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PO-03 Incidence and risk factors for venous thromboembolism in cancer patients qualifying for chemotherapy
Thrombosis Research 125 Suppl. 2 (2010) S166–S191
Contents lists available at ScienceDirect
Thrombosis Research j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / t h r o m r e s
5th ICTHIC Abstracts: Poster Sessions Poster session 1. Epidemiology PO-01 Venous thromboembolism in patients with lung cancer 2 ´ 1 , D. Tassies ` , J.C. Reverter2 , N. Reguart1 , C. Font1 *, M. Campayo1 , B. Farrus 1 , P. Gascon1 . 1 Medical Oncology service; 2 Hemotherapy and N. Vinolas ˜ Hemostasis service Hospital Cl´ınic i Provincial de Barcelona, Spain
Introduction: Venous thromboembolism (VTE) is a leading cause of death and morbidity in cancer patients. Improving knowledge about the epidemiology and behavior of VTE can contribute to its prevention and optimal management of this life-threatening complication. Aim: To describe clinical characteristics and outcome of cancer patients with VTE regarding if they whether had lung cancer (LC) or other cancers (OC). Patients and Methods: A prospective observational study of consecutive cancer patients and newly diagnosisof VTE was performed between May 2006 and April 2009. All patients were uniformly treated according to the 2004 American College of Chest Physicians guidelines and followed up. Data analysis was performed in July 2009. Results: A total of 339 patients were included. LC was the most frequent tumor in our series and occurred in 86 patients (25.4%) (66 males; median age 62±11 years). Histological subtypes of LC were: adenocarcinoma = 40 (46%), squamous cell carcinoma = 18 (21%), non-small cell carcinoma unspecified =15 (17%) and small-cell carcinoma = 9 (10%). Patients with LC had more frequently arterial hypertension (38% vs 25%, p = 0.01) and smoking habit (83% vs 41%, p < 0.0001) and presented more frequently with pulmonary embolism (51% vs 29%, p < 0.0001) than patients with OC. VTE was diagnosed earlier in patients with LC after the initial cancer diagnosis, with a median of 4 months (95% CI 2.79–5.2) compared to 7 months (95% CI 4.40–9.59) in patients with OC (p < 0.0001). The actual probability of rethrombosis was higher in LP, with a median of 6 months (95% CI 3.74–8.26) vs 17 months (95% CI 11.58–22.42) from the initial VTE event to venous rethrombosis (p < 0.0001) compared to patients with OC. Conclusions: VTE in patients with LC occurs earlier in the course of cancer and has a worse outcome regarding venous rethrombosis than observed in patients with OC. PO-02 Incidence of venous thromboembolism and prophylaxis use in ambulatory cancer patients receiving chemotherapy 1 E. Panizo1 , R. Lecumberri1 *, S. Varea1 , A. Garc´ıa-Mouriz2 , J.A. Paramo ´ . Hematology Service, 2 Informatics Service. University Clinic of Navarra. Pamplona, Spain
1
Introduction: Current guidelines recommend the administration of antithrombotic prophylaxis, mainly LMWH, in hospitalized cancer patients, unless contraindicated. In ambulatory cancer patients undergoing chemotherapy routinary prophylaxis is not recommended. Aim: To describe the incidence of VTE and prophylaxis use in cancer outpatients receiving chemotherapy according to the Khorana predictive model (Blood 2008; 111: 4902–7) and a new clinical score, termed CUN score. Methods: Consecutive ambulatory cancer patients receiving chemotherapy were included and followed for 3 months. Main outcome was the incidence of objectively confirmed VTE. Results: As of June 2009, 302 patients, median age 58 years (19–87), were included. According to the Khorana score, 154 patients (51%) were 0049-3848 /$ – see front matter © 2010 Elsevier Ltd. All rights reserved.
