Incidence of venous thromboembolism in patients with cancer – A cohort study using linked United Kingdom databases

Walker, Alex J; Card, Timothy R.; West, Joe; Crooks, Colin J; Grainge, Matthew J.

doi:10.1016/j.ejca.2012.10.021

Cited by 408 publications

(407 citation statements)

References 41 publications

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“…This rate was 3.5 times (95% CI, 3.2-3.9) higher than in age-matched controls, as shown in our previous report on this cohort. 1 The rate of VTE in breast cancer patients increased over the time period of the study from 5.4 (95% CI, 3.6 to 8.2) per 1000 person-years for women with breast cancer diagnosed in 1997 to 10.5 (95% CI, 8.5 to 13.2) per 1000 person-years for 2005. Of the women who experienced VTE events, 273 developed pulmonary embolism either with or without deep vein thrombosis (DVT), 314 developed DVT alone, and 24 had other thrombosis events.…”

Section: Patient Characteristicsmentioning

confidence: 91%

“…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.…”

Section: 2mentioning

confidence: 99%

“…33 As we have previously acknowledged, our algorithm for defining VTE was not validated specifically in cancer patients and would not capture anticoagulant prescriptions emanating from secondary care. 1 However, the usual requirement is for cancer patients to receive continuous anticoagulant therapy for a minimum of 3 months after the primary VTE, and such prescriptions would be captured in primary care. Furthermore, previous studies that used administrative data have relied solely on physician coding of VTE without requiring evidence of anticoagulation.…”

Section: 2mentioning

confidence: 99%

“…1,2 Because breast cancer is the most common cancer worldwide, 3 this equates to a substantial impact of breast cancer-related VTE for patients and medical resources. Breast cancer-associated VTE accounts for approximately 17% of cancerrelated VTEs presenting to anticoagulation clinics.…”

Section: Introductionmentioning

confidence: 99%

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

Walker

West

Card

et al. 2016

Blood

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Key Points• Patients with breast cancer have a risk of VTE equivalent to 6% a year while undergoing chemotherapy and in the month after treatment.• Tamoxifen is associated with a risk of VTE equivalent to 2% a year, which is 4 times higher than the risk before starting therapy.Patients with breast cancer are at increased risk of venous thromboembolism (VTE), particularly in the peridiagnosis period. However, no previous epidemiologic studies have investigated the relative impact of breast cancer treatments in a time-dependent manner. We aimed to determine the impact of breast cancer stage, biology, and treatment on the absolute and relative risks of VTE by using several recently linked data sources from England. .6 per 1000 person-years) than that in women who did not receive chemotherapy. After surgery, the risk was significantly increased in the first month (hazard ratio [HR], 2.2; 95% CI, 1.4-3.4; AR, 23.5; reference group, no surgery), but the risk was not increased after the first month. Risk of VTE was noticeably higher in the 3 months after initiation of tamoxifen compared with the risk before therapy (HR, 5.5; 95% CI, 2.3-12.7; AR, 24.1); however, initiating therapy with aromatase inhibitors was not associated with VTE (HR, 0.8; 95% CI, 0.5-1.4; AR, 28.3). In conclusion, women receiving chemotherapy for breast cancer have a clinically important risk of VTE, whereas an increased risk of VTE immediately after endocrine therapy is restricted to tamoxifen. (Blood. 2016;127(7):849-857) Medscape Continuing Medical Education onlineThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at http://www.medscape.org/journal/blood; and (4) view/print certificate. For CME questions, see page 953. Disclosures Thomas L. Ortel, Associate Editor, served as an advisor or consultant for Instrumentation Laboratory and received grants for clinical research from Instrumentation Laboratory; Eisai; Pfizer; and GlaxoSmithKline. The authors and CME questions author Laurie Barclay, freelance writer and reviewer, Medscape, LLC, declare no competing financial interests. Learning objectives1. Identify the effect of chemotherapy for breast cancer on the risk for venous thromboembolism, based on an English cohort study.2. Determi...

