Predictors of Early Mortality in Cancer-Associated Thrombosis: Analysis of the RIETE Database

Abstract

Cancer-associated thrombosis (CT) carries a high, heterogeneous, and poorly predicted likelihood of mortality. Thus, we aimed to define predictors of 30-day mortality in 10,025 patients with CT. In a randomly selected derivation cohort, we used recursive partitioning analysis to detect variables that select for a risk of mortality within 30 days. In a validation cohort, we evaluated our results using Cochran-Armitage test. The most common types of cancer were lung (16%), breast (14%), and colorectal (14%); median age was 69 years (range, 14-101); most had metastatic disease (63%); 13% of patients died within 30 days. In the derivation cohort (n ¼ 6,660), a white blood cell (WBC) count in the highest quartile predicted early mortality (odds ratio, 7.8; 95% confidence interval [CI], 4.6-13.1); and the presence of metastatic disease, pulmonary embolism (PE), and immobility defined the risk of those with normal WBC count. We defined death risk according four sequential questions: (1) (Yes, group C; no, group B). In the validation cohort (n ¼ 3,365), the 30-day risk of death was 2.9% in group A (95% CI, 1.9-4.3), compared with 25% in group D (95% CI, 22.5-27.5), and there was a rate escalation between groups (p for trend < 0.01). In conclusion, with four sequential questions, the risk of death in CT can be easily stratified. An elevated WBC count at baseline predicted 30-day mortality better than metastases, PE, or immobility.

Incidence and Risk Factors for Venous Thromboembolism in Female Patients Undergoing Breast Surgery

“…Globally, cancer among women is associated with a significant burden of venous thromboembolism (VTE). Despite the low incidence of VTE in localized breast cancer (5 per 1000 person years), the great number of early breast cancers worldwide justifies the numerous VTE cases associated with breast cancer (about 14% of all cancer-associated VTE) [ 2 , 3 ]. In particular, the introduction of systematic mammographic screening programs all over the world increased the number of early breast cancer diagnoses, as well as the number of women susceptible to surgical treatment, and significantly improved the survival after surgery or after the exposure to adjuvant treatments [ 4 , 5 ].…”

Outcomes after venous thromboembolism in patients with gastric cancer: Analysis of the RIETE Registry

“…Indeed, immobilization due to the malignancy or its treatment has been identified as a factor associated with mortality in other cancers. 27,45,46 With the advent of the results of the APEX trial, in which betrixaban was effective in reducing the VTE likelihood after hospitalization, it is plausible that patients with gastric cancer also would benefit from extended post-hospitalization thromboprophylaxis. 47 Notably, immobility is not accounted for in the cancer-specific VTE prediction scores and few patients with cancer were recruited in the APEX trial.…”

“…These cut-offs were adopted given prior literature specific to cancer-associated thrombosis. 26,27 Taller height has been associated with CAT outcomes and was defined as the upper quartile of height per sex. 28 Other quantitative variables such as platelet count, time from cancer diagnosis to VTE, and glomerular filtration rate were categorized according to quartiles or by pre-existing criteria as available.…”

Happy New Year!

“…Amongst the clinical studies published in the journal, two papers from the RIETE Registry dealing with cancer-associated thrombosis stand out, which have been widely cited. 2 3 In the basic science field, a paper by Kashiwagi et al indicating that nicotine- and tar-free cigarette smoke extract (CSE) inhibits COX-1 activity and thereby decreases TXA 2 production in platelets, leading to inhibition of platelet aggregation. 4…”