- Email: [email protected]
3B.1 Epidemiology of cancer and thrombosis in women – findings from the RIETE Registry
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2nd Int. Symp. on Women’s Health Issues in Thrombosis and Haemostasis / Thrombosis Research 119 Suppl. 1 (2007) S1–S96
3B.1 Epidemiology of cancer and thrombosis in women
findings from the RIETE Registry
M. Monreal *, A.M. Angl´ es, F. Garc´ ıa Bragado, R. Lecumberri, G. Tiberio, A. Blanco, R. Otero, for the RIETE Investigators. Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona; Servicio de Medicina Interna, Hospital Josep Trueta, Gerona; Servicio de Hematolog´ ıa, Cl´ ınica Universitaria de Navarra, Pamplona; Servicio de Medicina Interna, Hospital Virgen del Camino, Pamplona; Servicio de Medicina Interna, Hospital Reina Sof´ ıa, C´ ordoba; Servicio de Neumolog´ ıa, Hospital Virgen del Roc´ ıo, Sevilla, Spain Introduction Venous thromboembolism (VTE) is a common and potentially serious complication in cancer patients [1 3]. Reducing the incidence of VTE can lead to reduced numbers of sudden deaths due to pulmonary embolism (PE) or bleeding. However, this requires better recognition of at-risk patients, avoiding exposure of patients to VTE risk factors whenever possible, and more widespread use of safe and effective thromboprophylaxis. Importantly, preventive strategies should be targeted to those patients who will benefit most. Identifying clinical characteristics that put cancer patients at increased risk of VTE is important if their outcomes are to be improved. The Registro Informatizado de la Enfermedad TromboEmb´ olica (RIETE) was initiated in March 2001 to prospectively record the current clinical management of VTE. It is an ongoing, multicenter, observational registry in consecutive patients with symptomatic, objectively confirmed, acute VTE [4 6]. The aim of the present study was to analyze the clinical characteristics and 3-month clinical outcomes of all women with cancer enrolled in RIETE to try to identify which cancer women are at a higher risk of VTE. Patients and methods Inclusion and exclusion criteria Consecutive patients with symptomatic, acute deepvein thrombosis (DVT) or PE, confirmed by objective tests (contrast venography or ultrasonography for suspected DVT; pulmonary angiography, lung scintigraphy, or helical computed tomography [CT] scan for suspected PE), are enrolled in RIETE. Variables The parameters recorded by the registry comprise details of each patient’s baseline characteristics; clinical status, including any coexisting or underlying conditions; cancer characteristics; the type, dose, and duration of treatment received on VTE diagnosis and clinical outcome during the first 3 months of therapy. Clinical definitions Immobilized patients are defined in this analysis as non-surgical patients who had been immobilized (i.e., total bed rest with bathroom privileges) for
4 days in the 2-month period prior to VTE diagnosis. Surgical patients are defined as those who had undergone an operation in the 2 months prior to VTE diagnosis. Fatal PE was defined as any death occurring shortly (<7 days) after PE diagnosis (either the initial episode or recurrent PE), in the absence of an alternative cause of death. Fatal bleeding was defined as any death occurring shortly (<7 days) after a major bleeding episode. Bleeding complications were classified as “major” if they were overt and were associated with a decrease in hemoglobin level of 2.0 g/dL, required a transfusion of 2 units of blood, or were retroperitoneal or intracranial. Follow-up After hospital discharge, all patients were followedup for 3 months. During each visit, any signs or symptoms suggesting either DVT or PE recurrence or bleeding complications were noted. Each episode of clinically suspected recurrent DVT or PE was documented by repeat compression ultrasonography, venography, lung scanning, helical CT scan or pulmonary angiography. Statistical analysis Odds ratios and corresponding 95% confidence intervals were calculated using Confidence Interval Analysis software (version 2.0.0), and a p value <0.05 was considered to be statistically significant. Study support The RIETE registry is an independent registry, partially supported by sanofi-aventis in Spain and Red Respira from the Instituto Carlos III, Spain (RedRespira-ISCiiiRTIC-03/11). sanofi-aventis has no right to accede to the database, and there is no payment per recruited patient. Results Up to September 2006, a total of 16,047 patients with symptomatic, objectively confirmed acute VTE had been enrolled in RIETE and followed-up for 3 months. Of these, 3,269 patients (20%) had active cancer: 1479 were females, 1790 males. Comparison between cancer vs non-cancer women Women with cancer were younger, weighed less and had more often a recent episode of surgery than those without cancer, but recent immobility for 4 days was less common (Table 1). They presented more