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Section: Patient Characteristicsmentioning

confidence: 91%

Section: 2mentioning

confidence: 99%

Section: 2mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Walker

West

Card

et al. 2016

Blood

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“…have a higher risk of developing incident VTE compared to matched non-cancer patients [15,16], they have a higher risk of recurrent VTE [17,18], and development of VTE in cancer patients is associated with higher mortality [19][20][21]. The management of acute VTE in cancer patients is challenging because they have an increased risk of developing major bleeding during anticoagulation therapy [17].…”

Section: Cancer and Thrombosis Inferior Vena Cava Filter Venous Thrommentioning

confidence: 99%

Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE): patterns of use and outcomes

Brunson¹,

Ho²,

White

et al. 2016

Thrombosis Research

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Systemic Anticancer Therapy and Thromboembolic Outcomes in Hospitalized Patients With Cancer and COVID-19

Gulati,

Hsu,

Shah

et al. 2023

JAMA Oncol

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ImportanceSystematic data on the association between anticancer therapies and thromboembolic events (TEEs) in patients with COVID-19 are lacking.ObjectiveTo assess the association between anticancer therapy exposure within 3 months prior to COVID-19 and TEEs following COVID-19 diagnosis in patients with cancer.Design, Setting, and ParticipantsThis registry-based retrospective cohort study included patients who were hospitalized and had active cancer and laboratory-confirmed SARS-CoV-2 infection. Data were accrued from March 2020 to December 2021 and analyzed from December 2021 to October 2022.ExposureTreatments of interest (TOIs) (endocrine therapy, vascular endothelial growth factor inhibitors/tyrosine kinase inhibitors [VEGFis/TKIs], immunomodulators [IMiDs], immune checkpoint inhibitors [ICIs], chemotherapy) vs reference (no systemic therapy) in 3 months prior to COVID-19.Main Outcomes and MeasuresMain outcomes were (1) venous thromboembolism (VTE) and (2) arterial thromboembolism (ATE). Secondary outcome was severity of COVID-19 (rates of intensive care unit admission, mechanical ventilation, 30-day all-cause mortality following TEEs in TOI vs reference group) at 30-day follow-up.ResultsOf 4988 hospitalized patients with cancer (median [IQR] age, 69 [59-78] years; 2608 [52%] male), 1869 had received 1 or more TOIs. Incidence of VTE was higher in all TOI groups: endocrine therapy, 7%; VEGFis/TKIs, 10%; IMiDs, 8%; ICIs, 12%; and chemotherapy, 10%, compared with patients not receiving systemic therapies (6%). In multivariable log-binomial regression analyses, relative risk of VTE (adjusted risk ratio [aRR], 1.33; 95% CI, 1.04-1.69) but not ATE (aRR, 0.81; 95% CI, 0.56-1.16) was significantly higher in those exposed to all TOIs pooled together vs those with no exposure. Among individual drugs, ICIs were significantly associated with VTE (aRR, 1.45; 95% CI, 1.01-2.07). Also noted were significant associations between VTE and active and progressing cancer (aRR, 1.43; 95% CI, 1.01-2.03), history of VTE (aRR, 3.10; 95% CI, 2.38-4.04), and high-risk site of cancer (aRR, 1.42; 95% CI, 1.14-1.75). Black patients had a higher risk of TEEs (aRR, 1.24; 95% CI, 1.03-1.50) than White patients. Patients with TEEs had high intensive care unit admission (46%) and mechanical ventilation (31%) rates. Relative risk of death in patients with TEEs was higher in those exposed to TOIs vs not (aRR, 1.12; 95% CI, 0.91-1.38) and was significantly associated with poor performance status (aRR, 1.77; 95% CI, 1.30-2.40) and active/progressing cancer (aRR, 1.55; 95% CI, 1.13-2.13).Conclusions and RelevanceIn this cohort study, relative risk of developing VTE was high among patients receiving TOIs and varied by the type of therapy, underlying risk factors, and demographics, such as race and ethnicity. These findings highlight the need for close monitoring and perhaps personalized thromboprophylaxis to prevent morbidity and mortality associated with COVID-19–related thromboembolism in patients with cancer.

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Incidence of venous thromboembolism in patients with cancer – A cohort study using linked United Kingdom databases

Cited by 408 publications

References 41 publications

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

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

Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE): patterns of use and outcomes

Systemic Anticancer Therapy and Thromboembolic Outcomes in Hospitalized Patients With Cancer and COVID-19

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