Asymptomatic deep vein thrombosis in advanced cancer patients: The value of venous sonography

Beck-Razi, Nira; Kuzmin, Alexander; Koren, Dorith; Sarig, Galit; Brenner, Benjamin; Haim, Nissim; Gaitini, Diana

doi:10.1002/jcu.20691

Cited by 20 publications

(10 citation statements)

References 27 publications

(24 reference statements)

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“…8 In a retrospective analysis of 300 patients with asymptomatic lower extremity DVT (70% with distal DVT only), 17 developed symptomatic recurrent VTE during the 5-year followup; however, active cancer was present in 8 of these 17 patients, indicating a higher risk for developing symptomatic VTE in cancer patients. 9 Anticoagulant therapy in the cancer subgroup was associated with a reduced risk of symptomatic VTE. In the CASSINI trial, patients underwent duplex compression ultrasonography (CU) during screening, at weeks 8 and 16, and at the end of treatment.…”

Section: Discussionmentioning

confidence: 99%

Assessing Full Benefit of Rivaroxaban Prophylaxis in High-Risk Ambulatory Patients with Cancer: Thromboembolic Events in the Randomized CASSINI Trial

Khorana

McNamara

Kakkar

et al. 2020

TH Open

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Introduction In the CASSINI study, rivaroxaban thromboprophylaxis significantly reduced primary venous thromboembolism (VTE) endpoints during the intervention period, but several thromboembolic events designated as secondary efficacy endpoints were not included in the primary analysis. This study was aimed to evaluate the full impact of rivaroxaban thromboprophylaxis on all prespecified thromboembolic endpoints occurring on study. Methods CASSINI was a double-blind, randomized, placebo-controlled study in adult ambulatory patients with cancer at risk for VTE (Khorana score ≥2). Patients were screened at baseline for deep-vein thrombosis (DVT) and randomized if none was found. The primary efficacy endpoint was a composite of lower extremity proximal DVT, symptomatic upper extremity, or lower extremity distal DVT, any pulmonary embolism, and VTE-related death. This analysis evaluated all prespecified thromboembolic endpoints occurring on study to determine the full benefit of rivaroxaban prophylaxis. All endpoints were independently adjudicated. Results Total thromboembolic events occurred in fewer patients randomized to rivaroxaban during the full study period (29/420 [6.9%] and 49/421 [11.6%] patients in rivaroxaban and placebo groups, respectively [hazard ratio (HR) = 0.57; 95% confidence interval (CI): 0.36–0.90; p = 0.01]; number needed to treat [NNT] = 21). Similarly, fewer patients randomized to rivaroxaban experienced thromboembolism during the intervention period (13/420 [3.1%] patients) versus placebo (38/421 [9.0%] patients; HR = 0.33; 95% CI: 0.18–0.62; p < 0.001; NNT = 17). Conclusion Our findings confirm the substantial benefit of rivaroxaban thromboprophylaxis when considering all prespecified thromboembolic events, even after excluding baseline screen-detected DVT. The low NNT, coupled with prior data demonstrating a high number needed to harm, should assist clinicians in determining the risk/benefit of thromboprophylaxis in high-risk patients with cancer.

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Section: Discussionmentioning

confidence: 99%

Assessing Full Benefit of Rivaroxaban Prophylaxis in High-Risk Ambulatory Patients with Cancer: Thromboembolic Events in the Randomized CASSINI Trial

Khorana

McNamara

Kakkar

et al. 2020

TH Open

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“…The overall prevalence of IVT was 6.3% in 397 patients with cancer in a study by Cronin et al [77]. In a small study of 44 nonambulatory cancer patients (12 having lung cancer) who were asymptomatic for DVT, 15 patients were diagnosed with DVT when screening lower extremity Doppler sonography was performed [78]. Another study of 838 cancer patients (120 patients had lung cancer) found 1.3% of incidental DVT or PE [79].…”

Section: Diagnosismentioning

confidence: 95%

Lung cancer associated venous thromboembolic disease: A comprehensive review

Corrales-Rodriguez¹,

Blais

2012

Lung Cancer

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“…Incidental thrombosis is not an uncommon diagnosis in clinical practice, especially in high-risk medical patients. Recent studies indicate a variable prevalence of asymptomatic VTE in cancer patients ranging from 2.1% to more than 6% for PE, and up to 34% for DVT (Gladish et al, 2006;Cronin et al, 2007;Larici et al, 2007;O'Connell et al, 2008;Heidrich et al, 2009;Beck-Razi et al, 2010;). However, the presence of true asymptomatic nature of PE in cancer patients has been challenged as many of the patients considered to be asymptomatic, were found to have some symptoms related to VTE present on careful inquiry (O'Connell et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Frequency, Clinical Pattern and Outcome of Thrombosis in Cancer Patients in Saudi Arabia

Aleem

Diab²,

Alsaleh³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Objectives: Thrombotic risk is increased in patients with cancer and there are important implications for those who suffer a venous thromboembolism (VTE). We undertook this study to determine the frequency, clinical patterns, and outcome of VTE in Saudi patients with cancer. Methods: Cancer (solid tumors and lymphoma) patients who developed VTE from January 2004 to January 2009 were studied retrospectively. Demographics and clinical characteristics related to thrombosis and cancer were evaluated. Results: A total of 701 patients with cancer were seen during the study period. VTE was diagnosed in 47 (6.7%) patients (median age 52, range 18-80 years). Lower limb DVT was the most common type, seen in 47% patients, followed by PE in 19%, and 19% patients had both DVT & PE. Thrombosis was symptomatic in 72% patients while it was an incidental finding on routine workup in 28% . Cancer and VTE were diagnosed at the same time in 38% of patients, and 47% patients developed VTE during the course of disease after the cancer diagnosis. The majority of VTE post cancer diagnoses occurred during the first year (median 4 months, range 1-14). Additional risk factors for VTE were present in 22 (47%) patients and 14 (30%) of these patients were receiving chemotherapy at the time of thrombosis. Only 5 (10.6%) patients were receiving thrombo-prophylaxis at the time of VTE diagnosis. Most common types of tumors associated with thrombosis were breast cancer, non-Hodgkin's lymphoma and lung cancer. The majority of the affected patients (79%) had advanced stage of cancer. After a median follow-up of 13 (range 0.5-60) months, 38 (81%) patients had died. There was no difference in the mortality of patients with symptomatic or asymptomatic thrombosis (82% vs 78.6%). Conclusions: Thrombotic complications can develop in a significant number of patients with cancer, and almost half of the patients have additional risk factors for VTE. Thrombosis is usually associated with advanced disease and can be asymptomatic in more than a quarter of cases. Thromboprophylaxis in cancer patients is under-utilized. Community based studies are needed to accurately define the extent of this problem and to develop effective prophylactic strategies.

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Asymptomatic deep vein thrombosis in advanced cancer patients: The value of venous sonography

Abstract: USD of the lower extremities detected asymptomatic DVT in 34% of advanced nonambulatory cancer patients and may serve as an additional decision-making tool in the consideration of anticoagulant therapy for this specific population.

Cited by 20 publications

References 27 publications

Assessing Full Benefit of Rivaroxaban Prophylaxis in High-Risk Ambulatory Patients with Cancer: Thromboembolic Events in the Randomized CASSINI Trial

Assessing Full Benefit of Rivaroxaban Prophylaxis in High-Risk Ambulatory Patients with Cancer: Thromboembolic Events in the Randomized CASSINI Trial

Lung cancer associated venous thromboembolic disease: A comprehensive review

Frequency, Clinical Pattern and Outcome of Thrombosis in Cancer Patients in Saudi Arabia

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