2021.01.031. View

Jara-Palomares L, Solier-Lopez A, Elias-Hernandez T, Asensio-Cruz M, Blasco-Esquivias I, Sanchez-Lopez V . D-dimer and high-sensitivity C-reactive protein levels to predict venous thromboembolism recurrence after discontinuation of anticoagulation for cancer-associated thrombosis. Br J Cancer. 2018; 119(8):915-921. PMC: 6203717. DOI: 10.1038/s41416-018-0269-5. View

Prandoni P, Lensing A, Piccioli A, Bernardi E, Simioni P, Girolami B . Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002; 100(10):3484-8. DOI: 10.1182/blood-2002-01-0108. View

10.

Shinagare A, Okajima Y, Oxnard G, DiPiro P, Johnson B, Hatabu H . Unsuspected pulmonary embolism in lung cancer patients: comparison of clinical characteristics and outcome with suspected pulmonary embolism. Lung Cancer. 2012; 78(2):161-6. PMC: 3605722. DOI: 10.1016/j.lungcan.2012.08.007. View

11.

Canonico M, Santoro C, Avvedimento M, Giugliano G, Mandoli G, Prastaro M . Venous Thromboembolism and Cancer: A Comprehensive Review from Pathophysiology to Novel Treatment. Biomolecules. 2022; 12(2). PMC: 8961522. DOI: 10.3390/biom12020259. View

12.

den Exter P, Hooijer J, Dekkers O, Huisman M . Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: a comparison with symptomatic patients. J Clin Oncol. 2011; 29(17):2405-9. DOI: 10.1200/JCO.2010.34.0984. View

13.

Tritschler T, Sadeghipour P, Bikdeli B . Subgroup analysis in randomized controlled trials: Useful or misleading?. Thromb Res. 2022; 232:160-162. DOI: 10.1016/j.thromres.2022.10.009. View

14.

Peris M, Lopez-Nunez J, Maestre A, Jimenez D, Muriel A, Bikdeli B . Clinical characteristics and 3-month outcomes in cancer patients with incidental clinically suspected and confirmed pulmonary embolism. Eur Respir J. 2020; 58(1). DOI: 10.1183/13993003.02723-2020. View

15.

Moik F, Colling M, Mahe I, Jara-Palomares L, Pabinger I, Ay C . Extended anticoagulation treatment for cancer-associated thrombosis-Rates of recurrence and bleeding beyond 6 months: A systematic review. J Thromb Haemost. 2021; 20(3):619-634. PMC: 9299994. DOI: 10.1111/jth.15599. View

16.

Farge D, Frere C, Connors J, Ay C, Khorana A, Munoz A . 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2019; 20(10):e566-e581. DOI: 10.1016/S1470-2045(19)30336-5. View

17.

Monreal M, Falga C, Valdes M, Suarez C, Gabriel F, Tolosa C . Fatal pulmonary embolism and fatal bleeding in cancer patients with venous thromboembolism: findings from the RIETE registry. J Thromb Haemost. 2006; 4(9):1950-6. DOI: 10.1111/j.1538-7836.2006.02082.x. View

18.

Khorana A, Francis C, Culakova E, Kuderer N, Lyman G . Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007; 5(3):632-4. DOI: 10.1111/j.1538-7836.2007.02374.x. View

19.

Jara-Palomares L, Solier-Lopez A, Elias-Hernandez T, Asensio-Cruz M, Blasco-Esquivias I, Marin-Barrera L . Tinzaparin in cancer associated thrombosis beyond 6months: TiCAT study. Thromb Res. 2017; 157:90-96. DOI: 10.1016/j.thromres.2017.07.004. View

20.

Key N, Khorana A, Kuderer N, Bohlke K, Lee A, Arcelus J . Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2019; 38(5):496-520. DOI: 10.1200/JCO.19.01461. View