We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site.
We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with with one of the 4 more frequent cancer (breast, prostate, colorectal or lung cancer).
As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95%CI: 3.8-8.1] vs. 4.1 [95%CI: 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95%CI: 7.6-13] vs. 12 [95%CI: 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95%CI: 4.4-10] vs. 13 [95%CI: 9.2-17] events per 100 patient-years) whereas in those with lung cancer, the rate of thromboembolic recurrences was two-fold higher than the rate of major bleeding (27 [95%CI: 22-23] vs. 11 [95%CI: 8.6-15] per 100 patient-years).
Significant differences in the clinical profile of venous thromboembolic related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.
The American journal of medicine. 2016 Jan 21 [Epub ahead of print]
Isabelle Mahe, Jean Chidiac, Laurent Bertoletti, Carme Font, Javier Trujillo-Santos, Marisa Peris, Cristina Pérez Ductor, Santiago Nieto, Elvira Grandone, Manuel Monreal, RIETE investigators
Department of Internal Medicine. Hôpital Louis Mourier,Colombes (APHP),University Paris 7,EA Remes7334,F-CRIN,INNOVTE.France. Electronic address: ., Department of Internal Medicine. Hôpital Louis Mourier. Colombes,(APHP),University Paris 7.France., Department of Vascular and Therapeutic Medicine. CHU Saint-Etienne,Hôpital Nord,Saint-Etienne,F-CRIN, INNOVTE.France., Department of Medical Oncology. IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors. Hospital Clinic de Barcelona. Spain., Department of Internal Medicine. Complejo Hospitalario Universitario de Cartagena. Murcia. Spain., Department of Internal Medicine. Hospital Provincial Castellon; CEU Cardenal Herrero University, Castellon. Spain., Department of Emergency. Hospital Universitario Doctor Peset. Valencia. Spain., Department of Haematology. Hospital de la Vega Lorenzo Guirao. Murcia. Spain., Atherosclerosis and Thrombosis Unit. Casa Sollievo Della Sofferenza. Foggia. Italy., Department of Internal Medicine. Hospital Universitari Germans Trias i Pujol. Badalona. Universidad Católica de Murcia. Spain.