Epidemiology of Thrombosis in Cancer

Abstract

We have utilized epidemiological data to address three questions in patients with cancer and venous thromboembolism (VTE): (1) What is the risk for occult cancer in patients with idiopathic versus secondary VTE? (2) What is the risk for thrombosis in patients with cancer (vs. noncancer patients)? (3) What is the risk of recurrent VTE in cancer patients with an initial episode of VTE compared to noncancer patients? The risk for a new cancer diagnosis within 6–12 months of the diagnosis of idiopathic VTE (including pulmonary embolism) is well supported by retrospective analyses of large numbers of unselected patients, population-based retrospective cohort analyses from large registries and prospective studies. The odds ratios for these studies are in the range of 4- to 7-fold increased risk. In surgical patients with known cancer the odds ratio for an episode of postoperative VTE is approximately 2, when compared to a control group of noncancer patients subjected to the same procedures. A similar odds ratio of approximately 2 exists for the relative risk for recurrence of VTE in the first 3 months after an initial episode in cancer patients treated with heparin and warfarin (Coumadin^®) compared to noncancer patients. Therefore, patients with idiopathic VTE are at increased risk for occult cancer and cancer patients are at increased risk for VTE. Appropriate studies are underway to determine the best strategies for anticoagulant management of these patients.

Examining the Involvement of Erythropoiesis-Stimulating Agents in Tumor Proliferation (Erythropoietin Receptors, Receptor Binding, Signal Transduction), Angiogenesis, and Venous Thromboembolic Events

“…The risk for a VTE is 4.1 times higher in cancer patients than in patients without cancer and 6.5 times higher in patients receiving chemotherapy [25]. Whereas the clinical rates of VTEs are reported to be in the range of 4%-20% in cancer patients, the incidence of VTEs was found to be 50% in cancer patients at autopsy [23,24,26,27]. VTEs are thus often not diagnosed while the patient is alive, and constitute a serious complication in cancer patients.…”

“…VTEs are thus often not diagnosed while the patient is alive, and constitute a serious complication in cancer patients. A fatal pulmonary embolus and VTE recurrence are about three times more likely to occur in a cancer patient than in a patient without cancer [27]. A patient with a VTE has up to a 25% chance of having a pulmonary embolism, and a patient with a pulmonary embolism has a death rate up to 20% [23][24][25][26][27].…”

Long-term activation of the pro-coagulant response after neoadjuvant chemoradiation and major cancer surgery

“…Cancer surgery is associated with an approximate doubling of the VTE risk compared with non-cancer surgery (Rickles and Levine, 2001). The triad of factors associated with coagulation postulated by Virchow, including venous stasis, activation of coagulation and inflammatory pathways, as well as an associated shift to a pro-coagulant endothelium, are all relevant to cancer surgery.…”

The risk of a second cancer after hospitalisation for venous thromboembolism

“…Patients with clinically overt cancer may develop venous thromboembolism (VTE) at any stage of the disease (Agnelli, 1997;Rickles and Levine, 2001), aggravated by surgery, chemotherapy and intravenous catheters (Rickles and Levine, 2001). Occasionally, the thromboembolic event may occur before the clinical presentation of the cancer, and it is well known that the risk of a first cancer diagnosis is greatly increased in the year immediately after VTE (Prandoni et al, 1992;Baron et al, 1998;Sørensen et al, 1998Sørensen et al, , 2000Murchison et al, 2004).…”