Incidence of Cancer after a Second Unprovoked Venous Thromboembolic Event

Rézig, Shéhérazade; Mao, Raphaël Le; Couturaud, Francis; Lacut, Karine; Delluc, Aurélien

doi:10.1055/s-0039-1677745

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…The incidence of cancer in patients with VTE is up to sixfold higher when compared with a population of similar age without VTE. [1][2][3] In clinical practice, suspicion of an underlying cancer is frequently raised in patients with VTE, especially when the event is unprovoked, that is, in the absence of a trigger or identifiable VTE risk factor. 4 The 1-year incidence of a cancer diagnosis following unprovoked VTE has been reported to be 5 to 10%, with most of the cancers being diagnosed in the first 6 months after VTE.…”

Section: Introductionmentioning

confidence: 99%

“…10 Recently, Rézig et al published a prospective study of 197 patients who had recurrent unprovoked VTE that occurred within 2 years. 1 The 1-year risk of a cancer diagnosis was 36% (95% confidence interval [CI]: 20-59) in patients with VTE recurrence during anticoagulant treatment versus 5.5% (95% CI: 2.9-10) among patients with VTE recurrence after stopping anticoagulation.…”

Section: Introductionmentioning

confidence: 99%

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Screening for Occult Cancer in Patients with Venous Thromboembolism: Past, Present, and Future

Jara‐Palomares

2020

Hamostaseologie

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A strong link between cancer and thrombosis has been well recognized. The occurrence of venous thromboembolism (VTE) can be the first clinical sign of an undiagnosed (i.e., occult) cancer. Cancer is more often diagnosed after unprovoked compared with provoked VTE events, with a reported risk in recent studies of around 5%. Extensive, imaging-based screening strategies to detect occult cancer after unprovoked VTE do not appear to have a clear clinical benefit compared with a more limited cancer screening. To identify patients with unprovoked VTE at high risk of occult cancer, risk factors have been explored and prediction models developed. Relevant risk factors for occult cancer include male sex, age, anemia, chronic lung disease, and thrombocytosis. Studies with preselection of patients based on risk assessment and evaluation of limited versus extensive screening strategies are currently ongoing. Also, novel and promising approaches for early detection of cancer in patients with unprovoked VTE by means of liquid biopsies, which include analysis of circulating tumor cells, cell-free tumor DNA, proteomics, or platelet mRNA sequencing, are currently under investigation. In this review, we provide an overview of the risk of cancer diagnosis after VTE, discuss the studies which investigated different screening strategies for occult cancer, summarize risk factors and risk scoring models for identification of patients at high risk of cancer diagnosis after VTE, and highlight ongoing research to optimize screening and identification of patients at risk of occult cancer, which will shape the future clinical practice.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Screening for Occult Cancer in Patients with Venous Thromboembolism: Past, Present, and Future

Jara‐Palomares

2020

Hamostaseologie

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“…In patients with recurrent VTE on anticoagulation, re-screening for occult or recurrent cancer is recommended. 15…”

Section: Management Strategiesmentioning

confidence: 99%

“…In patients with recurrent VTE on anticoagulation, re-screening for occult or recurrent cancer is recommended. 15 In patients with a confirmed VTE recurrence during vitamin K antagonists (VKAs) treatment, several options to modify the anticoagulation regimen are possible and suggested in ►Table 1. After ruling out insufficient dosage and non-compliance with the previous treatment (INR values in the target range?…”

Section: Management Strategiesmentioning

confidence: 99%

Recurrent Venous Thromboembolism in Patients on Anticoagulation: An Update Based on the Revised AWMF S2k Guideline

Klamroth,

Riess,

Beyer-Westendorf

et al. 2024

Hamostaseologie

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In the recently updated German S2k Guideline “Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism,” a new chapter was incorporated about recurrent venous thromboembolism (VTE) in patients on anticoagulation treatment. Despite the high efficacy of anticoagulation in most patients, approximately 2% experience a recurrent VTE event while receiving anticoagulant drugs. The proper diagnosis of the recurrent VTE is important and possible only with the knowledge of localization and thrombus burden of the primary VTE event. Possible reasons for recurrent VTE events in patients on anticoagulation are non-adherence to medication, sub-therapeutic drug levels due to resorption disorders or drug interactions, or concomitant disease with high thrombogenicity. Cancer is the most common underlying disease, but it is important to investigate and understand possible other causes whenever a breakthrough VTE event occurs. This results in the recommendation that in patients with VTE recurrence on therapeutic anticoagulation, in particular, the presence of malignant disease, antiphospholipid syndrome, and rare diseases like paroxysmal nocturnal hemoglobinuria or Behçet's disease should be considered. For VTE recurrence during heparin therapy, heparin-induced thrombocytopenia type II needs to be ruled out, even if platelet counts are within the normal range. Although the mechanisms of recurrence on anticoagulation can be evaluated in a certain degree, clinical evidence for the management of recurrent VTE in anticoagulated patients is minimal and mainly based on expert opinion. Switching anticoagulant medication and intensifying anticoagulant treatment are possible options.

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“…In patients without documented cancer, clinicians/patients/policymakers may question whether a search for underlying occult cancer is warranted in those with therapeutic failure. Indeed, Rezig and colleagues recently showed that the incidence of occult cancer detection in patients with a second episode of unprovoked VTE while on anticoagulant therapy was very high with a rate of 35.8% (95% CI, 19.7-59.2%) [23]. These high rates suggest that clinicians should have a low threshold for occult cancer screening and start with history, physical and simple age appropriate screening tests to start, followed by more costly tests such as CT chest, abdomen and pelvis [24].…”

Section: Consider the Etiology Of Recurrent Vte On Anticoagulantsmentioning

confidence: 99%

Management of suspected and confirmed recurrent venous thrombosis while on anticoagulant therapy. What next?

Rodger

Miranda

Delluc

et al. 2019

Thrombosis Research

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Suspected recurrent venous thromboembolism (VTE) is a common and vexing clinical problem. Confounding the diagnosis of recurrent VTE is a high frequency of residual VTE from prior VTE. The diagnosis of recurrent VTE must be established by comparing current imaging with past imaging to distinguish acute from chronic thrombosis. Next, we must ascertain if non-compliance was the cause of "apparent therapeutic failure" and if non-compliance is at play then re-initiate anticoagulant therapy. Therapeutic failure is relatively uncommon. As such, we must consider underlying causes of therapeutic failures including malignancy and potent thrombophilias. Finally, short term anticoagulant management of therapeutic failures is controversial, and requires further research, but the best current evidence supports a course of full-dose low-molecular-weight heparin (LMWH) (and dose escalated LMWH if failure occurs while on full-dose LMWH). 2.1. How frequent is residual venous disease? Cohort studies with serial imaging of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) demonstrate how often residual venous disease will persist on imaging. In the REVERSE study, 646 patients with unprovoked VTE had "baseline" leg vein imaging and/or ventilation/perfusion scan (V/Q) 5-7 months after index DVT and/or PE [1]. Baseline imaging was abnormal in 60.5% (391/646) of patients.

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Incidence of Cancer after a Second Unprovoked Venous Thromboembolic Event

Cited by 6 publications

References 17 publications

Screening for Occult Cancer in Patients with Venous Thromboembolism: Past, Present, and Future

Screening for Occult Cancer in Patients with Venous Thromboembolism: Past, Present, and Future

Recurrent Venous Thromboembolism in Patients on Anticoagulation: An Update Based on the Revised AWMF S2k Guideline

Management of suspected and confirmed recurrent venous thrombosis while on anticoagulant therapy. What next?

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