Clinical course of isolated distal deep vein thrombosis in patients with active cancer: a multicenter cohort study

Dentali, Francesco; Pegoraro, Samuela; Barco, Stefano; Minno, Matteo Nicola Dario Di; Mastroiacovo, Daniela; Pomero, Fulvio; Lodigiani, Corrado; Bagna, F; Sartori, Michelangelo; Barillari, Giovanni; Mumoli, Nicola; Napolitano, Mariasanta; Passamonti, Serena Maria; Benedetti, Raffaella; Ageno, Walter; Nisio, Marcello Di

doi:10.1111/jth.13761

Cited by 42 publications

(34 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Second, in our study, we found a 1‐year VTE recurrence at 6% with an overall incidence rate of 6.5 recurrent VTEs per 100 patient‐years in patients with IDDVT and active cancer despite receiving anticoagulant treatment. This was comparable to the findings in two recent studies by Dentali et al and Galanaud et al in which they found a high risk of recurrent VTEs in patients with IDDVT and cancer . These studies together support initial treatment with anticoagulation in this population as the rate of VTE recurrence would presumably be much higher with a serial monitoring approach.…”

Section: Discussionsupporting

confidence: 90%

“…Studies to evaluate the long‐term clinical outcomes of IDDVT in cancer patients have been limited. In a recent multicenter retrospective cohort study, Dentali et al described the clinical course of 308 cancer patients diagnosed with an isolated distal DVT . These investigators reported that 99% of their study population received anticoagulation up front (mean treatment duration, 4.2 months) and there were 47 recurrent VTE events during the follow‐up period (incidence rate, 13.2 events per 100 patient‐years).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical outcomes of isolated distal deep vein thrombosis versus proximal venous thromboembolism in cancer patients: The Cleveland Clinic experience

Poudel

Park

Xing

et al. 2020

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Background Previous studies suggest isolated distal deep vein thrombosis (IDDVT) has a self‐limited clinical course. However, these studies excluded cancer patients, who remain a high‐risk population. In addition, studies to evaluate the long‐term clinical outcomes of IDDVT in cancer patients have been limited. Here, we report outcomes from our experience in treating cancer‐associated IDDVT versus proximal venous thromboembolism (VTE). Methods We prospectively evaluated a cohort of patients referred to our cancer‐associated thrombosis clinic from August 2014 through May 2018. We compared clinical characteristics, anticoagulation prescription, VTE recurrence, overall survival, major bleeding, and subsequent hospital admission between cancer patients with IDDVT and proximal VTE. A propensity score matching method was used to reduce bias from confounding variables. Results Of 1100 patients referred to the clinic, 124 IDDVT and 178 proximal VTE events were analyzed. After propensity score matching, 96 patients were included in each cohort. There was no difference in the rate of recurrent VTE between cancer patients with proximal VTE vs IDDVT, with or without matching (matched: hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.31‐1.92; P = .58). There was no difference in overall survival between cancer patients with proximal VTE vs. IDDVT with or without matching (matched: HR, 1.18; 95% CI, 0.77‐1.82; P = .45). Furthermore, subsequent hospital admissions and major bleeding events were similar between patients with proximal VTE events versus IDDVT. Conclusions Cancer patients with IDDVT have similar outcomes as their proximal counterparts, including rate of recurrence and overall survival. These findings suggest treatment of cancer‐associated IDDVT should mirror treatment of proximal events.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of isolated distal deep vein thrombosis versus proximal venous thromboembolism in cancer patients: The Cleveland Clinic experience

Poudel

Park

Xing

et al. 2020

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…14 15 Preliminary results from cohort studies suggest that cancer, initial burden of thrombus and degree of thrombus resolution, bilateral presentation, inpatient setting, and patient demographics might explain a significant proportion of the individual risk of recurrence in patients with first acute IDDVT. 8 10 16 17 18 19 The differential role of DVT location may therefore be less relevant in the presence of major risk factors for recurrence, which would then play as the main determinants of patients' prognosis and dictate the duration of anticoagulation; however, this question has not formally been addressed yet.…”

Section: Introductionmentioning

confidence: 99%

Recurrence Risk after First Symptomatic Distal versus Proximal Deep Vein Thrombosis According to Baseline Risk Factors

Valerio

Ambaglio

Barone

et al. 2019

TH Open

Self Cite

View full text Add to dashboard Cite

Background It remains unclear whether the distal location of deep vein thrombosis (DVT) is independently associated with a lower risk of recurrence in all patients, or represents a marker of the presence and severity of provoking factors for venous thromboembolism (VTE). Methods We investigated the impact of distal (vs. proximal) DVT location on the risk of developing symptomatic, objectively confirmed recurrent VTE in 831 patients with a first acute symptomatic DVT not associated with pulmonary embolism (PE), who were stratified by the presence of transient or persistent risk factors at baseline. The primary outcome was symptomatic, objectively diagnosed recurrent VTE, including proximal DVT and PE. Results A total of 205 (24.7%) patients presented with a transient risk factor, 189 (22.7%) with a minor persistent risk factor, 202 (24.3%) with unprovoked DVT, and 235 (28.3%) with cancer-associated DVT. One-hundred twenty-five patients (15.0%) experienced recurrent DVT or PE. The largest relative difference between patients with distal (vs. proximal) DVT was observed in the absence of identifiable risk factors (adjusted hazard ratio [aHR]: 0.11; 95% CI [confidence interval]: 0.03–0.45). In patients with cancer, distal and proximal DVT had a comparable risk of recurrence (aHR: 0.70; 95% CI: 0.28–1.78]). Conclusions The distal (vs. proximal) location of first acute symptomatic DVT represented, in the absence of any identifiable transient or persistent risk factors, a favorable prognostic factor for recurrence. In contrast, the prognostic impact of DVT location was weaker if persistent provoking risk factors for VTE were present, notably cancer.

