Hospitalisation for venous thromboembolism in cancer patients and the general population: a population-based cohort study in Denmark, 1997–2006

Abstract

Background:Venous thromboembolism (VTE) frequently complicates cancer. Data on tumour-specific VTE predictors are limited, but may inform strategies to prevent thrombosis.Methods:We computed incidence rates (IRs) with 95% confidence intervals (CIs) for VTE hospitalisation in a cohort of cancer patients (n=57 591) and in a comparison general-population cohort (n=287 476) in Denmark. The subjects entered the study in 1997–2005, and the follow-up continued through 2006. Using Cox proportional-hazards regression, we estimated relative risks (RRs) for VTE predictors, while adjusting for comorbidity.Results:Throughout the follow-up, VTE IR was higher among the cancer patients (IR=8.0, 95% CI=7.6–8.5) than the general population (IR=4.7, 95% CI=4.3–5.1), particularly in the first year after cancer diagnosis (IR=15.0, 95% CI=13.8–16.2, vs IR=8.6, 95% CI=7.6–9.9). Incidence rates of VTE were highest in patients with pancreas (IR=40.9, 95% CI=29.5–56.7), brain (IR=17.7, 95% CI=11.3–27.8) or liver (IR=20.4, 95% CI=9.2–45.3) tumours, multiple myeloma (IR=22.6, 95% CI=15.4–33.2) and among patients with advanced-stage cancers (IR=27.7, 95% CI=24.0–32.0) or those who received chemotherapy or no/symptomatic treatment. The adjusted RR (aRR) for VTE was highest among patients with pancreas (aRR=16.3, 95% CI=8.1–32.6) or brain cancer (aRR=19.8 95% CI=7.1–55.2), multiple myeloma (aRR=46.1, 95% CI=13.1–162.0) and among patients receiving chemotherapy, either alone (aRR=18.5, 95% CI=11.9–28.7) or in combination treatments (aRR=16.2, 95% CI=12.0–21.7).Conclusions:Risk of VTE is higher among cancer patients than in the general population. Predictors of VTE include recency of cancer diagnosis, cancer site, stage and the type of cancer-directed treatment.

New Oral Anticoagulants and the Cancer Patient

“…It is well established that cancer patients carry a higher thrombotic risk than the general population [1][2][3][4]. Malignancy is a strong thrombotic risk, and it is not clear that the doses of NOACs used for AF or VTE in the general population will provide the same protection against thromboembolic events in patients with active malignancy.…”

“…Large studies suggest that patients with active cancer experience a 4-to 8-fold increase in VTE compared with the general population [1,2]. The relationship between cancer and thrombosis is complex and incompletely understood.Variables that increase thrombotic risk in the cancer patient include the following: expression and/or release of procoagulants by tumor cells, increased procoagulant activity of host cells in response to tumor, stasis (either from tumor compression or immobilization of the host), endothelial damage, advanced age, chemotherapy, and presence of central venous catheters.…”

When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data

“…Previous cohort studies have identified several risk factors for VTE in breast cancer patients including metastatic disease, 2,7,8 chemotherapy, 2,8,9 and tamoxifen treatment. 10 A recent systematic review demonstrated that on average, breast cancer patients selected because they had either metastatic disease or were undergoing surgery or chemotherapy had a 10-fold increase in VTE risk compared with the breast cancer population as a whole.…”

“…1,2 Because breast cancer is the most common cancer worldwide, 3 this equates to a substantial impact of breast cancer-related VTE for patients and medical resources. Breast cancer-associated VTE accounts for approximately 17% of cancerrelated VTEs presenting to anticoagulation clinics.…”

Management of pulmonary embolism: recent evidence and the new European guidelines

“…Although the largest absolute numbers of VTE episodes occur in patients with lung, colon and prostate cancer, the relative risk for VTE is highest in multiple myeloma, brain, and pancreatic cancer (46-, 20-, and 16-fold increased relative risk versus healthy controls, respectively) [32]. Patients receiving chemotherapy have a sixfold increase in the adjusted risk ratio for VTE compared with a healthy population [31].…”