classified as low-risk, 132 (43.7%) as medium-risk and 16 (5.3%) as highrisk. With the CUN score, 151 patients (50%) were included in the low-risk and 151 (50%) in the high-risk groups. During follow-up 17 patients (5.6%) developed a VTE episode. Distribution following the Khorana predictive model were 4 events (2.6%), 9 events (6.8%) and 4 events (25%) in the low-, medium-, and high-risk groups respectively. With the CUN score, 9 (6.0%) and 8 VTE episodes (5.3%) were diagnosed in low-risk and high-risk patients respectively. Interestingly, prophylaxis with LMWH was used in 19% of the high-risk patients according to the CUN score, while only in 6% of the low-risk patients. On the contrary, LMWH use was equally distributed among all subgroups of the Khorana predictive model (10–14%). Conclusions: In our population, the overall 3-month incidence of VTE is 5.6%. Only 12% of the patients were prescribed antithrombotic prophylaxis. Although the CUN score seems not to be helpful to predict the development of a VTE event, the results could have been influenced by the increased use of prophylaxis in the high-risk group. Data obtained from a higher number of patients analysed will be presented at the meeting. PO-03 Incidence and risk factors for venous thromboembolism in cancer patients qualifying for chemotherapy 1 ¨ , G.L. van Sluis1 *, L. Verberne1 , M. Kok1 , J.C. van Houwelingen3 , H.R. Buller H.-M.M.B. Otten2,3 . 1 Department of Vascular Medicine, 2 Department of Medical Oncology, Academic Medical Center Amsterdam, 3 Department of Internal Medicine, Slotervaart Hospital, Amsterdam, Netherlands
Background: Venous thromboembolism (VTE) is a frequent and significant complication in cancer patients. Pharmacological thromboprophylaxis is not routinely used in out-patients receiving chemotherapy, mainly because of the perceived low risk-benefit ratio. Therefore, effective tools to identify cancer patients at high risk for VTE are warranted. Aim: To assess the incidence of and predictors for VTE in cancer patients qualifying for chemotherapy with or without surgery. Methods: Consecutive cancer patients, without anticoagulant treatment, qualifying for chemotherapy with or without surgery were included. Patient’s clinical characteristics were documented with respect to the risk of VTE, such as cancer type, stage, immobilisation, routine laboratory investigations, surgery and treatment modality. The primary outcome was symptomatic VTE (deep venous thrombosis (of upper/lower limb) or pulmonary embolism or vena cava thrombosis). Univariate and multivariate analyses were used to identify risk factors for VTE and subsequently a prediction model was derived. Results: Four-hundred-thirty-two patients with both solid and haematological tumors were included. VTE was diagnosed in 34 (7.8%, 95% confidence interval (CI) = 5.5–11%) patients during a median follow up of 23 months (interquartile range 9–47 months). Independent predictors for VTE were age over 60 years, history of VTE, surgery and haemoglobin <10 g/dL. The derived prediction score was able to separate patients with a relatively low risk (4.2%) and high risk (18%) for VTE. Conclusions: The incidence of symptomatic VTE varies widely among subgroups of cancer patients. A combination of several clinical characteristics at entry allow for the identification at high risk patients for VTE. Validation of this prediction rule as well as the effect of thromboprophylaxis are needed.
Contents lists available at ScienceDirect
Thrombosis Research j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / t h r o m r e s
5th ICTHIC Abstracts: Poster Sessions Poster session 1. Epidemiology PO-01 Venous thromboembolism in patients with lung cancer 2 ´ 1 , D. Tassies ` , J.C. Reverter2 , N. Reguart1 , C. Font1 *, M. Campayo1 , B. Farrus 1 , P. Gascon1 . 1 Medical Oncology service; 2 Hemotherapy and N. Vinolas ˜ Hemostasis service Hospital Cl´ınic i Provincial de Barcelona, Spain
Introduction: Venous thromboembolism (VTE) is a leading cause of death and morbidity in cancer patients. Improving knowledge about the epidemiology and behavior of VTE can contribute to its prevention and optimal management of this life-threatening complication. Aim: To describe clinical characteristics and outcome of cancer patients with VTE regarding if they whether had lung cancer (LC) or other cancers (OC). Patients and Methods: A prospective observational study of consecutive cancer patients and newly diagnosisof VTE was performed between May 2006 and April 2009. All patients were uniformly treated according to the 2004 American College of Chest Physicians guidelines and followed up. Data analysis was performed in July 2009. Results: A total of 339 patients were included. LC was the most frequent tumor in our series and occurred in 86 patients (25.4%) (66 males; median age 62±11 years). Histological subtypes of LC were: adenocarcinoma = 40 (46%), squamous cell carcinoma = 18 (21%), non-small cell carcinoma unspecified =15 (17%) and small-cell carcinoma = 9 (10%). Patients with LC had more frequently arterial hypertension (38% vs 25%, p = 0.01) and smoking habit (83% vs 41%, p < 0.0001) and presented more frequently with pulmonary embolism (51% vs 29%, p < 0.0001) than patients with OC. VTE was diagnosed earlier in patients with LC after the initial cancer diagnosis, with a median of 4 months (95% CI 2.79–5.2) compared to 7 months (95% CI 4.40–9.59) in patients with OC (p < 0.0001). The actual probability of rethrombosis was higher in LP, with a median of 6 months (95% CI 3.74–8.26) vs 17 months (95% CI 11.58–22.42) from the initial VTE event to venous rethrombosis (p < 0.0001) compared to patients with OC. Conclusions: VTE in patients with LC occurs earlier in the course of cancer and has a worse outcome regarding venous rethrombosis than observed in patients with OC. PO-02 Incidence of venous thromboembolism and prophylaxis use in ambulatory cancer patients receiving chemotherapy 1 E. Panizo1 , R. Lecumberri1 *, S. Varea1 , A. Garc´ıa-Mouriz2 , J.A. Paramo ´ . Hematology Service, 2 Informatics Service. University Clinic of Navarra. Pamplona, Spain
1
Introduction: Current guidelines recommend the administration of antithrombotic prophylaxis, mainly LMWH, in hospitalized cancer patients, unless contraindicated. In ambulatory cancer patients undergoing chemotherapy routinary prophylaxis is not recommended. Aim: To describe the incidence of VTE and prophylaxis use in cancer outpatients receiving chemotherapy according to the Khorana predictive model (Blood 2008; 111: 4902–7) and a new clinical score, termed CUN score. Methods: Consecutive ambulatory cancer patients receiving chemotherapy were included and followed for 3 months. Main outcome was the incidence of objectively confirmed VTE. Results: As of June 2009, 302 patients, median age 58 years (19–87), were included. According to the Khorana score, 154 patients (51%) were 0049-3848 /$ – see front matter © 2010 Elsevier Ltd. All rights reserved.
