This article is more than 5 years old. Information may no longer be current.
Recurrent VTE linked to certain cancers, leg paresis
Click Here to Manage Email Alerts
Specific types of malignancies — including brain, lung and ovarian cancers, as well as myeloproliferative or myelodysplastic disorders — increased risk for recurrent venous thromboembolism among patients with active cancer, according to results of a population-based analysis.
Stage IV disease, cancer stage progression and leg paresis also predicted venous thromboembolism (VTE) recurrence, results showed.
Cheng E. Chee, MD, of the division of hematology and oncology at Case Western Reserve University School of Medicine, and colleagues evaluated data from 477 patients who experienced active cancer-related incident VTE from 1966 to 2000. The mean age of patients at the time of the VTE incident was 66.8 years, and 46.3% were women.
Nearly 80% of patients were diagnosed with cancer within 4 weeks of the VTE incident, and 66% of these patients had stage III or stage IV disease.
During 1,533 person-years of follow-up, 139 cases of recurrent VTE occurred. The median time to recurrence was 92 days (interquartile range, 26-751).
Using these data, researchers calculated an adjusted 10-year cumulative VTE recurrence rate of 28.6%, and the adjusted 90-day cumulative incidence of major bleeding on anticoagulation was 1.9%.
Cumulative mortality at 10 years was 85.2%. The 90-day cumulative mortality among patients who experienced pulmonary embolism (PE) with or without deep vein thrombosis (DVT) was significantly worse than the mortality observed among patients who experienced DVT alone (67.2% vs. 30.7%; P≤.001).
Results of a multivariate analysis indicated patients with brain cancer (HR=4.57; 95% CI, 2.07-10.09), ovarian cancer (HR=3.22; 95% CI, 1.57-6.59) and lung cancer (HR=2.73; 95% CI, 1.63-4.55) were at significantly increased risk for VTE recurrence. Those with stage IV pancreatic cancer (HR=6.38; 95% CI, 2.69-15.13), as well as those with any stage IV cancer other than pancreatic cancer (HR=2.85; 95% CI, 1.74-4.67), also were at significant risk for VTE recurrence.
Myeloproliferative or myelodysplastic disorders (HR=3.49; 95% CI, 1.59-7.68), neurological disease with leg paresis (HR=2.38; 95% CI, 1.14-4.97) and cancer stage progression (HR=2.14; 95% CI, 1.30-3.52) also independently and significantly predicted VTE recurrence.
Patients with multiple active cancers (HR=1.78; 95% CI, 0.87-3.63), non-colorectal gastrointestinal cancers (HR=1.94; 95% CI, 0.9-4.17), and stage III acute lymphoblastic leukemia or acute myeloid leukemia (HR=1.47; 95% CI, 0.95-2.27) demonstrated an insignificant trend toward increased risk for VTE recurrence.
However, warfarin therapy significantly reduced the risk for VTE recurrence (HR=0.43; 95% CI, 0.28-0.66).
“Recurrence rates were significantly higher for cancer patients with one or more vs. no predictors of recurrence, suggesting these predictors may be useful for stratifying recurrence risk,” Chee and colleagues wrote.
Disclosure: One researcher reports advisory board roles with and honoraria from Daiichi Sankyo and Janssen Pharmaceuticals.
Click Here to Manage Email Alerts