Should we screen extensively for cancer after unprovoked venous thrombosis?

Khan, Faizan; Vaillancourt, Christian; Carrier, Marc

doi:10.1136/bmj.j1081

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…Extensive screening for cancer using computed tomography (CT) may be considered on an individual basis, such as in patients with worrisome signs (e.g., unexplained weight loss, gastrointestinal bleeding, cytopenias, or elevated hepatic enzymes in blood tests). 27 VTE-related death was the second adjudicated cause of death (20% of all deaths) after cancer and had an incidence as low as 0.7% per year. Similarly, fatal bleeding only accounted for 6% of all deaths and had an incidence as low as 0.2% per year.…”

Section: Discussionmentioning

confidence: 99%

Causes of Death in Patients with Venous Thromboembolism Anticoagulated with Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis

Gómez-Outes

Terleira-Fernández

Suárez-Gea

et al. 2018

Semin Thromb Hemost

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Death is more frequent than nonfatal recurrent venous thromboembolism (VTE) and major bleeding after acute VTE. The analysis of the causes of death is fundamental to explore new strategies to reduce mortality rates in these patients. The authors performed a meta-analysis to analyze mortality and independently adjudicated causes of death in anticoagulated patients due to VTE, and to evaluate potential differences between different anticoagulant schemes. They searched MEDLINE and CENTRAL, from January 1, 2000, to January 31, 2017, and performed additional searches in Web sites of regulatory agencies, clinical trial registers, and conference proceedings. Two investigators independently selected studies and extracted the data. Study quality was assessed with the Cochrane Collaboration's tool for assessing the risk of bias in randomized studies. Seven prospective randomized trials in 29,844 patients (22,025 patient-year follow-up) were included, comparing dabigatran, rivaroxaban, apixaban, and edoxaban with the standard anticoagulant treatment of VTE. A total of 718 patients died during the follow-up (3.4% per year; 95% confidence interval [CI]: 2.3-4.8). The most frequent causes of death were cancer (42%), followed by VTE (20%), infections (13%), hemorrhage (6%), heart disease (4%), and stroke (2%). There were no differences in the overall survival and causes of death according to the anticoagulant type. Concomitant active cancer during the study was significantly associated with death (odds ratio: 15.2; 95% CI: 9.2-25.1). Cancer is the leading cause of death in contemporary VTE trials. Interventions beyond anticoagulation, particularly in patients with active cancer, are needed.

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Section: Discussionmentioning

confidence: 99%

Causes of Death in Patients with Venous Thromboembolism Anticoagulated with Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis

Gómez-Outes

Terleira-Fernández

Suárez-Gea

et al. 2018

Semin Thromb Hemost

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“…There is much debate about screening for occult malignancy in patients with unprovoked venous thromboembolism, whether it is unilateral or bilateral 3. The incidence of cancer in patients without risk factors for pulmonary emboli is estimated to be around 4% 3.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of cancer in patients without risk factors for pulmonary emboli is estimated to be around 4% 3. Currently, guidance from the National Institute for Health and Care Excellence recommends routine screening (history, examination, basic blood tests, chest radiography, and urinalysis) in all patients, and more extensive screening (abdominopelvic computed tomography scan and mammograms for women) in patients over 40 4.…”

Section: Discussionmentioning

confidence: 99%

Atypical chest pain in an older woman

Amin

Howlett

2018

BMJ

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“…More than half of physicians that we surveyed recommended performing a CT chest/abdomen/pelvis to further investigate for malignancy. At present the extensive investigation of malignancy in patients with an unprovoked VTE (and in the absence of further signs or symptoms to suggest malignancy) is not routinely recommended, as the yield of uncovering an underlying malignancy is low [35][36][37].…”

Section: Doi: 101177/2045894020953841mentioning

confidence: 99%