classified as low-risk, 132 (43.7%) as medium-risk and 16 (5.3%) as highrisk. With the CUN score, 151 patients (50%) were included in the low-risk and 151 (50%) in the high-risk groups. During follow-up 17 patients (5.6%) developed a VTE episode. Distribution following the Khorana predictive model were 4 events (2.6%), 9 events (6.8%) and 4 events (25%) in the low-, medium-, and high-risk groups respectively. With the CUN score, 9 (6.0%) and 8 VTE episodes (5.3%) were diagnosed in low-risk and high-risk patients respectively. Interestingly, prophylaxis with LMWH was used in 19% of the high-risk patients according to the CUN score, while only in 6% of the low-risk patients. On the contrary, LMWH use was equally distributed among all subgroups of the Khorana predictive model (10–14%). Conclusions: In our population, the overall 3-month incidence of VTE is 5.6%. Only 12% of the patients were prescribed antithrombotic prophylaxis. Although the CUN score seems not to be helpful to predict the development of a VTE event, the results could have been influenced by the increased use of prophylaxis in the high-risk group. Data obtained from a higher number of patients analysed will be presented at the meeting. PO-03 Incidence and risk factors for venous thromboembolism in cancer patients qualifying for chemotherapy 1 ¨ , G.L. van Sluis1 *, L. Verberne1 , M. Kok1 , J.C. van Houwelingen3 , H.R. Buller H.-M.M.B. Otten2,3 . 1 Department of Vascular Medicine, 2 Department of Medical Oncology, Academic Medical Center Amsterdam, 3 Department of Internal Medicine, Slotervaart Hospital, Amsterdam, Netherlands
Background: Venous thromboembolism (VTE) is a frequent and significant complication in cancer patients. Pharmacological thromboprophylaxis is not routinely used in out-patients receiving chemotherapy, mainly because of the perceived low risk-benefit ratio. Therefore, effective tools to identify cancer patients at high risk for VTE are warranted. Aim: To assess the incidence of and predictors for VTE in cancer patients qualifying for chemotherapy with or without surgery. Methods: Consecutive cancer patients, without anticoagulant treatment, qualifying for chemotherapy with or without surgery were included. Patient’s clinical characteristics were documented with respect to the risk of VTE, such as cancer type, stage, immobilisation, routine laboratory investigations, surgery and treatment modality. The primary outcome was symptomatic VTE (deep venous thrombosis (of upper/lower limb) or pulmonary embolism or vena cava thrombosis). Univariate and multivariate analyses were used to identify risk factors for VTE and subsequently a prediction model was derived. Results: Four-hundred-thirty-two patients with both solid and haematological tumors were included. VTE was diagnosed in 34 (7.8%, 95% confidence interval (CI) = 5.5–11%) patients during a median follow up of 23 months (interquartile range 9–47 months). Independent predictors for VTE were age over 60 years, history of VTE, surgery and haemoglobin <10 g/dL. The derived prediction score was able to separate patients with a relatively low risk (4.2%) and high risk (18%) for VTE. Conclusions: The incidence of symptomatic VTE varies widely among subgroups of cancer patients. A combination of several clinical characteristics at entry allow for the identification at high risk patients for VTE. Validation of this prediction rule as well as the effect of thromboprophylaxis are needed.