Incidence of Cancer after a Second Unprovoked Venous Thromboembolic Event.

Published on Jan 27, 2019in Thrombosis and Haemostasis5.723
· DOI :10.1055/S-0039-1677745
Shéhérazade Rézig1
Estimated H-index: 1
,
Raphael Le Mao7
Estimated H-index: 7
+ 2 AuthorsAurélien Delluc24
Estimated H-index: 24
(U of O: University of Ottawa)
Sources
Abstract
Patients with two unprovoked venous thromboembolism (VTE) events could be at high risk for cancer diagnosis and may therefore benefit from extended cancer screening strategies. However, accurate data on the incidence of cancer in this population is lacking. In a prospective cohort study, we followed-up with all patients who experienced two unprovoked symptomatic VTE events that occurred in less than 2 years apart. We estimated the 1-year incidence rate of cancer following the second unprovoked VTE event using the Kaplan–Meier method. Potential predictors for cancer diagnosis were assessed using a Cox proportional hazard regression model. Between May 2000 and December 2013, we included 197 patients with two episodes of symptomatic unprovoked VTE that occurred in less than 2 years apart. Their mean age was 66.2 ± 16.3 years, and 122 (51.8%) were male. Seventeen patients were diagnosed with cancer during the year following the second episode of unprovoked VTE, corresponding to a cumulative incidence rate of 9.19% (95% confidence interval [CI]: 5.81–14.37). The 1-year cumulative incidence rate of cancer was 35.88% (95% CI: 19.75–59.25) in patients with VTE recurrence on anticoagulation, 5.51% (95% CI: 2.9–10.32) among patients with a second episode of unprovoked VTE occurring after stopping anticoagulation and 1.15% (95% CI: 0.16–7.88) when time elapsed between the first and recurrent VTE was > 1 year. Our study suggests that the incidence of cancer in patients with a second episode of unprovoked VTE that occurs off anticoagulation, or > 1 year after the first event, is similar to that of patients with a first unprovoked VTE event.
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References17
Newest
#1Aurélien DellucH-Index: 24
Last. Dominique Mottier (French Institute of Health and Medical Research)H-Index: 34
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Abstract Background Venous thromboembolism (VTE) can be the first manifestation of cancer; however, the current incidence of malignancy in unselected patients with first unprovoked VTE needs to be confirmed. Material and methods Between March 1st, 2013 and February 28th, 2015 we included and followed-up all patients living in the Brest district, France, who were seen in hospitals or the community for a first symptomatic unprovoked VTE event. The primary study outcome was the one-year incidence o...
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#1Nick van Es (UvA: University of Amsterdam)H-Index: 25
#2Grégoire Le Gal (Ottawa Hospital Research Institute)H-Index: 15
Last. Marc Carrier (Ottawa Hospital Research Institute)H-Index: 60
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Background: Screening for cancer in patients with unprovoked venous thromboembolism (VTE) often is considered, but clinicians need precise data on cancer prevalence, risk factors, and the effect of different types of screening strategies. Purpose: To estimate the prevalence of occult cancer in patients with unprovoked VTE, including in subgroups of different ages or those that have had different types of screening. Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Tr...
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#1S. Vaidyanathan (St James's University Hospital)H-Index: 2
#2Jenny WalshH-Index: 1
Last. Fahmid U. Chowdhury (St James's University Hospital)H-Index: 18
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Aim To analyse the positive rate for cancer on additional abdominopelvic computed tomography (CT) in patients with unprovoked venous thromboembolism (VTE), evaluate the subsequent emergence of a cancer diagnosis in the clinical follow-up period, and identify any possible predictive factors of cancer in this cohort, which may allow better selection of patients for additional imaging. Materials and methods Consecutive adult patients with VTE were retrospectively identified in two large teaching ho...
