Screening for occult cancer in patients with acute deep vein thrombosis or pulmonary embolism.

Published on Jun 1, 2004in Journal of Thrombosis and Haemostasis5.824
· DOI :10.1111/J.1538-7836.2004.00721.X
Manuel Monreal76
Estimated H-index: 76
,
A. W. A. Lensing22
Estimated H-index: 22
+ 5 AuthorsJ Angel Jiménez1
Estimated H-index: 1
Sources
Abstract
Summary.  Patients with acute venous thromboembolism have an increased risk for occult malignancy. Limited screening for these malignancies has become common practice but little is known about its usefulness. This is a prospective cohort follow-up study in consecutive patients with acute venous thromboembolism. All patients underwent a routine clinical evaluation for malignancy, if negative, followed by a limited diagnostic work-up consisting of abdominal and pelvic ultrasound and laboratory markers for malignancy. Clinical follow-up was conducted to detect screening failures. The routine clinical evaluation was performed in 864 patients and revealed malignancy in 34 (3.9%) of them. Among the remaining 830 patients the limited diagnostic work-up revealed 13 further malignancies. During follow-up, cancer became symptomatic in 14 patients who were negative for cancer at screening (sensitivity of limited diagnostic work-up, 48.1%). Malignancies that were identified by the limited diagnostic work-up were early stage in 61% of cases vs. 14% in cases occurring during follow-up. Most patients with occult cancer had idiopathic venous thromboembolism and were older than 70 years. A limited diagnostic work-up for occult cancer in patients with venous thromboembolism has the capacity to identify approximately one-half of the malignancies. Identified malignancies were predominantly in an early stage.
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References31
Newest
#1Andrea Piccioli (UNIPD: University of Padua)H-Index: 25
#2A. W. A. Lensing (UvA: University of Amsterdam)H-Index: 22
Last. Paolo Prandoni (UNIPD: University of Padua)H-Index: 107
view all 11 authors...
Patients with symptomatic idiopathic venous thromboembolism and apparently cancer-free have an approximate 10% incidence of subsequent cancer. Apparently cancer-free patients with acute idiopathic venous thromboembolism were randomized to either the strategy of extensive screening for occult cancer or to no further testing. Patients had a 2-year follow-up period. Of the 201 patients, 99 were allocated to the extensive screening group and 102 to the control group. In 13 (13.1%) patients, the exte...
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Background The length of time after an episode of venous thromboembolism during which the risk of newly diagnosed cancer is increased is not known, and whether vitamin K antagonists have an antineoplastic effect is controversial. Methods In a prospective, randomized study of the duration of oral anticoagulation (six weeks or six months) after a first episode of venous thromboembolism, patients were questioned annually about any newly diagnosed cancer. After a mean follow-up of 8.1 years, we used...
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#1Henrik Toft Sørensen (AU: Aarhus University)H-Index: 145
#2Mellemkjaer LH-Index: 1
Last. GL NielsenH-Index: 1
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: We report a nationwide study based on a cohort of patients with a thromboembolic event (TE) defined as deep venous thrombosis and/or pulmonary embolism identified from the Danish National Registry of Patients from 1977 to 1993. Cancer occurrence in the cohort was determined by linkage to the Danish Cancer Registry. Expected number of cancer cases was estimated from age, sex and site-specific incidence rates. A total of 26,653 TE-cases were identified. We observed 1737 cases of cancer versus 13...
Summary Deep-vein thrombosis is an important complication of several inherited and acquired disorders, but may also occur spontaneously. Prevention of recurrent venous thrombosis and pulmonary embolism is the main reason for accurate diagnosis and adequate treatment. This seminar discusses only symptomatic deep-vein thrombosis. The diagnosis can be confirmed by objective tests in only about 30% of patients with symptoms. Venous thromboembolic complications happen in less than 1% of untreated pat...
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: Numerous studies, performed in recent years, have provided the convincing demonstration that the incidence of newly diagnosed malignancy is increased among patients with unexplained venous thromboembolism during the first 6 to 12 months after the thromboembolic event. Among malignancies presenting with venous thromboembolism as a first clinical manifestation, prostate and colorectal cancer are the most commonly identified. Other common sites are cancer of the lung, pancreas, stomach, ovary, br...
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#1Rohan J. K. Hettiarachchi (UvA: University of Amsterdam)H-Index: 10
#2Judith J. Lok (UvA: University of Amsterdam)H-Index: 13
Last. Paolo PrandoniH-Index: 107
view all 5 authors...
BACKGROUND The reported incidence of a subsequent diagnosis of malignancy in patients presenting with deep vein thrombosis (DVT) varies from 2-25%. Risk indicators and diagnostic procedures to be performed in these patients are controversial. METHODS Four hundred consecutive patients with confirmed DVT included in a randomized clinical trial were followed prospectively for 6 months. The incidence of a subsequent diagnosis of malignancy was calculated and compared between patients with unexplaine...
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#1Henrik Toft Sørensen (AU: Aarhus University)H-Index: 145
#2Lene MellemkjærH-Index: 68
Last. Gunnar Lauge NielsenH-Index: 44
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Background Several small studies have indicated an association between deep venous thrombosis or pulmonary embolism and a subsequent diagnosis of cancer, but the subject is controversial. Methods We conducted a nationwide study of a cohort of patients with deep venous thrombosis or pulmonary embolism that was drawn from the Danish National Registry of Patients for the years 1977 through 1992. The occurrence of cancer in the cohort was determined by linkage to the Danish Cancer Registry. The expe...