Extended Abstracts / Thrombosis Research 119 Suppl. 1 (2007) S1–S96
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Table 1. Clinical characteristics and 3-month outcome of 8011 women with VTE, according to the presence or absence of cancer
Clinical characteristics Age >70 years Body weight >70 kg Outpatients Risk factors for VTE Immobility 4 days Surgery <2 months Prior VTE Clinical presentation DVT signs PE signs DVT+PE signs 3-month outcome Major bleeding Fatal bleeding Recurrent DVT Recurrent PE Fatal PE Overall mortality
Cancer (N = 1479)
No cancer (N = 6532)
Odds ratio (95% CI)
P value
830 (56%) 614 (41%) 1014 (69%)
3935 (60%) 3389 (52%) 4578 (70%)
0.84 (0.75 0.95) 0.66 (0.59 0.74) 0.93 (0.82 1.05)
0.003 <0.001 0.248
329 (22%) 240 (16%) 231 (16%)
1972 (30%) 889 (14%) 953 (15%)
0.66 (0.58 0.76) 1.23 (1.05 1.44) 1.08 (0.92 1.27)
<0.001 0.009 0.314
812 (55%) 401 (27%) 266 (18%)
3264 (50%) 2189 (34%) 1079 (17%)
1.22 (1.09 1.37) 0.74 (0.65 0.84) 1.11 (0.95 1.29)
<0.001 <0.001 0.173
62 (4.2%) 13 (0.9%) 35 (2.4%) 36 (2.4%) 40 (2.7%) 332 (22%)
163 (2.5%) 33 (0.5%) 49 (0.8%) 63 (1.0%) 117 (1.8%) 369 (5.6%)
1.71 1.69 3.21 2.56 1.52 4.83
<0.001 0.107 <0.001 <0.001 0.022 <0.001
(1.25 (0.84 (2.02 (1.66 (1.04 (4.10
2.33) 3.33) 5.07) 3.94) 2.22) 5.70)
Abbreviations: VTE, venous thromboembolism; DVT, deep vein thrombosis; PE, pulmonary embolism; UFH, unfractionated heparin; LMWH, low-molecular-weight heparin; AVK, anti-vitamin K; CI, confidence interval.
often with symptomatic DVT, and less frequently with PE signs only. During the 3-month follow-up period, the rates of fatal PE, recurrent VTE, major bleeding, and death were all significantly higher in women with cancer than in those without cancer. Comparison between women with cancer vs men with cancer Women with cancer were older and weighed less than men with cancer (Table 2). Otherwise, we failed to find any difference in either additional risk factors, the clinical presentation of VTE, extent of the malignancy or clinical outcome. The most common sites of cancer in women were the breast and the colon. Discussion A number of studies have shown that cancer patients with VTE have an increased risk of recurrent VTE and major bleeding compared to those without cancer [7 9]. The data in this analysis, obtained from a large prospective series of consecutive patients in the RIETE registry, confirm that also fatal PE and fatal bleeding are more common in cancer women with VTE than in those with no cancer. Furthermore, we found VTE to develop more often in younger women, with a recent episode of immobilization less commonly, and presenting more often with clinical signs of DVT only, instead of PE. Furthermore, we found that the two most common sites of cancer in women with VTE are the breast and the colon. Overall, 38% of the cancer women in our series developed VTE shortly after immobilization for
4 days or surgery. We have recently reported that cancer patients with VTE who have recently been immobilized (due to their cancer per se, side-effects of cancer therapy, or an acute medical illness) have a significantly worse clinical outcome [10,11]. Of the patients with recent immobilization who died from a PE or bleeding complication, 41% had nonmetastatic cancer and would have had a favorable prognosis for survival in the absence of the fatal PE or bleeding. However, only 28% of non-surgical cancer patients with immobilization for 4 days days who were enrolled in RIETE had received prior thromboprophylaxis, in contrast to 69% of the surgical cancer patients. This represents a significant underuse of thromboprophylaxis in this patient group and suggests a lack of awareness of VTE risk factors and their cumulative effect. In summary, our findings suggest that increasing the use of thromboprophylaxis in women with cancer undergoing surgery or in those who have to remain in bed for 4 days could significantly improve outcomes in this group of high-risk patients.
