Incidence of and Risk Factors for Venous Thrombosis in Hospitalized Patients with Hematologic Malignancies: A Single-center, Prospective Cohort Study

Overview

Journal North Clin Istanb

Publisher Kare Publishing

Specialty General Medicine

Date 2024 Aug 21

PMID 39165714

Authors

Nevin Alayvaz Aslan

Ozde Elver

Cansu Korkmaz

Hande Senol

Alperen Halil Hayla

Nil Guler

Affiliations

Soon will be listed here.

Abstract

Objective: Incidence of venous thromboembolism (VTE) is higher than the expected in patients with hematologic malignancies and duration of hospitalization period increases the risk of thrombosis. The objective of this study was to investigate the incidence of and risk factors for venous thrombosis in hospitalized patients with hematologic malignancies.

Methods: We designed a prospective cohort study and enrolled patients with hematologic malignancies, who had been hospitalized between 2020 and 2021. Thromboprophylaxis was given to all patients, other than those under a high risk of hemorrhage.

Results: 94 patients were enrolled. The incidence of superficial vein thrombosis was 11.7% and the incidence of deep vein thrombosis (including pulmonary embolism and catheter thrombosis) was 7.4%. Patients, who developed thrombosis, had statistically significantly longer hospital stays (21 vs. 11.5 days, p=0.023) and a higher number of hospitalizations (1 vs. 3, p=0.015) compared to those, who did not develop thrombosis. Patients, who had 3 or more risk factors for thrombosis, were found to be under the highest risk. (p=0.017, OR=4.32; 95% CI: 1.3-14.35). Furthermore, patients with recurrent hospitalizations (p=0.024, OR=1.49; 95% CI: 1.05-2.11) and higher fibrinogen levels (p=0.028, OR=1; 95% CI: 1-1.006) were under an increased risk of thrombosis.

Conclusion: Venous thrombosis is frequently seen in hospitalized patients with hematologic malignancies. A universally accepted risk scoring system is required for detection of patients, under a high risk for thrombosis.

References

Gade I, Braekkan S, Naess I, Hansen J, Rosendaal F, Cannegieter S . Epidemiology of venous thromboembolism in hematological cancers: The Scandinavian Thrombosis and Cancer (STAC) cohort. Thromb Res. 2017; 158:157-160. DOI: 10.1016/j.thromres.2017.09.002. View

Khorana A, Francis C, Culakova E, Kuderer N, Lyman G . Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer. 2007; 110(10):2339-46. DOI: 10.1002/cncr.23062. View

Rupa-Matysek J, Gil L, Kazmierczak M, Baranska M, Komarnicki M . Prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies: validation of the Khorana Risk Score. Med Oncol. 2017; 35(1):5. PMC: 5717131. DOI: 10.1007/s12032-017-1065-4. View

Santi R, Ceccarelli M, Bernocco E, Monagheddu C, Evangelista A, Valeri F . Khorana score and histotype predicts incidence of early venous thromboembolism in non-Hodgkin lymphomas. A pooled-data analysis of 12 clinical trials of Fondazione Italiana Linfomi (FIL). Thromb Haemost. 2017; . DOI: 10.1160/TH16-11-0895. View

Adelborg K, Corraini P, Darvalics B, Frederiksen H, Ording A, Horvath-Puho E . Risk of thromboembolic and bleeding outcomes following hematological cancers: A Danish population-based cohort study. J Thromb Haemost. 2019; 17(8):1305-1318. DOI: 10.1111/jth.14475. View

Sanfilippo K . Venous thromboembolism and risk stratification in hematological malignancies. Thromb Res. 2022; 213 Suppl 1:S16-S21. DOI: 10.1016/j.thromres.2022.01.008. View

Kristinsson S, Fears T, Gridley G, Turesson I, Mellqvist U, Bjorkholm M . Deep vein thrombosis after monoclonal gammopathy of undetermined significance and multiple myeloma. Blood. 2008; 112(9):3582-6. PMC: 2572787. DOI: 10.1182/blood-2008-04-151076. View

Gonzalez-Porras J, Mateo J, Gonzalez-Calle V, Marco P, Garcia-Gutierrez V, Reverter J . Prevention of venous thromboembolism in hematologic neoplasms: an expert consensus from SEHH-SETH. Clin Transl Oncol. 2021; 24(5):770-783. DOI: 10.1007/s12094-021-02735-1. View

Kekre N, Connors J . Venous thromboembolism incidence in hematologic malignancies. Blood Rev. 2018; 33:24-32. DOI: 10.1016/j.blre.2018.06.002. View

10.

Khorana A, Kuderer N, Culakova E, Lyman G, Francis C . Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008; 111(10):4902-7. PMC: 2384124. DOI: 10.1182/blood-2007-10-116327. View

11.

Ashrani A, Gullerud R, Petterson T, Marks R, Bailey K, Heit J . Risk factors for incident venous thromboembolism in active cancer patients: A population based case-control study. Thromb Res. 2016; 139:29-37. PMC: 4769375. DOI: 10.1016/j.thromres.2016.01.002. View

12.

Neeman E, Liu V, Mishra P, Thai K, Xu J, Clancy H . Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients. JAMA Netw Open. 2022; 5(11):e2240373. PMC: 9679881. DOI: 10.1001/jamanetworkopen.2022.40373. View

13.

Sanfilippo K, Wang T, Gage B, Luo S, Riedell P, Carson K . Incidence of venous thromboembolism in patients with non-Hodgkin lymphoma. Thromb Res. 2016; 143:86-90. PMC: 4920731. DOI: 10.1016/j.thromres.2016.05.008. View

14.

Lyman G, Carrier M, Ay C, Di Nisio M, Hicks L, Khorana A . American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021; 5(4):927-974. PMC: 7903232. DOI: 10.1182/bloodadvances.2020003442. View

15.

Carrier M, Abou-Nassar K, Mallick R, Tagalakis V, Shivakumar S, Schattner A . Apixaban to Prevent Venous Thromboembolism in Patients with Cancer. N Engl J Med. 2018; 380(8):711-719. DOI: 10.1056/NEJMoa1814468. View

16.

Khorana A, Soff G, Kakkar A, Vadhan-Raj S, Riess H, Wun T . Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients with Cancer. N Engl J Med. 2019; 380(8):720-728. DOI: 10.1056/NEJMoa1814630. View

17.

Mulder F, Horvath-Puho E, van Es N, van Laarhoven H, Pedersen L, Moik F . Venous thromboembolism in cancer patients: a population-based cohort study. Blood. 2020; 137(14):1959-1969. DOI: 10.1182/blood.2020007338. View

18.

Mirza A, Yun S, Al Ali N, Shin H, ONeil J, Elharake M . Validation of the Khorana score in acute myeloid leukemia patients: a single-institution experience. Thromb J. 2019; 17:13. PMC: 6604148. DOI: 10.1186/s12959-019-0202-z. View

19.

Park L, Woo S, Kim S, Jeon H, Ko Y, Kim S . Incidence, risk factors and clinical features of venous thromboembolism in newly diagnosed lymphoma patients: results from a prospective cohort study with Asian population. Thromb Res. 2012; 130(3):e6-12. DOI: 10.1016/j.thromres.2012.03.019. View

20.

Horowitz N, Brenner B . Thrombosis in hematological malignancies: mechanisms and implications. Thromb Res. 2020; 191 Suppl 1:S58-S62. DOI: 10.1016/S0049-3848(20)30398-4. View