Venous Thromboembolism in Solid Cancer Patients
Keywords:
Venous thromboembolism, Solid cancerAbstract
Background: Venous thromboembolism (VTE) is a frequent and significant complication of cancer. Many previous studies showed that malignancy was the most common acquired cause of VTE which potential caused many effects on cancer patients themselves, treatments and prognosis.
Objectives: To identify the incidence of VTE, risk factors and review the characteristics, clinical course including VTE treatment of patients with solid cancer who had VTE.
Methods: Non-gynecological solid cancer patients with VTE, treated at Ramathibodi hospital during January 2003 to December 2007, were enrolled in this study. Patient characteristics were obtained from their medical records with emphasis on primary site of cancer, staging, demographics, type of cancer treatment and circumstantial vascular risk factors.
Results: There are 178 cancer patients included in this study. The mean age of the patients is 58.77 years. It is equally by sex. Among the patients, lung, colorectal, hepatocellular carcinoma (HCC), breast cancer and cholangiocarcinoma are the top five most common cancers respectively. Our study shows that cancer patients with VTE tend to have advanced stage, higher recurrence and poorer response to treatment. Adenocarcinomas are the most common type of cancer in our study. Approximately 50% of our patients developed VTE at the same time with cancer diagnosis. The latter had developed this condition for the mean of 13.3 months later from that time. PORT implantation and some primary tumors are related with sites of VTE. Median time from VTE presentation until death is 22.3 months. Female has significantly better prognosis than male patients (p = 0.0123). Breast and colorectal cancers also have the same than others too (p < 0.001). One third of the patients treated with anticoagulant had major bleeding complication and 60% of them occurred within 1 month after warfarin usage.
Conclusion: Cancer patients with VTE have poor prognosis and tend to have more advanced stage and poorer response to therapy. Moreover, they might increase bleeding complication from anticoagulation therapy. However, our populations are too small to determine other risk factors which previously reported. Large number of patient needs to be more study in this condition.
References
Monreal M, Fernandez-Llamazares J, Perandreu J, Urrutia A, Sahuquillo JC, Contel E. Occult cancer in patients with venous thromboembolism: which patients, which cancers. Thromb Haemost. 1997;78(5):1316-1318.
Heit JA, O'Fallon WM, Petterson TM, Lohse CM, Silverstein MD, Mohr DN, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med. 2002;162(11):1245-1248. doi:10.1001/archinte.162.11.1245.
Levitan N, Dowlati A, Remick SC, Tahsildar HI, Sivinski LD, Beyth R, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine (Baltimore). 1999;78(5):285-291. doi:10.1097/00005792-199909000-00001.
Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med. 2000;343(25):1846-1850. doi:10.1056/NEJM200012213432504.
Khorana AA, Francis CW, Culakova E, Fisher RI, Kuderer NM, Lyman GH. Thromboembolism in hospitalized neutropenic cancer patients. J Clin Oncol. 2006;24(3):484-490. doi:10.1200/JCO.2005.03.8877.
Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166(4):458-464. doi:10.1001/archinte.166.4.458.
Blackwell K, Haroon Z, Broadwater G, Berry D, Harris L, Iglehart JD, et al. Plasma D-dimer levels in operable breast cancer patients correlate with clinical stage and axillary lymph node status. J Clin Oncol. 2000;18(3):600-608. doi:10.1200/JCO.2000.18.3.600.
Buccheri G, Ferrigno D, Ginardi C, Zuliani C. Haemostatic abnormalities in lung cancer: prognostic implications. Eur J Cancer. 1997;33(1):50-55. doi:10.1016/s0959-8049(96)00310-3.
Geenen RW, Delaere KP, van Wersch JW. Coagulation and fibrinolysis activation markers in prostatic carcinoma patients. Eur J Clin Chem Clin Biochem. 1997;35(2):69-72. doi:10.1515/cclm.1997.35.2.69.
von Tempelhoff GF, Dietrich M, Niemann F, Schneider D, Hommel G, Heilmann L. Blood coagulation and thrombosis in patients with ovarian malignancy. Thromb Haemost. 1997;77(3):456-461.
Haddad TC, Greeno EW. Chemotherapy-induced thrombosis. Thromb Res. 2006;118(5):555-568. doi:10.1016/j.thromres.2005.10.015.
Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160(6):809-815. doi:10.1001/archinte.160.6.809.
Fisher B, Dignam J, Wolmark N, DeCillis A, Emir B, Wickerham DL, et al. Tamoxifen and chemotherapy for lymph node-negative, estrogen receptor-positive breast cancer. J Natl Cancer Inst. 1997;89(22):1673-1682. doi:10.1093/jnci/89.22.1673.