Reference(s) [1] Svendsen E, Karwinski B. Prevalence of pulmonary embolism at necropsy in patients with cancer. J Clin Pathol 1989; 42: 805 809. [2] Thodiyil PA, Walsh DC, Kakkar AK. Thromboprophylaxis in the cancer patient. Acta Haematol 2001; 106: 73 80. [3] Lee AY, Levine MN. Venous thromboembolism and cancer: risks and outcomes. Circulation 2003; 107: I17 21. [4] Monreal M, Su´ arez C, Gonz´ alez Fajardo JA, et al., RIETE investigators. Management of patients with acute
S32
2nd Int. Symp. on Women’s Health Issues in Thrombosis and Haemostasis / Thrombosis Research 119 Suppl. 1 (2007) S1–S96 Table 2. Clinical characteristics and 3-month outcome of 3269 patients with cancer and VTE, according to gender
Clinical characteristics Age >70 years Body weight >70 kg Outpatients Risk factors for VTE Immobility 4 days Surgery <2 months Prior VTE Cancer characteristics Metastatic cancer Site of cancer Lung Breast Stomach Pancreas Colorectal Ovary Bladder Brain Haematologic Uterus Prostate Other Clinical presentation DVT signs PE signs DVT+PE signs 3-month outcome Major bleeding Fatal bleeding Recurrent DVT Recurrent PE Fatal PE Overall mortality
Females N = 1479
Males N = 1790
Odds ratio (95% CI)
P value
830 (56%) 614 (41%) 1014 (69%)
912 (51%) 1158 (65%) 1234 (69%)
1.23 (1.07 1.42) 0.39 (0.34 0.45) 0.98 (0.84 1.14)
0.003 <0.001 0.816
329 (22%) 240 (16%) 231 (16%)
366 (20%) 296 (17%) 246 (14%)
1.11 (0.94 1.32) 0.98 (0.81 1.18) 1.16 (0.95 1.42)
0.211 0.812 0.131
642 (43%)
789 (44%)
0.97 (0.84 1.12)
0.701
57 (3.9%) 418 (28%) 58 (3.9%) 57 (3.9%) 192 (13%) 92 (6.2%) 38 (2.6%) 82 (5.5%) 131 (8.9%) 106 (7.2%) 0 248 (17%)
317 (18%) 7 (0.4%) 82 (4.6%) 55 (3.1%) 260 (15%) 0 192 (11%) 90 (5.0%) 98 (5.5%) 0 377 (21%) 311 (17%)
0.19 (0.14 0.25) 100 (46 231) 0.85 (0.59 1.21) 1.26 (0.85 1.87) 0.88 (0.71 1.08) 0.22 (0.15 0.32) 1.11 (0.81 1.52) 1.68 (1.27 2.22) 0.96 (0.79 1.16)
<0.001 <0.001 0.354 0.222 0.203 <0.001 <0.001 0.510 <0.001 <0.001 <0.001 0.647
812 (55%) 401 (27%) 266 (18%)
995 (56%) 479 (27%) 316 (18%)
0.97 (0.84 1.12) 1.02 (0.87 1.19) 1.02 (0.85 1.23)
0.695 0.821 0.805
62 (4.2%) 13 (0.9%) 35 (2.4%) 36 (2.4%) 40 (2.7%) 332 (22%)
74 (4.1%) 20 (1.1%) 51 (2.8%) 42 (2.3%) 51 (2.8%) 424 (24%)
1.01 0.78 0.83 1.04 0.95 0.93
0.934 0.497 0.391 0.870 0.802 0.403
(0.71 (0.37 (0.52 (0.65 (0.61 (0.79
1.45) 1.66) 1.30) 1.67) 1.47) 1.10)
Abbreviations: VTE, venous thromboembolism; DVT, deep vein thrombosis; PE, pulmonary embolism; UFH, unfractionated heparin; LMWH, low-molecular-weight heparin; AVK, anti-vitamin K; CI, confidence interval.
