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Mahé I, Chidiac J, Bertoletti L, Font C, Trujillo-Santos J, Peris M, Pérez Ductor C, Nieto S, Grandone E, Monreal M, Arcelus J, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Casado I, Culla A, de Miguel J, del Toro J, Díaz-Peromingo J, Falgá C, Fernández-Capitán C, Font C, Font L, Gallego P, García-Bragado F, García-Brotons P, Gómez V, González J, Grau E, Grimón A, Guirado L, Gutiérrez J, Hernández G, Hernández-Blasco L, Isern V, Jara-Palomares L, Jaras M, Jiménez D, Lacruz B, Lecumberri R, Lobo J, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Madridano O, Marchena P, Martín-Antorán J, Martín-Martos F, Monreal M, Morales M, Nauffal D, Nieto J, Nieto S, Núñez M, Otalora S, Otero R, Pagán B, Pedrajas J, Pérez C, Pérez G, Peris M, Porras J, Ramírez L, Reig O, Riera A, Rivas A, Rodríguez-Dávila M, Rosa V, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Martínez C, Sampériz A, Sala C, Sanz O, Soler S, Sopeña B, Suarez I, Suriñach J, Tiberio G, Tolosa C, Trujillo-Santos J, Uresandi F, Valle R, Vela J, Villalta J, Malfante P, Verhamme P, Wells P, Hirmerova J, Malý R, Tomko T, Salgado E, Bertoletti L, Bura-Riviere A, Farge-Bancel D, Hij A, Mahé I, Merah A, Papadakis M, Braester A, Brenner B, Tzoran I, Apollonio A, Barillari G, Candeloro G, Ciammaichella M, Di Micco P, Ferrazzi P, Grandone E, Lessiani G, Lodigiani C, Mastroiacovo D, Pace F, Pinelli M, Prandoni P, Rota L, Tiraferri E, Tufano A, Visonà A, Belovs A, Skride A, Moreira M, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Alatri A, Bounameaux H, Calanca L, Mazzolai L, Serrano J, Decousus H, Reis A. The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site. Am J Med 2017; 130:337-347. [PMID: 27884650 DOI: 10.1016/j.amjmed.2016.10.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site. AIM AND METHODS 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 one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer). RESULTS 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% confidence interval (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 twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years). CONCLUSIONS 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.
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Affiliation(s)
- Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France.
| | - Jean Chidiac
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France
| | - Laurent Bertoletti
- Department of Vascular and Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, French Clinical Research Infrastructure Network (F-CRIN), INNOVTE
| | - Carme Font
- Department of Medical Oncology, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clinic de Barcelona, Spain
| | - Javier Trujillo-Santos
- Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain
| | - Marisa Peris
- Department of Internal Medicine, Hospital Provincial Castellon; CEU Cardenal Herrero University, Spain
| | - Cristina Pérez Ductor
- Department of Emergency Medicine, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Santiago Nieto
- Department of Haematology, Hospital de la Vega Lorenzo Guirao, Murcia, Spain
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain
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