Risk of Venous Thromboembolism in Patients with Cancer: A Systematic Review and Meta-Analysis

Horsted, Freesia; West, Joe; Grainge, Matthew J.

doi:10.1371/journal.pmed.1001275

Cited by 498 publications

(415 citation statements)

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“…Similar to our findings the UK linked databases found an overall IR of 14 per 1000 person-years, and a meta-analysis of 38 papers on cohorts with cancer patients (of which 7 were of average risk patients) reported an IR of 13 per 1000 person-years [24].…”

Section: Discussionsupporting

confidence: 90%

The increased risk of venous thromboembolism by advancing age cannot be attributed to the higher incidence of cancer in the elderly: the Tromsø study

et al. 2014

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Whether the high incidence of venous thromboembolism (VTE) in the elderly can be attributed to cancer is not wellstudied. We assessed the impact of cancer on risk of VTE in young, middle-aged and elderly. 26,094 subjects without a history of cancer or VTE were recruited from the Tromsø study. Incident cancer (n=2,290) and VTE (n=531) were recorded from baseline (1994-95) through December 31st, 2009. Cox regression with cancer as time-varying exposure was used to calculate hazard ratios with 95% confidence intervals (CI). Overt cancer was associated with a 5-fold (95%CI: 4.3, 6.7) increased risk of VTE, with an age-dependent gradient from 26-fold (95 %CI: 12.1, 56.5) increased in the young, 9-fold (95% CI: 6.6, 12.7) increased in the middleaged, and 3-fold (95 % CI: 2.5, 4.5) increased risk in the elderly. The population attributable risks were 14%, 27% and 18%, respectively. Conclusion: The relative risk of VTE by cancer were higher in young compared to elderly subjects, but the proportion of VTEs in the population due to cancer did not differ much across age groups. Our findings indicate that the increased risk of VTE by advancing age cannot be attributed to higher incidence of cancer in the elderly.

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Section: Discussionsupporting

confidence: 90%

The increased risk of venous thromboembolism by advancing age cannot be attributed to the higher incidence of cancer in the elderly: the Tromsø study

et al. 2014

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“…10 A recent systematic review demonstrated that on average, breast cancer patients selected because they had either metastatic disease or were undergoing surgery or chemotherapy had a 10-fold increase in VTE risk compared with the breast cancer population as a whole. 11 Although these studies go some way toward highlighting which groups are at highest risk of VTE, none have comprehensively assessed the relative importance of cancer treatments and biology in influencing VTE risk by using prospectively gathered data.…”

Section: Introductionmentioning

confidence: 99%

When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data

Walker

West

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et al. 2016

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Key Points• Patients with breast cancer have a risk of VTE equivalent to 6% a year while undergoing chemotherapy and in the month after treatment.• Tamoxifen is associated with a risk of VTE equivalent to 2% a year, which is 4 times higher than the risk before starting therapy.Patients with breast cancer are at increased risk of venous thromboembolism (VTE), particularly in the peridiagnosis period. However, no previous epidemiologic studies have investigated the relative impact of breast cancer treatments in a time-dependent manner. We aimed to determine the impact of breast cancer stage, biology, and treatment on the absolute and relative risks of VTE by using several recently linked data sources from England. .6 per 1000 person-years) than that in women who did not receive chemotherapy. After surgery, the risk was significantly increased in the first month (hazard ratio [HR], 2.2; 95% CI, 1.4-3.4; AR, 23.5; reference group, no surgery), but the risk was not increased after the first month. Risk of VTE was noticeably higher in the 3 months after initiation of tamoxifen compared with the risk before therapy (HR, 5.5; 95% CI, 2.3-12.7; AR, 24.1); however, initiating therapy with aromatase inhibitors was not associated with VTE (HR, 0.8; 95% CI, 0.5-1.4; AR, 28.3). In conclusion, women receiving chemotherapy for breast cancer have a clinically important risk of VTE, whereas an increased risk of VTE immediately after endocrine therapy is restricted to tamoxifen. (Blood. 2016;127(7):849-857) Medscape Continuing Medical Education onlineThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at http://www.medscape.org/journal/blood; and (4) view/print certificate. For CME questions, see page 953. Disclosures Thomas L. Ortel, Associate Editor, served as an advisor or consultant for Instrumentation Laboratory and received grants for clinical research from Instrumentation Laboratory; Eisai; Pfizer; and GlaxoSmithKline. The authors and CME questions author Laurie Barclay, freelance writer and reviewer, Medscape, LLC, declare no competing financial interests. Learning objectives1. Identify the effect of chemotherapy for breast cancer on the risk for venous thromboembolism, based on an English cohort study.2. Determi...

