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Hemostasis

The Clinical Course of Venous Thromboembolism May Differ With Cancer Site

Carme Font is one of a large group of investigators who have collaborated on a study of differences in the clinical course of venous thromboembolism (VTE) in relation to specific cancer sites (breast, prostate, colorectal, and lung). The study was based on data from an international registry of patients with VTE,* and included almost 4000 adult patients with active cancer.

VTE is a common and potentially life-threatening complication of cancer and its treatment. The incidence of VTE is higher among cancer patients than the general population and the rate varies with cancer site. A low risk of VTE has been associated with breast and prostate cancer compared with a higher risk for patients with lung and pancreatic cancer. In general, the more biologically active the cancer, the higher the risk of VTE. Moreover, rates of recurrence and bleeding complications associated with anticoagulation therapy are higher among cancer patients than among patients without cancer, but little is known about the course of VTE in relation to tumor site.

Current guidelines for antithrombotic therapy in cancer patients recommend that all cancer patients with VTE receive long-term therapy with similar doses of low-molecular- weight heparin regardless of the initial VTE presentation, spread, and cancer treatments. Some studies have documented that variables such as cancer stage, treatments, and comorbidities can affect VTE outcome. The authors hypothesized that the biological and clinical characteristics of different malignancies and their treatments might influence the balance between the rate of VTE recurrence and major bleeding during follow-up and, if so, this would have implications for anticoagulation treatment.

The investigators compared the clinical VTE-related outcomes during a course of anticoagulation with a mean duration of 139 days. They found that, during this period, the rate of thromboembolic recurrences was similar to the rate of major bleeding events in patients with breast and colorectal cancer, but was half the rate of major bleeding events in patients with prostate cancer and twofold higher than major bleeding events in patients with lung cancer. These data support the need for research to evaluate anticoagulation strategies with regard to the intensity and duration of therapy in relation to cancer site. This approach could lead to more individualized anticoagulation regimens for managing VTE in cancer patients, which in turn would improve both safety and quality of life and reduce the costs of care.

For more information, see Mahé I, Chidiac J, Bertoletti L, Font C, Trujillo-Santos J, Peris M et al; RIETE investigators. The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site. Am J Med. 2017 Mar;130(3):337-347.

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*The Computerized Registry of Patients with Venous Thromboembolism (RIETE), a multidisciplinary project initiated in March 2001, is an extensive data registry of consecutive patients with venous thromboembolism.