Concomitant Venous Thromboembolism [VTE] with Cancer and its Effect on Survival in Indian Patients (original) (raw)
Related papers
Risk factors of deep vein thrombosis in cancer patients
Iranian Journal of Blood and Cancer, 2018
Background: Venous thromboembolism (VTE) is a significant complication in cancer patients which was found in 4-20% of the patients. This study was aimed to evaluate risk factors of deep vein thrombosis (DVT) in cancer patients in an oncology center in Indonesia. Methods: This was a retrospective cohort study. Data were obtained from medical records of adult cancer patients with DVT referring to Dharmais National Cancer Center in Indonesia since 2013-2016. Control group were adult cancer patients without DVT. Association of risk factors (sex, age, presence of metastasis, Khorana score, complete blood count and D-dimer level) with DVT were compared and analyzed between DVT patients and control group. Results: A total of 129 cancer patients with DVT at Dharmais Cancer Hospital during year 2013-2016 met the inclusion criteria. Median age of the patients was 56 years old. Multivariate logistic regression analysis was performed to investigate the effect of sex, age, hypertension, diabetes...
Japanese Journal of Clinical Oncology, 2020
Background: The Cancer-VTE Registry evaluates the occurrence and management of venous thromboembolism in Japanese participants with major solid tumors. Using Registry data, we evaluated the frequency of concurrent venous thromboembolism in cancer patients prior to treatment initiation by cancer type. Methods: The Cancer-VTE Registry is an ongoing (March 2017-September 2020) prospective cohort study using a nationwide, multicentre clinical registry. Participants aged ≥20 years with colorectal, lung, stomach, pancreatic, breast or gynecologic cancer, confirmed staging, ≥6 months life expectancy post-registration and who had undergone venous thromboembolism screening were managed with routine clinical care. Venous thromboembolism frequency at registration was evaluated. Results: Of 9735 participants, 571 (5.9%) had venous thromboembolism at baseline, including asymptomatic [5.5% (n = 540)] and symptomatic venous thromboembolism [0.3% (n = 31)]. Most participants with venous thromboembolism (n = 506, 5.2%) had deep vein thrombosis only; 65 (0.7%) had pulmonary embolism with/without deep vein thrombosis. The prevalence of distal and proximal deep vein thrombosis was 4.8% (n = 466) and 0.9% (n = 83), respectively. The highest prevalence of venous thromboembolism was for pancreatic cancer (8.5%) and the lowest for breast cancer (2.0%). Venous thromboembolism prevalence increased as cancer stage advanced. Conclusions: Although there was a marked difference in venous thromboembolism by cancer type, the data suggest that cancer stage is an important risk factor for venous thromboembolism. Thus,
Characteristics and Risk Factors of Cancer Associated Venous Thromboembolism
Thrombosis research, 2015
The objective of this study was to examine the differences in commonly associated characteristics and risk factors of venous thromboembolism (VTE) between patients with and without cancer in a VTE population. Uniform data were collected for patients with a diagnosis of VTE obtaining care at CDC funded Thrombosis Network Centers. Patient characteristics and risk factors were compared in VTE patients with and without cancer. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to assess patient characteristics and thrombotic risk factors more frequently identified among VTE patients with cancer compared to those without cancer. Between August 2003 and April 2011, 3,115 adult patients with a diagnosis of VTE including 189 (6.1%) patients with active cancer participated in the multi-site thrombosis registry. VTE patients with cancer had a higher prevalence of PE and DVT in unusual sites compared to those without cance...
The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site
The American Journal of Medicine, 2016
BACKGROUND: We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site. AIM AND METHODS: We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer). RESULTS: As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal, and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95% confidence interval (CI), 3.8-8.1] vs 4.1 [95% CI, 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95% CI, 7.6-13] vs 12 [95% CI, 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95% CI, 4.4-10] vs 13 [95% CI, 9.2-17] events per 100 patient-years), whereas in those with lung cancer, the rate of thromboembolic recurrences was twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years). CONCLUSIONS: Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.
