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Scoring system stratified patients by recurrence risk of cancer-associated VTE
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52nd ASH Annual Meeting
ORLANDO — A risk model including variables such as tumor stage and history of venous thromboembolism was able to stratify patients by their recurrence risk for cancer-associated venous thromboembolism, according to results from a single-center retrospective cohort study conducted in Ottawa.
Martha L. Louzada, MD, a hematologist with the University of Western Ottawa, added that it did not appear that type of treatment — either vitamin K agonist or low-molecular–weight heparin — affected risk.
Researchers retrospectively analyzed charts of patients with cancer and VTE and followed them from 2002 to 2004 and from 2007 to 2008 to assess the possibility of creating a clinical prediction rule that stratified VTE recurrence risk in patients with cancer–associated VTE. Louzada and colleagues reviewed data from 543 patients who developed VTE within 6 months of beginning anticoagulation treatment, looking for characteristics of malignancy and other clinical characteristics.
The rate of recurrence was 9.5% in those assigned to vitamin K agonist and 10.5% for those assigned to LMWH (RR=1.13; 95% CI, 0.743-1.711).
“We were able to demonstrate that there are four independent predictors of venous thromboembolism recurrence: gender, primary tumor site, malignancy stage and prior history of venous thromboembolism,” Louzada said. “As such, high risk predictors are: female gender, lung cancer and prior history of venous thrombosis.”
She added that breast cancer and stage I disease were associated with reduced risk.
Using this model, researchers built a scoring system assigning a value to each independent risk predictor. A patient’s score could range from -3 to 3.
“Patients who scored zero or less have a low clinical probability of recurrence of 4.5%,” Louzada said. “Patients who scored one or more had a high probability of 19.7 to validate the model and evaluate the efficacy of various treatment strategies ac%. This difference is highly significant.”
Because this is the first time that a study has demonstrated a difference in VTE recurrence risk in patients with cancer, Louzada said researchers had already started working on a prospective study cording to an individual patient’s risk. – by Jason Harris
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This is a relatively small study and it’s retrospective. The results are convincing as far as they go, but they do need to be validated in a prospective setting. If these results can be reproduced prospectively, this predictor would be quite useful. Many patients with cancer have an increased for bleeding complications ; stratification by risk of thrombosis would enable physicians to better balance the chance for benefit vs. the risk for harm.
- J. Evan Sadler, MD, PhD
Professor of
Medicine, Washington University in St. Louis
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