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Hemostasis

Incidental Venous Thromboembolism in Cancer Patients on Routine CT Scans

In a prospective cohort study, Carmen Escalante et al. investigated the prevalence of incidental venous thromboemtolism (VTE) in almost 1100 adult cancer patients on routine staging CT scans of the chest, abdomen, or pelvis. The research team also documented symptoms associated with incidental VTEs and determined the incidence of VTE recurrence in these patients after 3 and 6 months.

VTE is a major complication of cancer. Although cancer patients have higher rates of VTE than those without cancer, few studies have previously investigated the prevalence of incidental VTE in cancer patients. Escalante et al. found a rate of incidental VTE in these patients to be 1.8%, which is higher than some other reports. However, this prospective study enrolled patients who had neither a prior history of PE or DVT nor a suspected VTE, and who were not taking anticoagulants.

Symptoms can help lead clinicians to a diagnosis of VTE. A previously published retrospective study of incidental VTE in cancer patients noted fatigue and dyspnea as more common in patients with incidental VTE than in the control group. In this prospective study, Escalante et al. found that fatigue, depression, stress, and poor quality of life were associated with incidental VTE, but dyspnea was not. The authors note, however, that both cases and controls experienced normal to mild symptoms, so it is not clear whether these symptoms, though statistically significant, are clinically relevant.

The authors are careful to point out features of the study, the cancer patients, and the cancer center from which they were recruited that might bias the findings. Nevertheless, the study sheds light on some important aspects of incidental VTEs that are often found on imaging studies requested for other purposes. While several symptoms were associated with VTE, further research is needed to determine their clinical relevance in this context. All of the patients with VTE had at least one comorbidity. No VTE recurrences were noted within 6 months of VTE diagnosis.

For more information, see Escalante CP, Gladish GW, Qiao W, Zalpour A, Assylbekova B, Gao S et al. Prospective cohort study of cancer patients diagnosed with incidental venous thromboembolism on routine computed tomography scans. Support Care Cancer. 2017 Jan 9. [Epub ahead of print]