Screening for Occult Cancer in Unprovoked Venous Thromboembolism

Carrier, Marc; Lazo‐Langner, Alejandro; Shivakumar, S; Tagalakis, Vicky; Zarychanski, Ryan; Solymoss, Susan; Routhier, Nathalie; Douketis, James D.; Danovitch, Kim; Lee, Agnes Y.; Gal, Grégoire Le; Wells, Philip S.; Corsi, Daniel J.; Ramsay, Tim; Coyle, Doug; Chagnon, Isabelle; Kassam, Zahra; Tao, Hardy; Rodger, Marc

doi:10.1056/nejmoa1506623

Cited by 249 publications

(171 citation statements)

References 14 publications

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“…More extensive screening programs including CT scans or PET scans (fludeoxyglucose positron emission tomography) have not been found to be beneficial in identifying more occult cancers or reducing mortality [20–22] and is not advised as routine for all VTE patients.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism and cancer risk

Sandén

Svensson²,

Själander

2016

J Thromb Thrombolysis

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Cancer increases the risk of venous thromboembolism (VTE) and about 20 % of all VTE are associated with cancer. VTE can also be used as a marker for occult cancer. The objective was to examine the correlation between VTE and cancer regarding predictors for a subsequent cancer diagnosis. Patients treated for VTE between January 1st 2006 and December 31th 2011 were extracted from the Swedish national quality register AuriculA and crossmatched with the Swedish National Patient Register. In total 7854 patients corresponding to 14284 treatments years were examined. Primary VTE was found in 6451 patients, with 3936 first and 2515 recurrent VTE. There were 1403 patients with secondary VTE. After a first or recurrent primary VTE the incidence of cancer diagnose was high being 9.4–10.0 % the first year compared to 2.7–2.5 % during the second year. Cancer in the digestive organs was the most common type of cancer among those with first primary VTE with 19.2 % of diagnoses. In multivariable analysis age was found to increase the risk of cancer diagnosis after both first and recurrent primary VTE HR 1.02 (CI 1.02–1.03) and HR 1.02 (CI 1.01–1.03). For a first primary VTE anemia HR 2.13 (CI 1.48–3.08) and male sex HR 1.38 (CI 1.09–1.76) increased the risk while hypertension HR 0.74 (0.57–0.96), dementia HR 0.30 (CI 0.10–0.95) and history of major bleeding HR 0.52 (CI 0.28–0.97) reduced the risk of a subsequent cancer diagnosis. There is a substantial proportion of patients being diagnosed with cancer the first year after a primary VTE, anaemia and male sex confers an increased risk.

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Section: Discussionmentioning

confidence: 99%

Venous thromboembolism and cancer risk

Sandén

Svensson²,

Själander

2016

J Thromb Thrombolysis

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“…Nedavno je bodovna ljestvica HERDOO (Tablica 2) prospektivno validirana u 2779 bolesnika; antikoagulantna terapija može se sa sigurnošću isključiti u žena s prvim neprovocirajućim događajem venskog tromboembolizma koje se prezentiraju rezultatom <2 prema HERDOO bodovnoj ljestvici. 34 Integracija ljestvica mogućnosti recidiva VTE-a i ljestvice rizika od krvarenja omogućuje individualizirani pristup, ali dostupne ljestvice za procjenu rizika od krvarenja nisu dovoljno uspješne u VTE-u. Nedavno razvijena VTE-BLEED bodovna ljeVorapaxar, a protease-activated receptor-1 antagonist, proved effective in reducing acute limb ischaemia (ALI) among 3787 patients with qualifying symptomatic LEAD enrolled in the TRA2°P trial, reducing the 3 year risk of ALI by 42% vs. placebo on top of aspirin and/or a thienopyridine (2.3% vs. 3.9%; P = 0.006) ( Table 1).…”

Section: Venski Tromboembolizamunclassified

“…Very recently, the HERDOO score ( Table 2) was prospectively validated in 2779 patients; anticoagulation could safely be discontinued in women with a first unprovoked VTE who presented with a HERDOO score <2. 34 The integration of recurrence and bleeding risk scores may allow a personalized management, but available bleeding scores have largely been unsuccessful in VTE. The recently developed VTE-BLEED accurately predicted 30 day bleeding risk in patients on dabigatran and warfarin, deserving further evaluation.…”

Section: Venous Thromboembolismmentioning

confidence: 99%

The year in cardiology 2016: peripheral circulation

Carlo¹,

Mazzolai²,

Bossone³

et al. 2017

Cardiologia Croatica

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“…Recently, another study on extensive cancer screening including abdominal/pelvic CT was published [50]. It found a non-significantly higher cancer detection rate during the initial staging with abdominal/pelvic CT but no difference in the rate of cancers that were missed.…”

Section: Addendummentioning

confidence: 99%

Cancer Screening in Patients with Idiopathic Venous Thromboembolism - a Position Paper of the German Society of Hematology and Oncology Working Group on Hemostasis

Matzdorff

Riess

Bergmann³

et al. 2015

Oncol Res Treat

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Cancer can trigger thromboembolism. There is a 4-10% chance of finding an asymptomatic occult cancer in patients with idiopathic venous thromboembolism (VTE). Current guidelines recommend limited cancer screening with history, physical examination, and screening examinations according to age after idiopathic VTE. Recent studies found that a more extensive screening program, including endoscopy and computed tomography, may increase the cancer detection rate. The Hemostasis Working Group of the German Society of Hematology and Oncology recommends a more extensive screening program after idiopathic VTE.

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Screening for Occult Cancer in Unprovoked Venous Thromboembolism

Cited by 249 publications

References 14 publications

Venous thromboembolism and cancer risk

Venous thromboembolism and cancer risk

The year in cardiology 2016: peripheral circulation

Cancer Screening in Patients with Idiopathic Venous Thromboembolism - a Position Paper of the German Society of Hematology and Oncology Working Group on Hemostasis

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