venous thromboembolism: findings from the RIETE registry. Pathophysiol Haemost Thromb 2003/2004; 33: 330 334. [5] Trujillo J, Perea-Milla E, Jim´ enez-Puente A, et al., RIETE Investigators. Bed rest or ambulation in the initial treatment of patients with acute deep vein thrombosis or pulmonary embolism. Findings from the RIETE registry. Chest 2005; 127: 1631 1636. [6] Nieto JA, D´ ıaz de Tuesta A, Marchena PJ, et al., RIETE investigators. Clinical outcome of patients with venous thromboembolism and recent major bleeding: findings from a prospective registry (RIETE). J Thromb Haemost 2005; 3: 703 709. [7] Levitan N, Dowlati A, Remick S, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine 1999; 78: 285 291.
[8] Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125: 1 7. [9] Prandoni P, Lensing AW, Piccioli A, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100: 3484 3488. [10] Monreal M, Kakkar AK, Caprini JA, et al., RIETE Investigators. The outcome after treatment of venous thromboembolism is different in surgical and acutely ill medical patients. Findings from the RIETE registry. J Thromb Haemost 2004; 2: 1892 1898. [11] Monreal M, Falg´ a C, Vald´ es M, et al.; for the RIETE Investigators. Fatal pulmonary embolism and fatal bleeding in cancer patients with venous thromboembolism: Findings from the RIETE registry. J Thromb Haemost 2006; 4: 1950 1956.
2nd Int. Symp. on Women’s Health Issues in Thrombosis and Haemostasis / Thrombosis Research 119 Suppl. 1 (2007) S1–S96
3B.1 Epidemiology of cancer and thrombosis in women
findings from the RIETE Registry
M. Monreal *, A.M. Angl´ es, F. Garc´ ıa Bragado, R. Lecumberri, G. Tiberio, A. Blanco, R. Otero, for the RIETE Investigators. Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona; Servicio de Medicina Interna, Hospital Josep Trueta, Gerona; Servicio de Hematolog´ ıa, Cl´ ınica Universitaria de Navarra, Pamplona; Servicio de Medicina Interna, Hospital Virgen del Camino, Pamplona; Servicio de Medicina Interna, Hospital Reina Sof´ ıa, C´ ordoba; Servicio de Neumolog´ ıa, Hospital Virgen del Roc´ ıo, Sevilla, Spain Introduction Venous thromboembolism (VTE) is a common and potentially serious complication in cancer patients [1 3]. Reducing the incidence of VTE can lead to reduced numbers of sudden deaths due to pulmonary embolism (PE) or bleeding. However, this requires better recognition of at-risk patients, avoiding exposure of patients to VTE risk factors whenever possible, and more widespread use of safe and effective thromboprophylaxis. Importantly, preventive strategies should be targeted to those patients who will benefit most. Identifying clinical characteristics that put cancer patients at increased risk of VTE is important if their outcomes are to be improved. The Registro Informatizado de la Enfermedad TromboEmb´ olica (RIETE) was initiated in March 2001 to prospectively record the current clinical management of VTE. It is an ongoing, multicenter, observational registry in consecutive patients with symptomatic, objectively confirmed, acute VTE [4 6]. The aim of the present study was to analyze the clinical characteristics and 3-month clinical outcomes of all women with cancer enrolled in RIETE to try to identify which cancer women are at a higher risk of VTE. Patients and methods Inclusion and exclusion criteria Consecutive patients with symptomatic, acute deepvein thrombosis (DVT) or PE, confirmed by objective tests (contrast venography or ultrasonography for suspected DVT; pulmonary angiography, lung scintigraphy, or helical computed tomography [CT] scan for suspected PE), are enrolled in RIETE. Variables The parameters recorded by the registry comprise details of each patient’s baseline characteristics; clinical status, including any coexisting or underlying conditions; cancer characteristics; the type, dose, and duration of treatment received on VTE diagnosis and clinical outcome during the first 3 months of therapy. Clinical definitions Immobilized patients are defined in this analysis as non-surgical patients who had been immobilized (i.e., total bed rest with bathroom privileges) for
