Rates of Initial and Recurrent Thromboembolic Disease Among Patients with Malignancy Versus Those without Malignancy: Risk Analysis Using Medicare Claims Data

Abstract

Although the association between malignancy and thromboembolic disease is well established, the relative risk of developing initial and recurrent deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients with malignancy versus those without malignancy has not been clearly defined. The Medicare Provider Analysis and Review Record (MEDPAR) database was used for this analysis. Patients hospitalized during 1988-1990 with DVT/PE alone, DVT/PE and malignancy, malignancy alone, or 1 of several nonmalignant diseases (other than DVT/PE) were studied. The association of malignancy and nonmalignant disease with an initial episode of DVT/PE, recurrent DVT/PE, and mortality were analyzed. The percentage of patients with DVT/PE at the initial hospitalization was higher for those with malignancy compared with those with nonmalignant disease (0.6% versus 0.57%, p = 0.001). The probability of readmission within 183 days of initial hospitalization with recurrent thromboembolic disease was 0.22 for patients with prior DVT/PE and malignancy compared with 0.065 for patients with prior DVT/PE and no malignancy (p = 0.001). Among those patients with DVT/PE and malignant disease, the probability of death within 183 days of initial hospitalization was 0.94 versus 0.29 among those with DVT/PE and no malignancy (p = 0.001). The relative risk of DVT/PE among patients with specific types of malignancy is described. This study demonstrates that patients with concurrent DVT/PE and malignancy have a more than threefold higher risk of recurrent thromboembolic disease and death (from and cause) than patients with DVT/PE without malignancy. An alternative management strategy may be indicated for such patients.

Regional lymph node metastases are a strong risk factor for venous thromboembolism: results from the Vienna Cancer and Thrombosis Study

“…[1][2][3][4][5][6] However, the risk of VTE among cancer patients differs considerably 3,5 and is below 10% even in certain groups of patients with advanced cancer. 7 Predictive parameters are, therefore, required to stratify patients into risk groups.…”

Microparticle‐associated tissue factor activity: a link between cancer and thrombosis?

“…The incidence of thrombosis is high in adenocarcinomas such as ovarian, prostate and gastro-intestinal carcinoma [2,3], but is particularly high (up to 57%) in patients with pancreatic cancer [4][5][6]. However, the cause of this association is still unknown.…”

Tissue factor expression as a possible determinant of thromboembolism in ovarian cancer

“…According to data from Medicare International Classification of Disease, 9th Revision (ICD-9) hospital discharge diagnoses between 1988 and 1990 in the United States, ovarian cancer exhibited the highest incidence of cancer-related VTE, at 120 out of 10 000 patients (Levitan et al, 1999). Moreover, some reports have suggested that clear cell carcinoma of the ovary is particularly likely to develop VTE (Pather and Quinn, 2005).…”