Reply to Frequency, Risk Factors, and Trends for Venous Thromboembolism Among Hospitalized Cancer Patients

Abstract Cancer-associated thrombosis (CAT) is a major cause of death in oncological patients. The mechanisms of thrombogenesis in cancer patients are not fully established, and it seems to be multifactorial in origin. Also, several risk factors for venous thromboembolism (VTE) are present in these patients such as tumor site, stage, histology of cancer, chemotherapy, surgery, and immobilization. Anticoagulant treatment in CAT is challenging because of high bleeding risk during treatment and recurrence of VTE. Current major guidelines recommend low molecular weight heparins (LMWHs) for early and long-term treatment of VTE in cancer patients. In the past years, direct oral anticoagulants (DOACs) are recommended as potential treatment option for VTE and have recently been proposed as a new option for treating CAT. This manuscript will give a short overview of risk factors involved in the development of CAT and a summary on the recent recommendations and guidelines for treatment of VTE in patients with malignancies, discussing also some special clinical situations (e.g. renal impairment, catheter-related thrombosis, and thrombocytopenia).

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RISK FACTORS FOR VENOUS THROMBOEMBOLISM (VTE) AMONG ACTIVE CANCER PATIENTS: A POPULATION-BASED CASE-CONTROL STUDY

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2007.tb01663.x ◽

2007 ◽

Vol 5 ◽

pp. O-T-006-O-T-006

Author(s):

J.A. Heit ◽

R.S. Marks ◽

A.A. Ashrani ◽

T.M. Petterson ◽

K.R. Bailey ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Case Control Study ◽

Population Based ◽

Case Control ◽

Control Study ◽

Active Cancer

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Association and prevalence of venous thromboembolism in cancer patients with COVID-19: A single healthcare system experience.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.2627 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 2627-2627

Author(s):

Aneesha Ananthula ◽

Dat Tran ◽

Katharine Thomas ◽

Katie Lauren McLemore McQueen Amaker ◽

Anh Nguyen ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Healthcare System ◽

Medical Center ◽

Meta Analysis ◽

Clinic Visit ◽

Cancer Therapies ◽

Search Field ◽

A Prospective Study

2627 Background: There are increasing reports of thromboembolic complications in patients with COVID-19 infection. According to a meta-analysis of 28,173 patients, the prevalence of venous thromboembolism (VTE) in hospitalized COVID-19 patients ranges from 7.9% to 22.7% based on the severity of COVID-19. Cancer and anti-cancer therapies are known risk factors for thrombosis. Another study based on registry data reported the overall prevalence of VTE in hospitalized COVID-19 patients with cancer to be 14.5%. Our study aimed to assess the prevalence of VTE in cancer patients diagnosed with COVID-19 as well as the association between VTE and cancer in the setting of COVID-19 infection in a large predominantly urban healthcare system. Methods: We utilized a cohort data query tool in the electronic medical record at University Medical Center in New Orleans, Louisiana to identify patients >17 years of age with a hospital or clinic visit in the LCMC Health system between March 1, 2020 and December 31, 2020 which were considered the base population for the study. Cancer patients were identified via the cancer registry tool. Patients with COVID-19 were identified using the abnormal COVID-19 PCR test result search field. An encounter diagnosis of deep venous thrombosis (DVT) or pulmonary embolism (PE) was used to identify patients with VTE. Odds ratios, p-values, and corresponding confidence intervals (CI) were calculated using 2x2 contingency tables. Results: In our database, we identified 3,807 patients with a diagnosis of COVID-19 and 9,560 with a cancer diagnosis. 158,812 patients had neither COVID-19 nor cancer. There were statistically significant greater odds of developing VTE in all subgroups compared: COVID-19 alone vs neither (OR 2.43), cancer alone vs neither (OR 3.8), and COVID-19 and cancer vs neither (OR 10.65). Conclusions: COVID-19 and cancer are both risk factors for VTE. Based on our study, appears that cancer has the greater effect on VTE compared with COVID-19 infection. Also, there is possibly a synergistic effect between COVID-19 and cancer, which further increases the likelihood of VTE. This study is a preliminary analysis. Further investigation is warranted in the form of either variable adjusted analysis of the same data, individual chart review, or a prospective study.[Table: see text]

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Risk of venous thromboembolism and primary prophylaxis in cancer

Hämostaseologie ◽

10.5482/ha-1173 ◽

2012 ◽

Vol 32 (02) ◽

pp. 132-137 ◽

Cited By ~ 11

Author(s):

C. Ay ◽

I. Pabinger

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

High Risk ◽

Cancer Patients ◽

Prediction Models ◽

Critical Evaluation ◽

Primary Prophylaxis ◽

Vte Prophylaxis ◽

Related Risk ◽

Hospitalised Patients

SummaryVenous thromboembolism (VTE) is a common complication in patients with cancer that causes significant morbidity and mortality. Several patient-, tumour-and treatment-related risk factors for VTE in cancer patients have been identified. An effective and safe thromboprophylaxis in cancer patients at high risk of VTE is desirable. Recently, the identification of potential biomarkers and the development of risk scoring models for prediction of cancer-associated VTE have been published. Whether primary VTE prophylaxis based on risk assessment through these biomarkers and risk prediction models might be useful, is currently not yet known. However, thromboprophylaxis is clearly indicated in high-risk situations. While VTE prophylaxis is recommended in cancer patients undergoing surgery and in hospitalised patients with acute disease, studies in ambulatory cancer patients are still rare and evidence for primary VTE prophylaxis is currently limited. In this review, risk factors associated with VTE in cancer patients and current approaches of thromboprophylaxis in different settings, specifically in ambulatory cancer patients are subjected to a critical evaluation.

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