show abstract

“…While there are various theories on therapeutic intervention in patients with asymptomatic VTE and peripheral DVT, our department is actively working on it. Peripheral DVT patients with cancer have also been shown to have a much poorer prognosis than peripheral DVT patients without cancer (23,24). The revised guidelines of the American College of Chest Physicians (ACCP; 2016) also recommends therapeutic intervention in patients with active cancer and peripheral DVT (25).…”

Section: Box-and-whisker Plot Of D-dimer Analysis Of Vte Patients (A)mentioning

confidence: 99%

VEGF Inhibitors Do Not Increase D-dimer Levels in Colorectal Cancer Patients Without Venous Thromboembolism : A Retrospective Non-inferiority Analysis

Toshima

Ikusue

Hisamatsu

et al. 2019

In Vivo

View full text Add to dashboard Cite

Background/Aim: If VEGF inhibitors contribute to an increase in D-dimer levels, they may adversely affect the diagnosis of venous thromboembolism (VTE). Consequently, this retrospective study examined the effects of VEGF inhibitors on D-dimer levels in colorectal cancer patients. Patients and Methods: A total of 104 colorectal cancer patients who received chemotherapy, were included in this study. To perform D-dimer analysis, patients were divided into two analysis targets: patients with VTE and without VTE. Statistical analysis included a natural logarithmic transformation of D-dimer data. Results: In the D-dimer analysis of non-VTE patients, the natural logarithm D-dimer mean difference was-0.186, with a 95% CI of-0.525 to 0.154. The upper limit of the 95%CI (0.154) did not exceed the non-inferiority margin (Δ) of 0.199, and therefore met the non-inferiority criteria. Conclusion: VEGF inhibitors don't contribute to increased D-dimer levels in colorectal cancer patients without VTE. Vascular endothelial growth factor (VEGF) inhibitors, introduced by Folkman et al., are antiangiogenic therapybased drugs (1) that inhibit tumor growth, invasion, and metastasis by inhibiting tumor angiogenesis. Approved in 2004 by the U.S. Food and Drug Administration (FDA), bevacizumab was the first VEGF inhibitor with indications for various cancers, including colorectal cancer. In Japan, ramucirumab and aflibercept have also been approved as VEGF inhibitors for colorectal cancer treatment. VEGF inhibitors play an important role in colorectal cancer chemotherapy, and the Pan-Asian Adapted European Society for Medical Oncology (ESMO) Consensus Guidelines also recommends the use of bevacizumab combination therapies in many patients (2). Although VEGF inhibitors have been widely used in various cancers, consequent adverse events such as venous thromboembolism (VTE) have been reported. In a multinational phase-III clinical trial (NO16966) in which bevacizumab was approved for colorectal cancer treatment, VTE (CTCAE ver3.0 all grade) incidence was 12.4% (3, 4). Similarly, adverse events have also been reported in ramucirumab-and aflibercept-treated patients; hence, in our routine medical care, these drugs are used with caution. The high negative predictive value of D-dimer in VTE diagnosis is widely known; thus, it is very useful in diagnosis by exclusion (5). In addition, D-dimer is reported as a useful VTE predictive marker even in malignant tumor patients (6). On the other hand, its positive predictive value is low because various factors such as surgery, infection, disseminated intravascular coagulation (DIC), liver cirrhosis, and malignant tumors increase D-dimer levels. In other words, while patients with negative D-dimer test results are very unlikely to develop VTE, those with positive D-dimer test results do not always develop VTE. As described above, VEGF inhibitors have been known to increase the risk of VTE. However, if they contribute to an increase in D-dimer levels, which are useful in VTE prediction, they may further re...

show abstract

Clinical course of isolated distal deep vein thrombosis in patients with active cancer: a multicenter cohort study

Cited by 42 publications

References 27 publications

Clinical outcomes of isolated distal deep vein thrombosis versus proximal venous thromboembolism in cancer patients: The Cleveland Clinic experience

Clinical outcomes of isolated distal deep vein thrombosis versus proximal venous thromboembolism in cancer patients: The Cleveland Clinic experience

Recurrence Risk after First Symptomatic Distal versus Proximal Deep Vein Thrombosis According to Baseline Risk Factors

VEGF Inhibitors Do Not Increase D-dimer Levels in Colorectal Cancer Patients Without Venous Thromboembolism : A Retrospective Non-inferiority Analysis

Contact Info

Product

Resources

About