4 days in the 2-month period prior to VTE diagnosis. Surgical patients are defined as those who had undergone an operation in the 2 months prior to VTE diagnosis. Fatal PE was defined as any death occurring shortly (<7 days) after PE diagnosis (either the initial episode or recurrent PE), in the absence of an alternative cause of death. Fatal bleeding was defined as any death occurring shortly (<7 days) after a major bleeding episode. Bleeding complications were classified as “major” if they were overt and were associated with a decrease in hemoglobin level of 2.0 g/dL, required a transfusion of 2 units of blood, or were retroperitoneal or intracranial. Follow-up After hospital discharge, all patients were followedup for 3 months. During each visit, any signs or symptoms suggesting either DVT or PE recurrence or bleeding complications were noted. Each episode of clinically suspected recurrent DVT or PE was documented by repeat compression ultrasonography, venography, lung scanning, helical CT scan or pulmonary angiography. Statistical analysis Odds ratios and corresponding 95% confidence intervals were calculated using Confidence Interval Analysis software (version 2.0.0), and a p value <0.05 was considered to be statistically significant. Study support The RIETE registry is an independent registry, partially supported by sanofi-aventis in Spain and Red Respira from the Instituto Carlos III, Spain (RedRespira-ISCiiiRTIC-03/11). sanofi-aventis has no right to accede to the database, and there is no payment per recruited patient. Results Up to September 2006, a total of 16,047 patients with symptomatic, objectively confirmed acute VTE had been enrolled in RIETE and followed-up for 3 months. Of these, 3,269 patients (20%) had active cancer: 1479 were females, 1790 males. Comparison between cancer vs non-cancer women Women with cancer were younger, weighed less and had more often a recent episode of surgery than those without cancer, but recent immobility for 4 days was less common (Table 1). They presented more
Extended Abstracts / Thrombosis Research 119 Suppl. 1 (2007) S1–S96
S31
Table 1. Clinical characteristics and 3-month outcome of 8011 women with VTE, according to the presence or absence of cancer
Clinical characteristics Age >70 years Body weight >70 kg Outpatients Risk factors for VTE Immobility 4 days Surgery <2 months Prior VTE Clinical presentation DVT signs PE signs DVT+PE signs 3-month outcome Major bleeding Fatal bleeding Recurrent DVT Recurrent PE Fatal PE Overall mortality
Cancer (N = 1479)
No cancer (N = 6532)
Odds ratio (95% CI)
P value
830 (56%) 614 (41%) 1014 (69%)
3935 (60%) 3389 (52%) 4578 (70%)
0.84 (0.75 0.95) 0.66 (0.59 0.74) 0.93 (0.82 1.05)
0.003 <0.001 0.248
329 (22%) 240 (16%) 231 (16%)
1972 (30%) 889 (14%) 953 (15%)
0.66 (0.58 0.76) 1.23 (1.05 1.44) 1.08 (0.92 1.27)
<0.001 0.009 0.314
812 (55%) 401 (27%) 266 (18%)
3264 (50%) 2189 (34%) 1079 (17%)
1.22 (1.09 1.37) 0.74 (0.65 0.84) 1.11 (0.95 1.29)
<0.001 <0.001 0.173
62 (4.2%) 13 (0.9%) 35 (2.4%) 36 (2.4%) 40 (2.7%) 332 (22%)
163 (2.5%) 33 (0.5%) 49 (0.8%) 63 (1.0%) 117 (1.8%) 369 (5.6%)
1.71 1.69 3.21 2.56 1.52 4.83
<0.001 0.107 <0.001 <0.001 0.022 <0.001
(1.25 (0.84 (2.02 (1.66 (1.04 (4.10
2.33) 3.33) 5.07) 3.94) 2.22) 5.70)
Abbreviations: VTE, venous thromboembolism; DVT, deep vein thrombosis; PE, pulmonary embolism; UFH, unfractionated heparin; LMWH, low-molecular-weight heparin; AVK, anti-vitamin K; CI, confidence interval.