Decensi A, Maisonneuve P, Rotmensz N, Bettega D, Costa A, Sacchini V, et al. Effect of tamoxifen on venous thromboembolic events in a breast cancer prevention trial. Circulation. 2005;111(5):650-656. doi:10.1161/01.CIR.0000154545.84124.AC.
Büller HR, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GE. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy [published correction appears in Chest. 2005 Jan;127(1):416]. Chest. 2004;126(3 Suppl):401S-428S. doi:10.1378/chest.126.3_suppl.401S.
Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med. 2000;160(22):3415-3420. doi:10.1001/archinte.160.22.3415.
Goldhaber SZ, Tapson VF; DVT FREE Steering Committee. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol. 2004;93(2):259-262. doi:10.1016/j.amjcard.2003.09.057.
Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol. 2003;21(19):3665-3675. doi:10.1200/JCO.2003.08.008.
Baarslag HJ, Koopman MM, Hutten BA, Linthorst Homan MW, Büller HR, Reekers JA, et al. Long-term follow-up of patients with suspected deep vein thrombosis of the upper extremity: survival, risk factors and post-thrombotic syndrome. Eur J Intern Med. 2004;15(8):503-507. doi:10.1016/j.ejim.2004.07.012.
Worasayan D, Angchaisuksiri P. Venous thrombosis in gynecological cancer patients. Chonburi Hospital Journal. 2006;31:129-36.
Sallah S, Wan JY, Nguyen NP. Venous thrombosis in patients with solid tumors: determination of frequency and characteristics. Thromb Haemost. 2002;87(4):575-579.
Ogren M, Bergqvist D, Wåhlander K, Eriksson H, Sternby NH. Trousseau's syndrome - what is the evidence? A population-based autopsy study. Thromb Haemost. 2006;95(3):541-545. doi:10.1160/TH05-10-0694.
Andtbacka RH, Babiera G, Singletary SE, Hunt KK, Meric-Bernstam F, Feig BW, et al. Incidence and prevention of venous thromboembolism in patients undergoing breast cancer surgery and treated according to clinical pathways. Ann Surg. 2006;243(1):96-101. doi:10.1097/01.sla.0000193832.40178.0a.
Gerber DE, Grossman SA, Streiff MB. Management of venous thromboembolism in patients with primary and metastatic brain tumors [published correction appears in J Clin Oncol. 2006 May 1;24(13):2133]. J Clin Oncol. 2006;24(8):1310-1318. doi:10.1200/JCO.2005.04.6656.
Chew HK, Wun T, Harvey DJ, Zhou H, White RH. Incidence of venous thromboembolism and the impact on survival in breast cancer patients. J Clin Oncol. 2007;25(1):70-76. doi:10.1200/JCO.2006.07.4393.
Sack GH Jr, Levin J, Bell WR. Trousseau's syndrome and other manifestations of chronic disseminated coagulopathy in patients with neoplasms: clinical, pathophysiologic, and therapeutic features. Medicine (Baltimore). 1977;56(1):1-37.
Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293(6):715-722. doi:10.1001/jama.293.6.715.
Alcalay AD, White RH, Wun T, et al. Venous thromboembolism in 68,142 colorectal cancer patients: Incidence and effect on survival: Abstract number 332 2006 Gastrointestinal Cancers Symposium. Retrieved from http://www.as co.org/ ASCO/Abstracts+&+ Virtual+ Meeting/ Abstracts?&vmview=abst detail view&conflD=41&abstractlD=50. Accessed March 5, 2009.
Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Increasing risk for venous thromboembolism among hospitalized cancer patients. JCO. 2007;25(18 suppl):9009.
Rasmussen MS, Jorgensen LN, Wille-Jørgensen P, Nielsen JD, Horn A, Mohn AC, et al. Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost. 2006;4(11):2384-2390. doi:10.1111/j.1538-7836.2006.02153.x.
Prandoni P, Lensing AW, Piccioli A, Bernardi E, Simioni P, Girolami B, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood. 2002;100(10):3484-3488. doi:10.1182/blood-2002-01-0108.
Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):338S-400S. doi:10.1378/chest.126.3_suppl.338S.
Prandoni P. Antithrombotic strategies in patients with cancer. Thromb Haemost. 1997;78(1):141-144.
Piccioli A, Prandoni P, Ewenstein BM, Goldhaber SZ. Cancer and venous thromboembolism. Am Heart J. 1996;132(4):850-855. doi:10.1016/s0002-8703(96)90321-x.
Prandoni P, Piccioli A, Girolami A. Cancer and venous thromboembolism: an overview. Haematologica. 1999;84(5):437-445.
.png){kind=logo}
