Incidence of venous thromboembolism in patients hospitalized with cancer

Reported by: Stein PD et al. Am J Med. 2006;119:60-68.

ABSTRACT Table 1. VTE, PE, and DVT in patients with cancer (all ages) ! The incidence of PE among patients with cancer increased Figure 5. The relative risk of PE ranged from 0.77 to 3.66
Background: While venous thromboembolism (VTE) is a common significantly between 1989 and 1999 (P<.001) (Figure 2). This
Diagnoses/100 hospitalizations increase was of substantially smaller magnitude than that observed
complication of cancer, little is known regarding the frequency of VTE
in various malignancies. This study assesses the incidence and risk Cancers VTE PE DVT for VTE 4.5
of VTE, pulmonary embolism (PE), and deep vein thrombosis (DVT) in Pancreas 4.3 1.2 3.5 4
patients with cancer. Figure 2. Changes in the incidence of PE in patients with and without
Brain 3.5 1.0 2.8 3.5

Relative risk of PE in
cancer patients
cancer, 1979 to 1999 3
Methods: Men and women of all ages discharged with a diagnostic Myeloproliferative, other 2.9 * 2.5
code for 19 types of malignancies, PE, or DVT from 1979 through lympathic/hematopoeitic 2.5

1999. Data were obtained from the National Hospital Discharge Stomach 2.7 0.7 2.3 2

Survey. 1.5
Lymphoma, lymphosarcoma, 2.5 0.6 2.0 2

and noncancer patients (%)

1.8
reticulosarcoma 1

PE in hospitalized cancer
1.6
Results: Two percent of patients with any of the studied malignancies 1.4
Uterus 2.2 0.5 1.8 0.5
had VTE which was twice the rate of VTE in patients without cancer. 1.2

Pancreas

Brain

Myeloprol

Stomach

Uterus

Lung

Esophagus

Prostate

Rectal

Kidney

Colon

Ovary

Liver

Leukemia

Breast

Cervix

Bladder
Lymphoma
1 Cancer patients
Venous thromboembolism was most common in patients with Trachea, bronchus and lung 2.1 0.6 1.6 0.8
pancreatic cancer, and was least frequent in patients with bladder, lip, Esophagus 2.0 * 1.3 0.6
0.4
oral cavity, or pharyngeal cancer. The rates of PE and DVT individually 0.2
were also twice the rates seen in patients without cancer. The Prostate 2.0 0.6 1.6 0
Noncancer patients

Rectum, rectosigmoid junction, 2.1 0.7 1.4 79 81 83 85 87 89 91 93 95 97 99

incidence of VTE began to increase in the late 1980s for patients with
cancer. anus Figure 6. The relative risk of DVT ranged from 1.07 to 4.65
Year
Kidney 2.0 0.5 1.6
Conclusions: The incidence of VTE, PE, and DVT was 2-fold higher in
patients with cancer compared with noncancer patients. The Colon 1.9 0.6 1.4
incidence differed according to cancer type. The rate of VTE in Ovary 1.9 0.5 1.6 ! The incidence of DVT among patients with cancer increased 5

patients with cancer increased in the late 1980s and 1990s. Liver, gallbladder, 1.8 0.9 1.1 significantly between 1989 and 1999 (P<.0001) (Figure 3)
4
intra- & extrahepatic ducts

Relative risk of DVT in

cancer patients
Leukemia 1.7 0.4 1.4 Figure 3. Changes in the incidence of DVT in patients with and without 3
INTRODUCTION Breast (female) 1.7 0.4 1.3 cancer, 1979 to 1999
! VTE is a common complication of cancer; patients are at greatest 2
Cervix 1.6 * 1.4
risk during the first few months after diagnosis
Bladder 1.0 0.3 0.8 1
! Previous data suggest that the risk for VTE varies according to type
Lip, oral cavity, pharynx <0.6 * * 4
of cancer

and noncancer patients (%)

DVT in hospitalized cancer
3.5 Cancer patients 0
! Pancreatic cancer is associated with the highest risk for Average 2.0 0.6 1.6

Pancreas

Brain

Myeloprol

Stomach

Uterus

Lung

Esophagus

Prostate

Rectal

Kidney

Colon

Ovary

Liver

Leukemia

Breast

Cervix

Bladder
Lymphoma
3
incidence of VTE 2.5
No cancer 1.0 0.3 0.8
! Lung, ovary, brain, pancreatic, stomach, kidney, and colon 2
cancer are also associated with an increased risk of VTE *Insufficient data
1.5 Noncancer patients
1
! The extent of cancer and use of chemotherapy and/or radiation
0.5
influence risk for VTE 0
! Patients with pancreatic cancer had the highest incidence of VTE
79 81 83 85 87 89 91 93 95 97 99
! Possible factors that may contribute to an increased risk for (4.3%); the lowest incidence was in patients with bladder cancer
thromboembolic events in patients with cancer include: (1.0%) ! Among cancer patients aged 40 to 59 years, the incidence of VTE,
! Tumor-cell procoagulants and/or cytokines Year PE, and DVT was 46% to 80% higher than in patients without
! The incidence of both PE and VTE in patients with cancer were
! Tumor-associated inflammatory cell procoagulants and/or cancer within the same age group
twice those of patients without cancer (0.6% vs 0.3% and 1.6% vs
cytokines ! Among cancer patients aged 60 to 79 years, the incidence of VTE,
0.8%), respectively The relative risk for VTE, PE and DVT in patients with malignancies
! Mediators of platelet adhesion or aggregation generated ! PE, and DVT was only 18% to 42% higher than in patients without
by tumor cells and/or tumor-associated inflammatory cells ! The incidence of VTE in hospitalized patients with cancer began to compared with patients without malignancies is shown in Figures 4 cancer within the same age group
increase sharply beginning in 1989 (Figure 1). The relative increase to 6
! This study examined the risk for VTE in patients with cancer using
for cancer vs noncancer patients was statistically significant
data from the National Hospital Discharge Survey
(P<.0001)
Figure 4. The relative risk of VTE ranged from 1.02 to 4.34
CONCLUSIONS
METHODS ! The incidence of VTE, PE, and DVT was 2-fold higher in patients
Figure 1. Changes in the incidence of VTE in patients with and without
! All patients discharged with the diagnostic code for 1 of 19 with cancer than in noncancer patients
cancer, 1979 to 1999
malignancies between 1979 and 1999 were included in the study 4.5
! In the late 1980s, rates of VTE, PE, and DVT increased.
! Data were obtained from the National Hospital Discharge Registry, 4
This increase may be attributable, in part, to improvements in
which samples ~8% of short term hospital stays and ~1% of
Relative risk of VTE in

3.5 diagnostic capabilities and greater awareness

discharges in the United States
cancer patients

4 Cancer patients 3
3.5
and noncancer patients (%)
VTE in hospitalized cancer

2.5
3
RESULTS 2.5 2
Patients 2 1.5
! Among 40,787,000 patients hospitalized with any of the 19 1.5
1
1
malignancies, 827,000 (2%) had VTE; of 662,309,000 patients who Noncancer patients
0.5 0.5
did not have malignancies, 6,854,000 had VTE (1%) 0
Pancreas

Brain

Myeloprol

Stomach

Uterus

Lung

Esophagus

Prostate

Rectal

Kidney

Colon

Ovary

Liver

Leukemia

Breast

Cervix

Bladder
Lymphoma

! Table 1 summarizes the incidences of VTE, PE, and DVT for cancer 79 81 83 85 87 89 91 93 95 97 99

overall, by site, and for noncancer patients

Year

For educational purposes only. These were not prepared or reviewed by the primary author.