Incidence and prediction of venous thromboembolism (VTE) in ambulatory patients (pts) with pancreas cancer receiving chemotherapy.

Abstract

368 Background: VTE is considered a main cause of mortality and morbidity in cancer pts and is commonly underestimated by oncologists. Pancreatic cancer is associated with the highest risk of VTE and the true incidence remains uncertain. Chemotherapy has been identified as an independent risk factor for VTE. The aim of this study is to analyze the incidence of cancer-associated thrombosis in ambulatory pts with pancreatic cancer receiving chemotherapy. Methods: We performed a retrospective review to determine the incidence of VTE in the gastrointestinal cancer unit of our centre. Between 2008 and 2010, 64 consecutives pts were identified and included in the analysis. Pancreatic neuroendocrine tumors were excluded. Results: Clinical characteristics ( table 1). Twenty pts (31.2%) experienced VTE including 7 pulmonary emboli (PE), 8 deep-vein thromboses (DVT) and 8 visceral vein thromboses (VVT). PE:25%. DVT:25%. VVT:35%. PE+DVT:10%. DVT+VVT:5%. Arterial thromboembolism (ATE): 2 pts (3.1%). 56% of the events were diagnosed during the first six months after diagnosis. Khorana’s predictive model for chemotherapy-associated thrombosis (risk category): intermediate risk (IR) 17 pts (27.9%) and high risk (HR) 44 pts (72.1%). VTE in HR and IR category: 14/44 pts (31.8%) and 6/17 pts (35.3%). Conclusions: The high incidence of VTE observed in this study is consistent with prior reports. Primary antithrombotic prophylaxis should be considered in this setting. Specific predictive model for chemotherapy-associated thrombosis in pancreas cancer must be investigated. [Table: see text]

Venous Thromboembolism and Primary Thromboprophylaxis in Perioperative Pancreatic Cancer Care

“…The placebo-controlled ENOXACAN II trial included 332 patients undergoing elective open surgery for abdominal or pelvic cancer, and was randomized between thromboprophylaxis for 6-10 days or an additional 21 days. This study also showed that an extended duration of enoxaparin prophylaxis was safe and reduced the incidence of VTE by 60% (95% CI [10][11][12][13][14][15][16][17][18][19][20][21][22]42,[42][43][44][45][46][47][48][49][50][50][51][52][53][54][55][55][56][57][58][59][60][61][62][63][64][65][66]68,[72][73][74][75][76][77]…”

“…Treatment with antineoplastic agents has been associated with an increased VTE risk in patients with all-type cancer [47][48][49][50]. In patients with PDAC, chemotherapy as the first-line cancer treatment is associated with an increased VTE incidence [22,51]. Withinthe neoadjuvant setting, patients with borderline resectable and locally advanced PDAC are commonly treated with FOLFIRINOX chemotherapy or gemcitabine-based chemoradiation in borderline resectable PDAC [4,52,53].…”