More than 100 years ago, Trousseau reported migratory thrombophlebitis in cancer patients (Trosseau A, Lectures on Clinical Medicine, delivered at the Hotel-Dieu, Paris, London: New Sydenham Society; 1872; p 281-95). Subsequently, patients with DVT or pulmonary embolism (PE) have been shown to have up to a fourfold increased risk of cancer in the first year after the venous thromboembolic (VTE) event (Baron JA et al, Br J Cancer 2004;91:92-5). However, only one previous study has investigated the relationship between SVT and cancer risk (van Doormaal FF et al, Ann Fam Med 2010;8:47-50). In an effort to understand the broader cancer risk associated with all types of venous thrombosis, the authors used populationbased registries in Denmark to investigate associations of cancer with SVT, DVT, and PE. They identified all patients in Denmark from 1994 to 2009 with a diagnosis of SVT, DVT in the legs, or PE. The occurrence of cancer in each of the venous cohorts was compared with expected numbers of cases using national incidence rates to compute standardized incidence ratios (SIRs). The authors identified 763 patients with SVT, 45,252 with DVT, and 24,332 with PE. Very similar proportions of patients in the three cohorts in the first year of follow-up were diagnosed with cancer. The SIRs (95% confidence intervals) were 2.46 (2.10-2.86) for SVT, 2.75 (2.6-2.9) for DVT, and 3.27 (3.03-3.52) for PE, and declined after 1 year to 1.05 (0.96-1.16), 1.11 (1.07-1.16), and 1.15 (1.09-1.22), respectively. Venous thrombotic cohorts showed strong associations for particular cancers (liver, lung, ovaries, pancreas, and non-Hodgkin lymphoma).Comment:The key point here is that all forms of lower extremity venous thrombosis, SVT, DVT, and potential sequelae, such as PE, are markers for a clearly higher occurrence rate of cancer, particularly during the first year after diagnosis. Practical implications for screening for cancer in patients with VTE are unclear. If someone has cancer and a VTE event within 1 year of diagnosis, the prognosis is poor, with only a 12% survival (Sorensen HT et al, N Engl J Med 2000;343:1846-50). However, the implications for screening derived from this particular study are also unclear. The authors point out 45,981 individuals with VTE would have to be investigated to find 304 excess cancers during the first year of follow-up. That is a lot of investigation for not many cancers, especially when it is unclear that an early cancer diagnosis stemming from evaluation of a VTE event would ultimately prolong the life of a VTE patient with underlying cancer.

The data suggest that the early risk of recurrent stroke in symptomatic significant carotid stenosis is not as high as some earlier studies have shown. The risk is similar to several studies in which a modern medical treatment regime could be assumed.

Background and Purpose— Current Swedish guidelines recommend that carotid endarterectomy should be performed within 14 days of a qualifying neurological event, but it is not clear if very urgent surgery after an event is associated with increased perioperative risk. The aim of this study was to determine how the time between the event and carotid endarterectomy affects the procedural risk of mortality and stroke. Methods— We prospectively analyzed data on all patients who underwent carotid endarterectomies for symptomatic carotid stenosis between May 12, 2008, and May 31, 2011, with records in the Swedish Vascular Registry (Swedvasc). Patients were divided according to time between the qualifying event and surgery (0–2 days, 3–7 days, 8–14 days, 15–180 days). Stroke rate and mortality at 30 days postsurgery were determined. Results— We analyzed data for 2596 patients and found that the combined mortality and stroke rate for patients treated 0 to 2 days after qualifying event was 11.5% (17 of 148) versus 3.6% (29 of 804), 4.0% (27 of 677), and 5.4% (52 of 967) for the groups treated at 3 to 7 days, 8 to 14 days, and 15 to 180 days, respectively. In a multivariate analysis, time was an independent risk factor for perioperative complications: patients treated at 0 to 2 days had a relative OR of 4.24 (CI, 2.07–8.70; P <0.001) compared with the reference 3- to 7-day group. Conclusions— In this study of patients treated for symptomatic carotid disease, it was safe to perform surgery as early as Day 3 after a qualifying neurological event in contrast to patients treated within 0 to 2 days, which has a significantly increased perioperative risk.

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