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#1John A. Baron (KI: Karolinska Institutet)H-Index: 143
#2Gloria GridleyH-Index: 81
Last. Martha S. LinetH-Index: 114
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Summary Background Although cancer has been clearly associated with venous thromboembolism (VTE), many aspects of this relation are poorly understood, including the cancer sites most affected and the cancer risk during long-term follow-up. To clarify these relations, we carried out a large, population-based analysis of VTE and cancer risk. Methods Using the Swedish Inpatient Register and linkage to the nationwide Cancer Registry, we assessed cancer incidence during 1989 among 61998 patients with...
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#1Raghu Rajan (McMaster University)H-Index: 2
#2Mark LevineH-Index: 133
Last. Jim A. JulianH-Index: 74
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Background: Several studies have reported that patients who present with idiopathic deep vein thrombosis (DVT) have an increased risk of subsequently developing cancer. A clinical trial had previously been conducted examining the optimal duration of oral anticoagulant therapy following initial heparin treatment in patients with proximal DVT. Methods: A historical cohort study was performed on patients enrolled in the duration of anticoagulant trial. Patients known to have cancer at the time of e...
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#1A RanceH-Index: 2
#2Joseph EmmerichH-Index: 54
Last. Jean-Noël FiessingerH-Index: 27
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BACKGROUND Venous thromboembolism is the second leading cause of death in cancer patients and its incidence seems underestimated. In addition, cancer patients have an increased risk of developing atrial fibrillation, which may be the first presentation of cancer itself. The primary aim of this study was to define the incidence of venous thromboembolism (VTE) and atrial fibrillation in a real-word series of advanced cancer patients. METHODS We performed a retrospective single-institution study on...
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#1Nick van Es (UvA: University of Amsterdam)H-Index: 25
#2Cihan Ay (Medical University of Vienna)H-Index: 55
Last. Luis Jara-Palomares (CSIC: Spanish National Research Council)H-Index: 16
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A strong link between cancer and thrombosis has been well recognized. The occurrence of venous thromboembolism (VTE) can be the first clinical sign of an undiagnosed (i.e., occult) cancer. Cancer is more often diagnosed after unprovoked compared with provoked VTE events, with a reported risk in recent studies of around 5%. Extensive, imaging-based screening strategies to detect occult cancer after unprovoked VTE do not appear to have a clear clinical benefit compared with a more limited cancer s...
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#2Luis Jara-Palomares (ISCIII: Carlos III Health Institute)H-Index: 16
ABSTRACT The relationship between venous thromboembolism (VTE) and cancer has become an area of intense debate due to the importance and the potential benefits of the identification of occult cancer following the diagnosis of unprovoked VTE. At present, extended screening is not recommended in patients with unprovoked VTE. However, if we were able to identify a group at greater risk of presenting cancer during follow-up, these patients would benefit from extended screening. The creation of a tra...
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#2I.A. SuchkovH-Index: 1
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We examined if syncope was a marker of an occult cancer by comparing the risk in patients with a syncope episode with that of the general population. Using Danish population-based medical registries, we identified all patients diagnosed with syncope during 1994–2013 and followed them until a cancer diagnosis, emigration, death or end of follow-up, whichever came first. We computed cumulative risks and standardised incidence ratios (SIR) with 95% confidence intervals (CI). Among 208,361 patients ...
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#1Yusuke S. HoriH-Index: 8
#2Yuki EbisudaniH-Index: 2
Last. Toru FukuharaH-Index: 5
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Abstract Background Unprovoked venous thromboembolism (VTE) may be the first manifestation of an underlying cancer. We aimed to assess the period prevalence of occult cancer detection stratified by VTE location (deep vein thrombosis [DVT], pulmonary embolism [PE] or both) and the anatomical relationship between occult cancer and VTE. Methods Post-hoc analysis of a systematic review and individual patient data meta-analysis of adults with unprovoked VTE with at least 12 months of follow-up. Cance...
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#1Pablo Demelo-Rodríguez (Complutense University of Madrid)H-Index: 10
#2Lucía Ordieres-Ortega (Hospital General Universitario Gregorio Marañón)H-Index: 4
Last. Jorge del Toro-Cervera (Complutense University of Madrid)H-Index: 5
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Summary Introduction Since Trousseau, we knows that venous thrombemboembolism (VTE) can reveal occult cancer. Different strategies of cancer screening have been evaluated: they are often time-consuming, cause stress and anxiety, and frequently require second-look examinations (due to the risk of false positives), with ultimately a very low yield (about 5%). We evaluated the number of suspect cancer tests before reporting them to the number of cancers finally diagnosed, after a VTE, in the settin...
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Der Einsatz von Antikoagulanzien beim alteren Menschen erfolgt im Spannungsfeld zwischen Blutungs- und Thromboembolierisiko. Neben dem Hauptrisikofaktor Alter beeinflussen Komorbiditaten (besonders Niereninsuffizienz) und Polymedikation die Blutungs- bzw. Thromboembolieneigung wesentlich. Doch Alter ist kein Ausschlusskriterium fur Antikoagulanzien. Alter gilt als Hauptrisikofaktor fur tiefe Venenthrombosen (TVT); auch Vorhofflimmern (VHF) gewinnt mit zunehmendem Lebensalter an Relevanz. Altere ...
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