- •Arterial events are a major cause of death in cancer patients with venous thrombosis.
- •Arterial events occur early after venous thrombosis in cancer patients.
- •The risk of arterial events should be considered in this clinical setting.
Abstract
Background
Venous thromboembolism is common in patients with malignancies, affecting up to 10%
of this patient population. The association between arterial ischemic events and venous
thromboembolism also has been established. However, the influence of arterial ischemic
events on outcomes in cancer patients with venous thromboembolism has not been fully
determined.
Methods
The current study analyzed clinical characteristics, time course, risk factors, incidence
and severity of venous thromboembolism recurrences, arterial ischemic events and major
bleeding in 5717 patients with active cancer and venous thromboembolism recruited
into RIETE (multi-center prospective registry of patients with objectively confirmed
venous thromboembolism).
Results
During the anticoagulation course (median 7.3 months), 499 (8.7%) patients developed
venous thromboembolism recurrences, 63 (1.1%) developed arterial events, and 346 (6.1%)
suffered from major bleeding. Overall, major bleeding and arterial events appeared
earlier (median 35 and 36 days, respectively) than venous thromboembolism recurrences
(median 97 days). Thirty-day mortality rates after each event were: 20% after recurrent
pulmonary embolism, 13% after recurrent deep vein thrombosis, 41% after major bleeding,
40% after myocardial infarction, 64% after ischemic stroke, and 83% after lower limb
amputation. Bleeding was the leading cause of death (67 fatal bleeds), whereas cumulative
mortality due to arterial ischemic events (n = 27) was similar to that related to
pulmonary embolism recurrences (n = 26).
Conclusions
In this study, arterial ischemic events and major bleeding appeared early after venous
thromboembolism in patients with active cancer and were among frequent causes of their
deaths. The risk and severity of arterial events need to be considered in this clinical
setting.
Keywords
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Article info
Publication history
Published online: May 26, 2018
Accepted:
April 21,
2018
Received in revised form:
April 15,
2018
Received:
March 21,
2018
Footnotes
Funding: B Bikdeli is supported by the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), through grant number T32 HL007854. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Conflict of Interest: The authors declare no conflicts of interest relevant to this submission.
Authorship: B Brenner designed research, interpreted the data, wrote the paper, and approved the final version of the paper; B Bikdeli designed research, interpreted the data, wrote the paper, and approved the final version of the paper; IT recruited patients, performed research, interpreted the data, and approved the final version of the paper; OM recruited patients, performed research, and approved the final version of the paper; RL-R recruited patients, performed research, and approved the final version of the paper; JMS recruited patients, performed research, and approved the final version of the paper; ÁB-M recruited patients, performed research, and approved the final version of the paper; AT recruited patients, performed research, and approved the final version of the paper; JJLN recruited patients, performed research, and approved the final version of the paper; JT-S recruited patients, performed research, interpreted the data, and approved the final version of the paper; and MM recruited patients, designed research, interpreted the data, wrote the paper, approved the final version of the paper, and obtained funding.
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