Rate of venous thromboembolism and atrial fibrillation in a real-world case series of advanced cancer patients: the CaTEV Study

Abstract

Background Venous thromboembolism is the second leading cause of death in cancer patients and its incidence seems underestimated. In addition, cancer patients have an increased risk of developing atrial fibrillation, which may be the first presentation of cancer itself. The primary aim of this study was to define the incidence of venous thromboembolism (VTE) and atrial fibrillation in a real-word series of advanced cancer patients. Methods We performed a retrospective single-institution study on patients diagnosed with stage IV solid neoplasia at the outpatient clinic of the Medical Oncology Unit (Spedali Civili Brescia, Italy), from January to December 2018. Results A total of 403 patients were enrolled, with a mean age at presentation of 63 years (range 18–85 years). A VTE was observed in 24% of cases, half of which occurred after diagnosis of metastatic neoplasia, with a median time of onset of 5.5 months (range 0–84). About 3% of patients developed atrial fibrillation after cancer diagnosis. In this patient series, no statistically significant differences were found when comparing Khorana and PROTECHT thromboembolic risk scores, both before and after the start of chemotherapy. Overall, about 25% of the patients received anticoagulant therapy; in most cases, the drug of choice was low-molecular-weight heparin (LMWH). Conclusion This study showed for cancer patients a considerably higher incidence of VTE and a comparable incidence of atrial fibrillation than reported in literature. Validated thromboembolic risk scores appear to be poorly predictive, and LMWH remains the most widely used anticoagulant drug.

Prevalence and treatment of venous thromboembolism in patients with solid tumors

“…Overall, DVT prevalence was higher than PE prevalence in patients with cancer-associated VTE in the present study (2.0% vs. 0.9%), which is consistent with the results of previous studies, showing that DVT was more common than PE (10,12,14). However, Cohen et al (13) showed that PE (53.7%) was more prevalent than DVT (46.3%) in patients with active cancer, a notable difference from the findings of the present study.…”

“…The present finding is also similar to that of a previous study, indicating that 57.6% of patients with cancer-associated VTE received oral anticoagulants ( 33 ). However, a recent study showed that only 25.0% of patients with cancer-associated VTE received anticoagulation therapy, and low-molecular-weight heparin (LMWH) remained the most widely used anticoagulant drug among patients with advanced cancer ( 14 ). The difference may be attributed to the patients with advanced cancer having an increased risk of bleeding because of rivaroxaban use ( 14 ).…”

“…However, a recent study showed that only 25.0% of patients with cancer-associated VTE received anticoagulation therapy, and low-molecular-weight heparin (LMWH) remained the most widely used anticoagulant drug among patients with advanced cancer ( 14 ). The difference may be attributed to the patients with advanced cancer having an increased risk of bleeding because of rivaroxaban use ( 14 ). Moreover, the results of the present study demonstrated that the anticoagulants associated with bleeding events were rivaroxaban (4.2%) and enoxaparin (1.9%).…”

“…These increased rates may be due to the aggressiveness of anticancer therapies, greater awareness of the issue, improved diagnostic imaging techniques or improved cancer survival rates. Although the prevalence of cancer-associated VTE has previously been described ( 2 , 10 , 14 ), research focusing on VTE in patients with cancer in China is lacking ( 11 ). Furthermore, clinical practice guidelines for VTE treatment among cancer patients are continually updated.…”

Nanoparticles of a New Small-Molecule P-Selectin Inhibitor Attenuate Thrombosis, Inflammation, and Tumor Growth in Two Animal Models

“…Venous thromboembolism is the second–most prevalent cause of death in cancer patients. 49 Since THCMA possesses inhibitory effects on both venous thrombosis and tumor proliferation, it has the potential to be developed into a dual-function drug treating cancer patients associated with venous thrombosis.…”