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“…general population is increased by a factor of 4 1 . In the cancer patient population, thromboembolism is associated with significant morbidity and mortality, and it is the second most common cause of death after cancer progression 2 .…”

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Clinical Challenges in Patients with Cancer-Associated Thrombosis: Canadian Expert Consensus Recommendations

et al. 2015

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general population is increased by a factor of 4 1 . In the cancer patient population, thromboembolism is associated with significant morbidity and mortality, and it is the second most common cause of death after cancer progression 2 . A number of published clinical practice guidelines have provided recommendations to medical oncologists for the management of cancer-associated thrombosis 3-5 ; however, currently available guidelines do not provide recommendations for challenging clinical situations (for example, thrombocytopenia, recurrent vte, catheter-related upper extremity dvt, etc.) encountered by health care practitioners caring for this patient population. METHODSThe purpose of the consensus process was to develop specific recommendations and to provide expert guidance for challenging cases that are not currently addressed in clinical practice guidelines on the treatment and prevention of vte in patients with cancer. The specific questions to be addressed were identified by the participants and supplemented by a systematic review of the available literature. Sources and SearchesFor each of the identified challenges, the literature in medline (1946 to March 2014), embase (1947 to March 2014), the Cochrane Central Register of Controlled Trials, and all Evidence Based Medicine Reviews (using the ovid interface) was systematically reviewed. References in included studies and previous systematic reviews were also reviewed for additional potential studies. The search was limited to human studies reported in the English language. One of the medline search strategies is depicted in Table i. Grading of the Evidence and Consensus ProcessThe multidisciplinary expert consensus group, which included 21 voting participants with expertise ABSTRACTVenous thromboembolism is a common complication in cancer patients, and thromboembolism is the second most common cause of death after cancer progression. A number of clinical practice guidelines provide recommendations for the management of cancerassociated thrombosis. However, the guidelines lack recommendations covering commonly encountered clinical challenges (for example, thrombocytopenia, recurrent venous thromboembolism, etc.) for which little or no evidence exists. Accordingly, recommendations were developed to provide expert guidance to medical oncologists and other health care professionals caring for patients with cancer-associated thrombosis. The current expert consensus was developed by a team of 21 clinical experts. For each identified clinical challenge, the literature in medline, embase, and Evidence Based Medicine Reviews was systematically reviewed. The quality of the evidence was assessed, summarized, and graded. Consensus statements were generated, and the experts voted anonymously using a modified Delphi process on their level of agreement with the various statements. Statements were progressively revised through separate voting iterations and were then finalized. Clinicians using these recommendations and suggestions should tailor patient management accord...

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Risk of Venous Thromboembolism in Patients with Cancer: A Systematic Review and Meta-Analysis

Cited by 498 publications

References 92 publications

The increased risk of venous thromboembolism by advancing age cannot be attributed to the higher incidence of cancer in the elderly: the Tromsø study

The increased risk of venous thromboembolism by advancing age cannot be attributed to the higher incidence of cancer in the elderly: the Tromsø study

When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data

Clinical Challenges in Patients with Cancer-Associated Thrombosis: Canadian Expert Consensus Recommendations

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