Indian Journal of Hematology and Blood Transfusion, 2015
Venous thromboembolism (VTE) represents one of the most important causes of morbidity and mortality in cancer patients. This investigation was undertaken to investigate the natural history of VTE in the oncology center in a tertiary care hospital. We did a retrospective study on cancer patients who presented to King Abdullah Medical city in Holly capital; a tertiary care hospital; from May 2011 to June 2013. Follow up period was calculated from time of VTE diagnosis till the last clinical visit or till patient death. Among 1,678 cancer patients, 132 (7.87 %) were diagnosed with VTE. The median patient age was 53.5 years, with female to male ratio 1.3/1. Thirty one patients (23.5 %) were diagnosed with VTE and cancer simultaneously, seventy four patients (56.1 %) were on chemotherapy and twenty eight patients (21.2 %) were on best supportive care.VTE were symptomatic in 110 patients (83.3 %) and asymptomatic in 22 patients (16.7 %). Lower limbs were the commonest site (42.4 %) with the highest incidence in patients with advanced stages (93 %). Forty nine (37 %) patients were receiving LMWH as prophylaxis. Median survival in months for patients with VTE prophylaxis versus without prophylactic, and asymptomatic versus symptomatic were (12.6 vs 6.3; p 0.12 and 9.8 vs 12.4; p 0.885, respectively). There is underutilization of thromboprophylaxis in our region, which needs more effort to reduce VTE burden. Also we need large prospective studies to clarify the impact of VTE symptoms and presentation on patient's survival.
Epidemiology, risk and outcomes of venous thromboembolism in cancer
Hämostaseologie, 2012
Cancer is associated with a fourfold increased risk of venous thromboembolism (VTE). The risk of VTE varies according to the type of malignancy (i. e. pancreatic cancer, brain cancer, lymphoma) and its disease stage and individual factors (i. e. sex, race, age, previous VTE history, immobilization, obesity). Preventing cancer-associated VTE is important because it represents a significant cause of morbidity and mortality. In order to identify cancer patient at particularly high risk, who need thromboprophylaxis, risk prediction models have become available and are under validation. These models include clinical risk factors, but also begin to incorporate biological markers. The major American and European scientific societies have issued their recommendations to guide the management of VTE in patients with cancer. In this review the principal aspects of epidemiology, risk factors and outcome of cancer-associated VTE are summarized.
Venous thromboembolism in cancer patients
Thrombosis Research, 2012
of the haemostatic system (defined as persistent elevation of fibrinopeptide A and prothrombin fragment 1+2 levels), total mortality was significantly higher in participants with persistent activation (17.1/1000 person-years) than in patients without activation (9.7/1000 person-years; p=0.015). This difference was attributed to an increased incidence of death from cancers (11.3/1000 vs. 5.1/1000 person-years). The majority of patients with cancer has increased levels of procoagualnt factors V, VIII, IX, and XI, as well as increased levels of markers of coagulation activation (e.g., thrombinantithrombin, prothrombin fragment 1+2, fibrinopeptide and D-dimer (2). In addition, patients with some disseminated malignancies seem to have a deficient activity of von Willebrand's factor-cleaving protease (ADAMTS-13), resulting in unusually large von Willebrand factor multimers leading to platelet thrombosis (3). www.intechopen.com Venous Thromboembolism in Cancer Patients 75 and provide a degree of protection to the cancer cells from the immune system. Fibrin has also been shown to increase expression of TF and induce expression of IL-8 and vascular endothelium growth factor (VEGF) and thereby, enhancing angiogenesis (9-10). The TF-factor VIIa complex can signal through cleavage of protease-activated receptors, which, in turn, induce the mitogen-activated protein kinase (MAPK) signal transduction cascade (11). The MAPK pathway is involved in the induction of genes involved in angiogenesis, migration, and proliferation. In addition, phosphorylation of the cytoplasmic tail of the TF receptor has also been shown to indirectly activate transcription of VEGF, downregulate thrombospondin (an antiangiogenic protein), and induce cell migration. Expression of TF by malignant cells also seems to support metastatic process and is dependent on the formation of the TF-factor VIIa complex (11). 2.2 The incidence of venous thromboembolism in cancer patients The first description of deep vein thrombosis (DVT) in patients with cancer was made by Bouillard in 1823(12) although this was popularly first credited to Armand Troussean, the French Physician, in 1865 (13-14). Since that time, hundreds of studies have provided solid data on the clinical association between VTE and cancer, and delineated the elevated risk for VTE particularly during the first few months following the diagnosis of cancer and in the presence of distant metastasis (15-18). The incidence of DVT or PE in patients with cancer varies widely because of the heterogeneity of the patients' population and the difficulty of conducting large epidemiological studies. Based on a prospective medical database in the United States, the annual incidence of a first episode of DVT or PE in the general population is 0.1% (15), while the estimated annual incidence of VTE in the cancer population is 0.5%. (19-21) The prevalence of cancer-associated thrombosis may be underestimated by more than 10-fold as autopsy studies in cancer patients have demonstrated even higher rates of VTE (17-22). In a large population-based epidemiological study, approximately 20% of all new cases of VTE are associated with underlying cancer, whereas 26% of incident