MEETING NEWS
Updates from recent hematology/oncology meetings
Researchers Define Long-Term Outcomes of
Cancer-Associated Thrombosis
Patients diagnosed with cancer-associated thrombosis (CAT)
remain at a high risk for recurrent venous thromboembolism
(VTE), bleeding, and death – even while on therapeutic anti-
coagulation – according to a retrospective analysis presented at
the 2018 ASCO Annual Meeting.
“[CAT] is a common complication of malignancies,” lead author
Robert Schmidt, a medical student in the department of internal
medicine at University of British Columbia in Vancouver, and col-
leagues wrote. “However, little is known about the clinical course of
CAT beyond the initial treatment period of three to six months.”
To define longer-term characteristics of CAT, the researchers
analyzed health records of 523 consecutive adults with active can-
cer who presented to the Vancouver General Hospital Thrombosis
clinic with a first CAT between 2013 and 2015.
A total of 327 patients (median age = 63 years; range not
reported) were alive six months after diagnosis of CAT and con-
stituted the survivors’ cohort. The authors documented patient
and cancer characteristics, as well as incidence of recurrent VTE,
clinically relevant bleeding, and overall mortality.
Participants were followed for a median of 605 days (range =
1-730 days) post-diagnosis. Beyond six months, anticoagulation
was continued in 68.8 percent of patients, for a median dura-
tion of 93 days (range not reported), and, more often than not,
patients were receiving anticoagulation (54.3% of patient-days
were on anticoagulation).
”Little is known about
the clinical course of
CAT beyond the initial
treatment period.”
—ROBERT SCHMIDT
In the six to 24 months after the initial CAT diagnosis, 30
patients (9.2%) experienced a total of 34 recurrent VTEs, corre-
sponding to 10.6 recurrent VTEs per 100 patient-years. Four-
teen patients (4.3%) experienced 16 events of clinically relevant
bleeding, corresponding to 5.0 episodes per 100 patient-years.
The authors observed that most of these events occurred
while patients were receiving anticoagulation: 21 recurrent VTEs
(61.8%) and 11 clinically relevant bleeding episodes (68.8%).
When looking at risk factors associated with recurrent VTE
or clinically relevant bleeding, the researchers observed that
female sex and cancer surgery were linked with a lower risk of
recurrent VTE:
• cancer surgery preceding initial VTE (hazard ratio [HR] =
0.12; 95% CI 0.01-0.85; p=0.034)
• female sex (HR=0.39; 95% CI 0.18-0.85; p=0.018)
Diagnosis of a cancer type with a known high thrombotic risk
(including brain, pancreatic, ovarian, upper gastrointestinal, and
lung), presence of two or more comorbidities, and progressive
cancer appeared to be associated with a higher risk for recurrent
VTE, but these associations did not reach statistical significance.
A total of 141 patients (43.1%) died during follow-up. The
most common cause of death, occurring at least six months after
diagnosis, was cancer (n=112; 79.4%), followed by bleeding (n=6;
4.3%) and recurrent VTE (n=3; 2.1%); the remaining causes
of death were identified as “other” (n=10; 7.1%) or “unknown”
(n=10; 7.1%). All instances of fatal recurrent VTE and four of the
six instances of fatal clinically relevant bleeding occurred while
patients were receiving anticoagulation, the researchers reported,
suggesting that “there is a high case fatality rate for both recurrent
VTE (10%) and clinically relevant bleeding (42.9%).”
Treatment guidelines recommend anticoagulation for three
to six months after diagnosis of CAT, the authors explained.
“After six months, anticoagulation is re-evaluated, but optimal
duration has not been studied. [The] information [from this
review] is important for clinicians and patients to inform their
decision regarding duration of anticoagulation,” they concluded.
The study is limited by its single-center, retrospective design.
The authors report no financial conflicts.
REFERENCE
Schmidt RA, Alzaki A, Desilet N, et al. Patient characteristics and long-term outcomes
beyond the first 6 months after a diagnosis of cancer-associated thrombosis. Abstract
#10057. Presented at the 2018 ASCO Annual Meeting, June 4, 2018; Chicago, IL.
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