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#1Philippe RobinH-Index: 31
#2Pierre-Yves Le RouxH-Index: 22
Last. Pierre-Yves SalaunH-Index: 24
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Summary Background Clear guidelines for the investigation of occult malignancy after unprovoked venous thromboembolism are not yet available. 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/CT could serve as a comprehensive screening strategy for occult malignancy in this context. We aimed to compare a screening strategy based on 18 F-FDG PET/CT with a limited screening strategy for detection of malignant disease in patients with unprovoked venous thromboembolism. Methods In an open-label, multicentre, ...
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BackgroundVenous thromboembolism may be the earliest sign of cancer. Currently, there is a great diversity in practices regarding screening for occult cancer in a person who has an unprovoked venous thromboembolism. We sought to assess the efficacy of a screening strategy for occult cancer that included comprehensive computed tomography (CT) of the abdomen and pelvis in patients who had a first unprovoked venous thromboembolism. MethodsWe conducted a multicenter, open-label, randomized, controll...
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#1Walter Ageno (University of Insubria)H-Index: 80
#2Alessandro Squizzato (University of Insubria)H-Index: 47
Last. G. Johnson (Veterans Health Administration)H-Index: 2
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This document is intended to give clinical guidance for the diagnosis of symptomatic recurrent pulmonary embolism (PE) and/or deep vein thrombosis (DVT). We define recurrent PE and DVT as those events occurring after an initial course of adequate antithrombotic treatment for a first venous thromboembolic event (VTE) [1,2]. The issue of a correct diagnosis of recurrence is clinically relevant since many patients with a previous VTE will complain of signs or symptoms suggesting the possibility of ...
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#1Marc Carrier (U of O: University of Ottawa)H-Index: 60
#2Grégoire Le Gal (U of O: University of Ottawa)H-Index: 56
Last. Marc A. Rodger (U of O: University of Ottawa)H-Index: 80
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Background: Identifying previously undiagnosed cancer in patients with newly diagnosed venous thromboembolism (VTE) is important. Screening for malignant conditions can potentially diagnose more cases of cancer and at earlier stages, thereby preventing cancer-associated morbidity and perhaps mortality. Purpose: To summarize the period prevalence of previously undiagnosed cancer at baseline (within 1 month of VTE diagnosis), 6 months, and 12 months after VTE diagnosis and to quantify the addition...
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#2Paolo Prandoni (UNIPD: University of Padua)H-Index: 107
Last. M. MonrealH-Index: 10
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Summary. Introduction: Although extensive screening in patients with venous thromboembolism (VTE) may result in early identification of hidden cancer, it is unknown whether the prognosis of these patients may be favorably influenced. Patients and methods: RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We compared the 3-month outcome of patients with hidden cancer with that in patients in whom no symptoms of cancer were noted....
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Background: It is unclear how frequently unprovoked venous thromboembolism (VTE) reflects the presence of an occult cancer. Methods: The California Cancer Registry was used to identify diagnosed cases of 19 common malignancies during a 6-year period. Cases were linked to a hospital discharge database to identify incident VTE events in the year before the cancer diagnosis date. The standardized incidence ratio (SIR) of unprovoked VTE was determined by using the age-, race-, and sex-specific incid...
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#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
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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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#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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#1Marc A. Rodger (Ottawa Hospital Research Institute)H-Index: 80
#2Sébastien Miranda (Ottawa Hospital Research Institute)H-Index: 8
Last. Marc Carrier (Ottawa Hospital Research Institute)H-Index: 60
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Abstract Suspected recurrent venous thromboembolism (VTE) is a common and vexing clinical problem. Confounding the diagnosis of recurrent VTE is a high frequency of residual VTE from prior VTE. The diagnosis of recurrent VTE must be established by comparing current imaging with past imaging to distinguish acute from chronic thrombosis. Next, we must ascertain if non-compliance was the cause of “apparent therapeutic failure” and if non-compliance is at play then re-initiate anticoagulant therapy....
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