often with symptomatic DVT, and less frequently with PE signs only. During the 3-month follow-up period, the rates of fatal PE, recurrent VTE, major bleeding, and death were all significantly higher in women with cancer than in those without cancer. Comparison between women with cancer vs men with cancer Women with cancer were older and weighed less than men with cancer (Table 2). Otherwise, we failed to find any difference in either additional risk factors, the clinical presentation of VTE, extent of the malignancy or clinical outcome. The most common sites of cancer in women were the breast and the colon. Discussion A number of studies have shown that cancer patients with VTE have an increased risk of recurrent VTE and major bleeding compared to those without cancer [7 9]. The data in this analysis, obtained from a large prospective series of consecutive patients in the RIETE registry, confirm that also fatal PE and fatal bleeding are more common in cancer women with VTE than in those with no cancer. Furthermore, we found VTE to develop more often in younger women, with a recent episode of immobilization less commonly, and presenting more often with clinical signs of DVT only, instead of PE. Furthermore, we found that the two most common sites of cancer in women with VTE are the breast and the colon. Overall, 38% of the cancer women in our series developed VTE shortly after immobilization for
4 days or surgery. We have recently reported that cancer patients with VTE who have recently been immobilized (due to their cancer per se, side-effects of cancer therapy, or an acute medical illness) have a significantly worse clinical outcome [10,11]. Of the patients with recent immobilization who died from a PE or bleeding complication, 41% had nonmetastatic cancer and would have had a favorable prognosis for survival in the absence of the fatal PE or bleeding. However, only 28% of non-surgical cancer patients with immobilization for 4 days days who were enrolled in RIETE had received prior thromboprophylaxis, in contrast to 69% of the surgical cancer patients. This represents a significant underuse of thromboprophylaxis in this patient group and suggests a lack of awareness of VTE risk factors and their cumulative effect. In summary, our findings suggest that increasing the use of thromboprophylaxis in women with cancer undergoing surgery or in those who have to remain in bed for 4 days could significantly improve outcomes in this group of high-risk patients.
Reference(s) [1] Svendsen E, Karwinski B. Prevalence of pulmonary embolism at necropsy in patients with cancer. J Clin Pathol 1989; 42: 805 809. [2] Thodiyil PA, Walsh DC, Kakkar AK. Thromboprophylaxis in the cancer patient. Acta Haematol 2001; 106: 73 80. [3] Lee AY, Levine MN. Venous thromboembolism and cancer: risks and outcomes. Circulation 2003; 107: I17 21. [4] Monreal M, Su´ arez C, Gonz´ alez Fajardo JA, et al., RIETE investigators. Management of patients with acute
S32
2nd Int. Symp. on Women’s Health Issues in Thrombosis and Haemostasis / Thrombosis Research 119 Suppl. 1 (2007) S1–S96 Table 2. Clinical characteristics and 3-month outcome of 3269 patients with cancer and VTE, according to gender
