Incidence and predictors of venous thromboembolism (VTE) among ambulatory high‐risk cancer patients undergoing chemotherapy in the United States

Abstract

BACKGROUND: Recent studies suggest that thromboprophylaxis is beneficial in preventing venous thromboembolism (VTE) in cancer outpatients, but this is not widely adopted because of incomplete understanding of the contemporary incidence of VTE and concerns about bleeding. Therefore, the authors examined the incidence and predictors of VTE in ambulatory patients with bladder, colorectal, lung, ovary, pancreas, or gastric cancers. METHODS: Data were extracted from a large health care claims database of commercially insured patients in the United States between 2004 and 2009. Demographic and clinical characteristics of the cancer cohort (N ¼ 17,284) and an age/sex-matched, noncancer control cohort were evaluated. VTE incidence was recorded during a 3-month to 12-month follow-up period after the initiation of chemotherapy. Multivariate analyses were conducted to identify independent predictors of VTE and bleeding. RESULTS: The mean age of the study population was 64 years, and 51% of patients were women. VTE occurred in 12.6% of the cancer cohort (n ¼ 2170) over 12 months after the initiation of chemotherapy versus 1.4% of controls (n ¼ 237; P < .0001); incidence ranged by cancer type from 19.2% (pancreatic cancer) to 8.2% (bladder cancer). Predictors of VTE included type of cancer, comorbidities (Charlson Comorbidity Index score or obesity), and commonly used specific antineoplastic or supportive care agents (cisplatin, bevacizumab, and erythropoietin). CONCLUSIONS: This large, contemporary, real-world analysis confirmed high rates of VTE in select patients with solid tumors and suggested that the incidence of VTE is high in the real-world setting. Awareness of the benefits of targeted thromboprophylaxis may result in a clinically significant reduction in the burden of VTE in this population. Cancer 2013;119:648-55.

Can Megestrol Acetate Induce Thrombosis in Advanced Oncology Patients Receiving Chemotherapy?

“…In a study, symptomatic VTE occured in 1.9 percent over a median follow-up 2.4 months or a rate of 0.8 percent/month after one cycle chemotherapy (Khorana et al, 2005). The impact of chemotherapy initiation on the incidence of VTE was demonstrated in a retrospective study of 17284 ambulatory patients with advanced cancer who were initiating systemic chemotherapy (Khorana et al, 2013). Compared with age-matched controls, patients with advanced cancer had a nine-fold increased risk of VTE within the first year of initiating chemotherapy (12.6 percent versus 1.4 percent).…”

“…Antineoplastic chemotherapy ınduces VTE, in addition to increased thrombogenesis in malignancy. In a study, symptomatic VTE occured in 1.9 percent over a median follow-up 2.4 months or a rate of 0.8 percent/month after one cycle chemotherapy (Khorana et al, 2005). The impact of chemotherapy initiation on the incidence of VTE was demonstrated in a retrospective study of 17284 ambulatory patients with advanced cancer who were initiating systemic chemotherapy (Khorana et al, 2013).…”

Thrombocytosis as a predictor of thromboembolic complications in patients with malignant diseases

“…18 Some studies have shown that a disseminated disease significantly increases the risk of VTE, compared to a disease without metastasis (OR=19.8; 95% CI=2.6-149). 19 Chemotherapy increases the incidence of thromboembolic events, which is explained by the potential iatrogenic damage to the endothelium of blood vessels and an increased synthesis and activation of coagulation factors. Prichard et al have demonstrated that the risk of venous thrombosis in female patients with breast cancer treated with tamoxifen amounts to 1.4%, while it amounts to 9.6% in patients treated with Tamoxifen and chemotherapy.…”

Minimising the impact of errors in the interpretation of CT images for surveillance and evaluation of therapy in cancer

“…1: Pulmonary Embolism: Venous thromboembolism (VTE) is common in all cancer patients 29 , with pancreas, stomach, and lung cancer appearing to be the most common cancer types 34 . Chemotherapy and modern biological therapies are also independent risk factors 32,33 .…”