Nationwide analysis of healthcare burden and risk of mortality in cancer patients with deep venous thrombosis.

Abstract

e19093 Background: Occurrence of venous thromboembolism is well known to have increased mortality in cancer patients with pulmonary embolism known to be the leading contributor. However, risk of mortality and healthcare burden with deep venous thrombosis (DVT) alone is not well elucidated, and primary prophylaxis is still controversial. We sought to evaluate risk of hospitalization, mortality, as well as, differences in resource utilization in patients with and without cancer, who were diagnosed in the emergency department (ED) with acute DVT alone. Methods: Adult patients diagnosed with acute DVT from January 2016 to December 2017 were identified from the Nationwide Emergency Department Samples (NEDS) database. Univariate and Multivariate logistic regression analysis was used to compare the risk of admission from the ED and inpatient mortality in DVT patients with cancer and those without. Secondary outcomes assessed were length of hospital stay (LOS), inpatient hospital charges, risk of GI bleed, and rates of inferior vena cava (IVC) filter placement and thrombolysis. Results: A total of 404,121 patients were diagnosed with acute DVT only, of which 8% had an underlying malignancy. Most common primary cancers were GI tract (20.1%), hematologic (16.5%) and lung (13.5%). Patients with cancer were older (mean age 66.4 vs 59.8 years, p<0.0001), with a slight male preponderance (51.8% vs 47.5%, p<0.0001). They were also more likely to be admitted from the ED (70.5% vs 39.1%, p<0.0001). Patients with malignancy had longer length of stay, higher hospital charges, higher mortality and rates of GI bleed (p<0.001 for all outcomes). On multivariable analysis, after adjusting for age, sex and comorbidities, patients with cancer were more likely to be admitted than those without cancer (OR 3.71, CI 3.41-4.04, p<0.001), had higher mortality (OR 3.09, CI 2.42-3.94, p<0.001) and rates of GI bleed (1.75, CI 1.45-2.12, p<0.001). Likely for this reason, patients with cancer were more likely to undergo IVC filter placement (15.2% vs 9.4%, p<0.0001) and less likely to receive thrombolysis (4.5% vs 7.4%, p<0.0001). Conclusions: Cancer patients with DVT presenting to ED had higher hospitalization rates with increased risk of mortality, GI bleed, IVC filter placement and decreased rates of thrombolysis than those without malignancy that was compounded by longer in-hospital LOS and healthcare costs. Further studies are needed to evaluate the need of prevention strategies for DVT that can help mitigate these factors in cancer patients.

How Well do European Patients Understand Cancer-Associated Thrombosis? A Patient Survey

“…Data support that up to 20% of patients with cancer will experience VTE, which is approximately 4-5 times higher than the general population [4]. Unfortunately, despite the large body of evidence demonstrating the safety and efficacy of anticoagulants in the prevention and treatment of venous thrombosis in this population [5,6], it is well recognized that patients with cancer associated thrombosis (CAT) continue to have higher hospitalization rates with increased risk of mortality and decreased rates of thrombolysis than in the general population [2,7,8]. The high rate of CAT suggests that, despite the clear guideline recommendations for patients with cancer (ISTH, ASCO, ESMO, ASH), CAT prevention and recognition remain low amongst healthcare professionals [3,9,10].…”