Predictors of venous thromboembolism recurrence and bleeding among active cancer patients: a population-based cohort study.
Blood. 2014 Apr 29;
Authors: Chee CE, Ashrani AA, Marks RS, Petterson TM, Bailey KR, Melton LJ, Heit JA
Active cancer is the major predictor of venous thromboembolism (VTE) recurrence but further stratification of recurrence risk is uncertain. In a population-based cohort study of all Olmsted County, MN residents with active cancer-related incident VTE over the 35-year period, 1966-2000, who survived ≥1 day, we estimated VTE recurrence, bleeding on anticoagulant therapy, and survival, and tested cancer and non-cancer characteristics and secondary prophylaxis as predictors of VTE recurrence and bleeding, using Cox proportional hazards modeling. Of 477 patients, 139 developed recurrent VTE over 1,533 person-years of follow-up. The adjusted 10-year cumulative VTE recurrence rate was 28.6%. The adjusted 90-day cumulative incidence of major bleeding on anticoagulation was 1.9%. Survival was significantly worse for cancer patients with recurrent VTE (particularly pulmonary embolism) and with bleeding on anticoagulation. In a multivariable model, brain, lung and ovarian cancer, myeloproliferative or myelodysplastic disorders, stage IV pancreatic cancer, other stage IV cancer, cancer stage progression and leg paresis were associated with an increased hazard, and warfarin therapy with a reduced hazard, of recurrent VTE. Recurrence rates were significantly higher for cancer patients with ≥ 1 vs. no predictors of recurrence, suggesting that these predictors may be useful for stratifying recurrence risk.
PMID: 24782507 [PubMed - as supplied by publisher]