cases had idiopathic VTE (15). The risk of VTE associated with different malignancies has more recently been quantified in NHL (23), colonic cancer (24) ovarian (25) lung (26) and breast cancer (27). It was generally thought that solid tumors, such as pancreatic, ovarian and brain cancer carry a much higher risk for VTE than haematological malignancies. However, recent studies suggest that the incidence of VTE in patients with haematological malignancies may be similar to that observed in patients with solid tumors (28). In a population based case-control study of patients with a first episode of VTE, Blom et al found that the odds ratio of developing VTE among patients with haematological malignancies was approximately 26 compared to the general population (18). Similar results were also reported by other authors (29-31). Prospective studies has shown that VTE have inflicted a higher risk of several adverse complications on patients with cancer including recurrent VTE, bleeding complications while on anticoagulant treatment, increase in both short-term and long-term mortality (32-33) and increased mortality during first 3 month of therapy. The risk of VTE is markedly different for cancer patients throughout the course of the disease and this variable incidence of VTE comorbidity in cancer patients can be attributed to a combination risk factors related to the patient, the cancer itself and treatment (34). www.intechopen.com Pathophysiology and Clinical Aspects of Venous Thromboembolism in Neonates, Renal Disease and Cancer Patients 76 2.3 Patient-related factors and risk of VTE a. Age: Older age has been shown to be associated with VTE in hospitalized cancer patients, but not in ambulatory patients (35-37). The rate of VTE in patients older than 60 years of age undergoing surgery for various solid tumors was significantly higher than that in younger patients by multivariate analysis (OR 2.6) (36-38). b. Gender: Among cancer patients, most studies have identified male gender as a significant predictor of VTE. (19-20) However, A recent pooled retrospective study of VTE rates in a large cohort of hospitalized cancer patients reported a higher rate in females (OR 1.1, p < 0.0001) (39) c. Race: In the general population, the incidence of VTE varies by race. In the USA, it is highest among blacks and lowest among Asian-Pacific Islanders (40). d. Previous thrombotic episode: Cancer patients with a past history of VTE have a 6-7 fold increased risk of developing VTE compared to those with no history of VTE (38). e. Obesity has been confirmed to be an important risk factor in cancer-associated thrombosis. Body mass index ≥35 kg/m 2 was identified as one of five variables in a risk prediction model proposed by Khorana et al with an OR of 2.1 (38) f. Chronic co-morbid Medical Conditions: The presence of chronic medical co-morbid conditions such as chronic renal disease, chronic liver disease, hypertension and chronic heart failure has a marked effect on the incidence of cancer-associated thrombosis and survival. The presence of three or more chronic medical conditions was the strongest risk factor for development of VTE among the patients with gliomas and ovarian cancer, and was the second strongest risk factor among patients with breast or colon cancer (39-40).
Survival after cancer-related venous thrombosis: the Scandinavian Thrombosis and Cancer Study
Blood Advances
Patients with cancer have an increased risk of developing venous thromboembolism (VTE), and this combination is reported to result in poorer survival compared with cancer alone. This study aimed to investigate the impact of VTE on the survival of patients with cancer in a general population. The Scandinavian Thrombosis and Cancer (STAC) cohort, a population-based cohort including 144 952 participants without previous VTE or cancer, was used. During follow-up, cancer and VTE incidences were registered. “Cancer-related VTE” was defined as VTE diagnosed in patients with overt or occult cancer. The survival of participants without cancer and/or VTE (“disease-free”) was compared with the survival of participants with cancer and cancer-related VTE. Cox regression models with cancer and VTE as time-varying exposures were performed to calculate hazard ratios for death. Subanalyses were performed across cancer types and stages and VTE type (deep vein thrombosis or pulmonary embolism). During...
Venous thrombosis in the patient with cancer
Southern African Journal of Gynaecological Oncology, 2012
The relationship between cancer and thrombosis has been known for many years. Thrombotic risk is increased in the patient with cancer, and the diagnosis of venous thromboembolism at the time that a malignancy presents influences patient outcome. Risk evaluation, prophylaxis and treatment of venous thromboembolism are practical issues that face doctors who are dealing with these patients.
TH Open
The risk of venous thromboembolism (VTE) in patients who survive the first years after a cancer diagnosis after the acute effects of disease and treatment in comparison to a similar background population has been sparsely investigated. The aim of the study was to investigate if incidence rates (IRs) of VTE differed in patients who were alive at least 2 years after a cancer diagnosis without VTE compared with cancer-free references in a population-based cohort study. The study entry was 2 years after a first cancer diagnosis. For each cancer-exposed subject, five reference subjects were identified within the cohort. The IRs were calculated as number of VTEs per 1,000 person years (×10−3 p-y) in total and in distinct cancer types and corresponding reference subjects. Incidence rate ratios (IRRs) were calculated by Poisson's regression. During a mean follow-up of 5.3 years, 110 VTEs occurred among the 7,288 cancer-exposed subjects and 321 VTEs occurred among the 36,297 identified r...