Bidirectional risk between venous thromboembolism and cancer in East Asian patients: synthesis of evidence from recent population-based epidemiological studies

Abstract

BackgroundUnprovoked (idiopathic) venous thromboembolism (VTE) with no obvious antecedent risk factors, is associated with a significant risk of subsequent occult cancer. Conversely, there is a heightened risk of VTE in cancer patients. This bidirectional risk can be estimated from population-based cohort studies conducted in East Asians.MethodsA literature search using medical subject heading terms and Boolean logic in PubMed and MedLine was performed in April 2017. Twenty-two papers reported from East Asia were retrieved for study and data synthesis. Proportional meta-analysis with a random-effects model was used to synthesize data with 95% confidence intervals (CIs) when appropriate.ResultsSynthesis of data on VTE incidence in the East Asian population (I2 = 76.2%) showed that pooled incidence was 20.3 (95% CI, 11.2–32) per 100,000 person-years. VTE incidence steadily increased with age. Unprovoked VTE accounted for 35% (95% CI, 24%–48%) of all cases of incident VTE (I2 = 99.7%). The overall cancer risk was significantly higher (2.3-fold) in the VTE cohort than in comparators. Among the patients with unprovoked VTE, approximately 7% had a subsequent cancer diagnosis within 2 years of the first episode of idiopathic VTE. The risk of VTE recurrence was increased in cancer patients (adjusted odds ratio, 1.64; 95% CI, 1.26–1.99). VTE incidence was 9.9 per 1,000 person-years in cancer patients, particularly in liver, pancreas, and lung cancer patients.ConclusionNewly diagnosed VTE incidence is estimated at approximately 4,400 new cases annually in Taiwan and 7,100 in South Korea. Similar to the trend in VTE incidence among the general population, VTE risk in East Asian cancer patients is markedly lessened.

Clinical outcomes of comorbid cancer patients with venous thromboembolism

“…Among all first VTE events, the proportion of cancer-associated VTE was higher in our patient population than that reported by Western studies. [5,9–11] In our analysis, various cancer-related and patient-related factors were significantly associated with the composite incidence of VTE recurrence or any-cause mortality, while the increased incidence of VTE recurrence was significantly associated with extensive DVT (involving the inferior vena cava), use of vitamin K antagonist, and cancer site (lung). The composite incidence of study outcomes was substantially higher among comorbid cancer patients with VTE than among VTE patients without cancer.…”

“…Several studies have shown that cancer patients may differ from the general population in terms of their VTE susceptibility and that the disparity is associated with ethnicity differences. [5–11] It is important to note that most epidemiological studies of VTE have largely been conducted on samples taken from predominantly European populations. [1] Reported incidence rates for VTE in Western countries have ranged from 45 to 117 per 100,000 person-years, [1,5–7] whereas the overall VTE incidence is reported to be lower in Asian countries.…”

“…[9,10] Patients with cancer-associated VTE are at a higher risk of bleeding complications during anticoagulant treatment, and they have a higher risk of recurrent VTE than patients with VTE and no cancer. [11–15] Although there is little empirical data regarding the outcomes of VTE among comorbid cancer patients—even less so for Asian populations—it is widely reported that VTE events are the second-leading cause of death among cancer patients as their cancer progresses.…”

Association of Gonadotropin-Releasing Hormone Therapies With Venous Thromboembolic Events in Patients With Prostate Cancer: A National Cohort Study

“…Although Chiang et al have reported a lower incidence of VTE in Asia than in Western countries, the risks of VTEs in Asia have risen ( 36 ). Compared with an incidence of approximately 100 cases per 100,000 patient-years in the western countries, using a proportional meta-analysis with a random-effects model ( 37 ), Kok found that VTE incidence in the East Asian population was 20.3 (95% CI, 11.2–32) per 100,000 person-years ( 38 ). In addition, the risk of VTE recurrence was increased in patients with cancer ( 38 ).…”

“direct Oral Anticoagulants Versus Low-molecular-weight Heparin for Acute Treatment of Venous Thromboembolism in Patients With Gastrointestinal Cancer: a Systematic Review and Meta-analysis”

“…The absolute rate of VTE in all cancers from a large United Kingdom database was 13.9 per 1,000 personyears [3,4]. A study in East Asian population revealed an incidence of cancer-associated VTE of 9.9 per 1,000 person-years, particularly in hepatocellular and pancreatic cancer [5]. In addition to ethnicity and cancer stage, the type of cancer also in uences the risk of thrombosis.…”