Clinical characteristics Age >70 years Body weight >70 kg Outpatients Risk factors for VTE Immobility 4 days Surgery <2 months Prior VTE Cancer characteristics Metastatic cancer Site of cancer Lung Breast Stomach Pancreas Colorectal Ovary Bladder Brain Haematologic Uterus Prostate Other Clinical presentation DVT signs PE signs DVT+PE signs 3-month outcome Major bleeding Fatal bleeding Recurrent DVT Recurrent PE Fatal PE Overall mortality
Females N = 1479
Males N = 1790
Odds ratio (95% CI)
P value
830 (56%) 614 (41%) 1014 (69%)
912 (51%) 1158 (65%) 1234 (69%)
1.23 (1.07 1.42) 0.39 (0.34 0.45) 0.98 (0.84 1.14)
0.003 <0.001 0.816
329 (22%) 240 (16%) 231 (16%)
366 (20%) 296 (17%) 246 (14%)
1.11 (0.94 1.32) 0.98 (0.81 1.18) 1.16 (0.95 1.42)
0.211 0.812 0.131
642 (43%)
789 (44%)
0.97 (0.84 1.12)
0.701
57 (3.9%) 418 (28%) 58 (3.9%) 57 (3.9%) 192 (13%) 92 (6.2%) 38 (2.6%) 82 (5.5%) 131 (8.9%) 106 (7.2%) 0 248 (17%)
317 (18%) 7 (0.4%) 82 (4.6%) 55 (3.1%) 260 (15%) 0 192 (11%) 90 (5.0%) 98 (5.5%) 0 377 (21%) 311 (17%)
0.19 (0.14 0.25) 100 (46 231) 0.85 (0.59 1.21) 1.26 (0.85 1.87) 0.88 (0.71 1.08) 0.22 (0.15 0.32) 1.11 (0.81 1.52) 1.68 (1.27 2.22) 0.96 (0.79 1.16)
<0.001 <0.001 0.354 0.222 0.203 <0.001 <0.001 0.510 <0.001 <0.001 <0.001 0.647
812 (55%) 401 (27%) 266 (18%)
995 (56%) 479 (27%) 316 (18%)
0.97 (0.84 1.12) 1.02 (0.87 1.19) 1.02 (0.85 1.23)
0.695 0.821 0.805
62 (4.2%) 13 (0.9%) 35 (2.4%) 36 (2.4%) 40 (2.7%) 332 (22%)
74 (4.1%) 20 (1.1%) 51 (2.8%) 42 (2.3%) 51 (2.8%) 424 (24%)
1.01 0.78 0.83 1.04 0.95 0.93
0.934 0.497 0.391 0.870 0.802 0.403
(0.71 (0.37 (0.52 (0.65 (0.61 (0.79
1.45) 1.66) 1.30) 1.67) 1.47) 1.10)
Abbreviations: VTE, venous thromboembolism; DVT, deep vein thrombosis; PE, pulmonary embolism; UFH, unfractionated heparin; LMWH, low-molecular-weight heparin; AVK, anti-vitamin K; CI, confidence interval.
venous thromboembolism: findings from the RIETE registry. Pathophysiol Haemost Thromb 2003/2004; 33: 330 334. [5] Trujillo J, Perea-Milla E, Jim´ enez-Puente A, et al., RIETE Investigators. Bed rest or ambulation in the initial treatment of patients with acute deep vein thrombosis or pulmonary embolism. Findings from the RIETE registry. Chest 2005; 127: 1631 1636. [6] Nieto JA, D´ ıaz de Tuesta A, Marchena PJ, et al., RIETE investigators. Clinical outcome of patients with venous thromboembolism and recent major bleeding: findings from a prospective registry (RIETE). J Thromb Haemost 2005; 3: 703 709. [7] Levitan N, Dowlati A, Remick S, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine 1999; 78: 285 291.
[8] Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125: 1 7. [9] Prandoni P, Lensing AW, Piccioli A, et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100: 3484 3488. [10] Monreal M, Kakkar AK, Caprini JA, et al., RIETE Investigators. The outcome after treatment of venous thromboembolism is different in surgical and acutely ill medical patients. Findings from the RIETE registry. J Thromb Haemost 2004; 2: 1892 1898. [11] Monreal M, Falg´ a C, Vald´ es M, et al.; for the RIETE Investigators. Fatal pulmonary embolism and fatal bleeding in cancer patients with venous thromboembolism: Findings from the RIETE registry. J Thromb Haemost 2006; 4: 1950 1956.