Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients

Abstract

BACKGROUND.Venous thromboembolism (VTE) contributes to morbidity and mortality in cancer patients and is a frequent complication of anticancer therapy. In the current study, the frequency, risk factors, and trends associated with VTE were examined among hospitalized cancer patients.METHODS.A retrospective cohort study was conducted using the discharge database of the University HealthSystem Consortium. This included 1,824,316 hospitalizations between 1995 and 2003 at 133 U.S. medical centers.RESULTS.Among 1,015,598 cancer patients, 34,357 (3.4%) were diagnosed with deep venous thrombosis and 11,515 with pulmonary embolism (PE) (1.1%) for an overall VTE rate of 4.1%. Subgroups of cancer patients with the highest rates included black ethnicity (5.1% per hospitalization) and those receiving chemotherapy (4.9%). Sites of cancer with the highest rates of VTE included pancreas (8.1%), kidney (5.6%), ovary (5.6%), lung (5.1%), and stomach (4.9%). Among hematologic malignancies, myeloma (5%), non‐Hodgkin lymphoma (4.8%), and Hodgkin disease (4.6%) had the highest rates of VTE. The rate of VTE increased by 28%, secondary to a near‐doubling of PE rates from 0.8% to 1.5% (P < .0001). Among patients receiving chemotherapy, the rates of VTE rose from 3.9% to 5.7%, an increase of 47% (P < .0001). In multivariate analysis, risk factors associated with VTE included age ≥65 years, female sex, black ethnicity, use of chemotherapy, primary site of cancer, presence of comorbidities, and year of admission.CONCLUSIONS.VTE, particularly PE, is an increasingly frequent complication of hospitalization in cancer patients. Patients with black ethnicity, specific sites of cancer, or those receiving chemotherapy are disproportionately at risk. Cancer 2007. © 2007 American Cancer Society.

When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data

“…This is consistent with reports of an increase in risk of cancer-associated VTE over time in this and in other populations, a trend which may be the result of either more aggressive cancer treatments or ascertainment resulting from greater knowledge of the link between cancer and thrombosis. 1,[20][21][22] This report contained both absolute risks (unadjusted) and adjusted HRs. Absolute risks and associated unadjusted HRs may be more useful in terms of clinical decision making if they are interpreted on the basis of a single factor.…”

Assessing the Risk and Prognosis of Thrombotic Complications in Cancer Patients

“…18 However, a study of hospitalized oncology patients showed an overall increase of VTE risk in women (OR, 1.1; 95% CI, 1.1-1.2). 19 Lifetime estrogen exposure may be related to high VTE risk in the female population.…”

“…22 In hospitalized cancer patients, several comorbidities, such as infection (OR, 1.8), arterial thromboembolic disease (OR, 1.5), renal disease (OR, 1.5), pulmonary disease (OR, 1.4%), and anemia (OR, 1.4), significantly affect the thrombotic risk. 19 Moreover, both anemia (OR, 2.4) and obesity (OR, 2.5) are associated with VTE risk in ambulatory cancer patients. 16 In malignancies characterized by high incidence of metastasis, the presence of comorbid conditions is the strongest risk factor for VTE, compared with malignancies with a lower metastatic rate, for which metastatic disease itself is the most important risk factor.…”

Venous thromboembolism in hematopoietic stem cell transplant recipients

“…A 3.7% 1-year incidence of VTE, and 8-20% incidence of catheter-related thrombosis (CRT) have been reported in autologous stem cell transplant recipients. 12 HSCT recipients have several identifiable risk factors for thrombosis including malignancy, high-dose myeloablative chemotherapy and immune-modulatory drugs, [13][14][15][16] graft versus host disease (GVHD), [17][18][19] infections, 14,20 indwelling vascular catheters and prolonged immobilization. 14 HSCT is also associated with an 'acquired hypercoagulable state' characterized by inflammation, endothelial damage and activation of endothelium-dependent coagulation factors, increase in von Willebrand factor and platelet adhesion, increased thrombin generation, decreased anti-thrombin levels and decreased levels of anticoagulant proteins such as protein C. [21][22][23][24][25][26][27] graft versus host disease (GVHD) is associated with inflammation that leads to endothelial damage and activation.…”