A nation-wide analysis of venous thromboembolism in 497,180 cancer patients with the development and validation of a risk-stratification scoring system

Abstract

The Asian population is thought to have a low risk of venous thromboembolism (VTE), but the epidemiology of VTE in cancer patients remains unclear. The National Health Insurance Research Database of Taiwan was used to find hospitalised patients newly-diagnosed with cancer to determine the incidence of VTE in cancer patients and to identify the risk factors for VTE. Between 1997 and 2005, 497,180 cancer patients were identified. During a median follow-up of 21.3 months (range 0-119.9 months), 5,296 patients developed VTE. The estimated incidence was 185 events per 100,000 person-years. Patients with a prior history of VTE and female patients between the ages of 40 and 80 carried high risk of VTE. The rate of VTE was relatively high in patients with myeloma, prostate cancer, lung cancer, gynaecologic cancers, sarcoma, and metastasis of unknown origin. We developed a risk-stratification scoring system to divide the cancer patients into four discrete risk groups (very low risk, low risk, intermediate, and high risk). The incidence of VTE in each group was 0.5%, 0.9%, 1.5%, and 8.7%, respectively (p < 0.001). This scoring system was validated in a separate patient cohort. In conclusion, VTE is a distinct burden for cancer patients in Taiwan. The risk scoring system could prove helpful in decision-making concerning thromboprophylaxis in cancer patients.

Venous thromboembolism in hospitalized patients receiving chemotherapy for malignancies at Japanese community hospital: prospective observational study

“…Lower limit of 95% CI of the OR was almost over 1.0 in a combination of non-increased PIC with increased TAT (OR, 2.6; 95% CI, 1.0–6.6; P  = 0.082) by univariate analysis. Table 3 shows VTE prevalence of a high- and low-risk group based on tumor subtypes [6, 18]. The absolute rates of the high- and low-risk group were 38% and 25%, respectively, which is not a significant difference.…”

“…of patientsPrevalenceTumor type( n  = 29)( n  = 97)(%)High-risk group for VTE Stomach a 518 Pancreas a 37 Ovary a 13 Lung a 22 Urinary tract a 12 CUP b 14 Sarcoma b 23 Lymphoma a 01 Total154038 c Low-risk group for VTE Colon or rectum626 Breast522 Esophagus36 Biliary tract01 Liver01 Urachus01 Total145725

VTE venous thromboembolism, CUP cancer of unknown primary

a Listed as a risk factor for VTE in National Comprehensive Cancer Network Guidelines 2016 [6]. b Listed as a risk factor for VTE in Asian patients [18]. c Odds ratio was 1.84 vs. low-risk group for VTE (95% confidence interval, 0.8–4.4; P  = 0.25).

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“…b Listed as a risk factor for VTE in Asian patients [18]. c Odds ratio was 1.84 vs. low-risk group for VTE (95% confidence interval, 0.8–4.4; P  = 0.25).…”

Migraine and Risk of Dementia: A Nationwide Retrospective Cohort Study

“…The Ethics Review Board of China Medical University granted approval for this study (CMU-REC-101-012). Several Taiwan studies had demonstrated the high accuracy and validity of ICD-9 diagnosis in NHIRD [9,10]. …”

Risk of Subsequent Dementia in Patients with Hypertensive Encephalopathy: A Nationwide Population-Based Study in Taiwan

“…In addition, this study was approved by the Ethics Review Board at China Medical University (CMU-REC-101-012). Several Taiwanese studies had demonstrated the high accuracy and validity of ICD-9 diagnosis in NHIRD [10,11]. …”