Venous Thromboembolism Risk in Patients With Cancer Receiving Chemotherapy: A Real-World Analysis

Duke University School of Medicine and the Duke Cancer Institute, Durham, North Carolina, USA
The Oncologist (Impact Factor: 4.87). 11/2013; 18(12). DOI: 10.1634/theoncologist.2013-0226
Source: PubMed


The occurrence of malignant disease increases the risk for venous thromboembolism (VTE). Here we evaluate the risk for VTE in a large unselected cohort of patients with cancer receiving chemotherapy.
The United States IMPACT health care claims database was retrospectively analyzed to identify patients with a range of solid tumors who started chemotherapy from January 2005 through December 2008. International Classification of Diseases, 9th revision, Clinical Modification Codes were used to identify cancer location, presence of VTE 3.5 months and 12 months after starting chemotherapy, and incidence of major bleeding complications. Health care costs were assessed one year before initiation of chemotherapy and one year after initiation of chemotherapy.
The overall incidence of VTE 3.5 months after starting chemotherapy was 7.3% (range 4.6%-11.6% across cancer locations) rising to 13.5% at 12 months (range 9.8%-21.3%). The highest VTE risk was identified in patients with pancreatic, stomach, and lung cancer. Patients in whom VTE developed had a higher risk for major bleeding at 3.5 months and at 12 months (11.0% and 19.8% vs. 3.8% and 9.6%, respectively). Health care costs were significantly higher in patients in whom VTE developed.
Those undergoing chemotherapy as outpatients are at increased risk for VTE and for major bleeding complications. Thromboprophylaxis may be considered for such patients after carefully assessing the risks and benefits of treatment.

    • "Even in this population, these were mostly transient and reversible events, with infrequent haematologic support required, and the few infections or major bleeding events that occurred could be attributed to complications of underlying disease. Coagulopathy and thromboembolic events are known risks in advanced pancreatic cancer with 10–20% incidence rates reported in some studies [32], and while treatment-related myelosuppression may have exacerbated the two cases of consumptive coagulopathy that occurred, there is little evidence that treatment was involved in the two cerebrovascular accidents that occurred. Most other AEs were mild-moderate constitutional and gastrointestinal events also expected in advanced pancreatic cancer, and comparison of events between treatment arms showed no substantial differences . "
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