Venous thromboembolism in patients with active cancer

Abstract

Patients with cancer have an increased risk of venous thromboembolism (VTE). To further define the demographics, comorbidities, and risk factors of VTE in these patients, we analyzed a prospective registry of 5,451 patients with ultrasound confirmed deep vein thrombosis (DVT) from 183 hospitals in the United States. Cancer was reported in 1,768 (39%), of whom 1,096 (62.0%) had active cancer. Of these, 599 (54.7%) were receiving chemotherapy, and 226 (20.6%) had metastases. Lung (18.5%), colorectal (11.8%), and breast cancer (9.0%) were among the most common cancer types. Cancer patients were younger (median age 66 years vs. 70 years; p < 0.0001), were more likely to be male (50.4% vs. 44.5%; p = 0.0005), and had a lower average body mass index (26.6 kg/m(2) vs. 28.9 kg/m(2); p < 0.0001). Cancer patients less often received VTE prophylaxis prior to development of DVT compared to those with no cancer (308 of 1,096, 28.2% vs. 1,196 of 3,444, 34.6%; p < 0.0001). For DVT therapy, low-molecular-weight heparin (LMWH) as monotherapy without warfarin (142 of 1,086, 13.1% vs. 300 of 3,429, 8.7%; p < 0.0001) and inferior vena caval filters (234 of 1,086, 21.5% vs. 473 of 3,429, 13.8%; p < 0.0001) were utilized more often in cancer patients than in DVT patients without cancer. Cancer patients with DVT and neurological disease were twice as likely to receive inferior vena caval filters than those with no cancer (odds ratio 2.17, p = 0.005). In conclusion, cancer patients who develop DVT receive prophylaxis less often and more often receive filters than patients with no cancer who develop DVT. Future studies should focus on ways to improve implementation of prophylaxis in cancer patients and to further define the indications, efficacy, and safety of inferior vena caval filters in this population.

Venous Thromboembolism in Cancer Patients: Comparison of Lung Cancer Patients to Other Solid Tumor Patients in a Prospective Observational Study

“…LC is the most common cause of cancer-related death worldwide (Jemal et al, 2009). Patients with LC show a high prevalence of VTE as observed by different authors (Blom et al 2004, Tagalakis et al 2007and Chew et al 2007 being one of the most common tumors in series of patients with cancer-related VTE (Seddighzadeh et al 2007, White at al 2005and Paneesha et al 2010. The thrombotic risk in patients with LC is 20-fold higher than in the general population according to findings by Blom et al (2004).…”

Clinical Experience of Nadroparin in Patients with Cancer

“…Concerning the prevention of venous thromboembolism, a significant proportion of cancer patients are not adequately treated. [88][89][90] Nadroparin may be valuable in this context because, in contrast to other low-molecular-weight heparins for which higher doses are required in cancer patients undergoing general surgery compared with non-cancer patients undergoing similar surgical procedures, a single dosage regimen of nadroparin 2,850 anti-Xa IU or 0.3ml once daily was effective and safe for preventing venous thromboembolism in both non-cancer and cancer patients. Furthermore, nadroparin is also the only low-molecular-weight heparin shown to reduce mortality in general surgery patients with or without cancer.…”

Neoadjuvant Chemotherapy for Colorectal Liver Metastases

“…A number of contributory risk factors are also present in this patient population in addition to the underlying malignancy. In particular, the insertion of indwelling central venous catheters can be associated with increased risk of thromboembolic complications (Seddighzadeh, Shetty, & Goldhaber, 2007). Given the spurious nature of reports on thromboembolic complications in irinotecan-containing neoadjuvant chemotherapy regimens, it is premature to completely dismiss their role in the management of colorectal liver metastases.…”