Deep venous thrombosis and occult malignancy: an epidemiological study

Abstract

Deep venous thrombosis is associated with a significantly higher frequency of malignancy during the first six months after diagnosis. Malignancies can be found with simple clinical and diagnostic methods and extensive screening is not required.

Idiopathic venous thromboembolic disease is associated with a poorer prognosis from subsequent malignancy

“…More recently, several large retrospective studies have shown an increased risk of cancer after a diagnosis of idiopathic VTE, with standardised incidence ratios of 3 -4.2 within the first 6 months (Nordstrom et al, 1994;Sorensen et al, 1998;Murchison et al, 2004). The length of time for which increased risk can be shown varies and we have shown a persistent, although declining, risk up to 2 years from VTE diagnosis (Murchison et al, 2004).…”

“…In view of this increased risk, there has been an interest in screening patients with idiopathic VTE for occult malignancy. Initial retrospective studies in patients with idiopathic deep vein thrombosis (DVT) suggested that most occult malignancy could be detected by routine evaluation (Nordstrom et al, 1994;Cornuz et al, 1996). However, more recent prospective studies advocate a more intensive investigative approach Piccioli et al, 2004).…”

Who is at risk for occult cancer after venous thromboembolism?

“…There is, however, no consensus on whether an extensive screening program for cancer may be meaningful in a subgroup of VTE patients [1][2][3]. We describe in the present study the time period of increased manifestation of cancer in VTE patients as compared to the background incidence in the Dutch population.…”

“…Lack of ADAMTS-13 activity can be caused either by a rare hereditary deficiency or by acquired autoantibodies that specifically inhibit ADAMTS-13 function [5,6]. The majority of clinically observed adult TTP patients are immune acquired cases [3,[6][7][8][9], with patients showing detectable levels of autoantibodies to ADAMTS-13. Patients exhibiting immune acquired TTP, also termed idiopathic TTP, usually respond well to plasma exchange (PE) therapy.…”

“…Full evaluation of an acquired case of thrombotic thrombocytopenic purpura following the surgical resection of glioblastoma multiforme Thrombotic thrombocytopenic purpura (TTP) is characterized by thrombocytopenia, hemolytic anemia, and microvascular thrombosis with ischemic injury to organs. Development of classic TTP is related to the impairment of the activity of ADAMTS-13, a key metalloprotease that cleaves von Willebrand factor (VWF) multimers and prevents VWF-induced platelet thrombosis [1][2][3][4]. Lack of ADAMTS-13 activity can be caused either by a rare hereditary deficiency or by acquired autoantibodies that specifically inhibit ADAMTS-13 function [5,6].…”