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Thromb Res. 2014 May;133 Suppl 2:S29-34. doi: 10.1016/S0049-3848(14)50005-9.

Influence of recent immobilization or surgery on mortality in cancer patients with venous thromboembolism.

Collaborators (135)

Monreal M, Decousus H, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Schellong S, Papadakis M, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Adarraga MD, Arcelus JI, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Casado I, Castejón N, Conget F, del Molino F, del Toro J, Falgá C, Fernández-Capitán C, Font L, Fuentes MI, Gallego P, García-Bragado F, García-Lorenzo MD, Gómez V, González J, González-Bachs E, Grau E, Guil M, Gutiérrez J, Hernández L, Hernández-Huerta S, Jaras MJ, Jiménez D, Lecumberri R, Lobo JL, López-Jiménez L, López-Montes L, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Luque JM, Madridano O, Marchena PJ, Martín M, Monreal M, Nauffal D, Nieto JA, Núñez MJ, Ogea JL, Pedrajas JM, Peris ML, Porras JA, Riera-Mestre A, Rivas A, Rodríguez-Dávila MA, Román P, Roncero A, Rosa V, Ruiz-Giménez N, Ruiz J, Sahuquillo JC, Samperiz A, Sánchez Muñoz-Torrero JF, Soler S, Suriñach JM, Tiberio G, Tolosa C, Trujillo-Santos J, Uresandi F, Valdés M, Valero B, Valle R, Vela J, Vidal G, Villalta J, Verhamme P, Peerlinck K, Gadelha T, Ribeiro R, Vassalo J, Wells P, Malý R, Hirmerova J, Kaletova M, Tomko T, Bertoletti L, Bura-Riviere A, Farge-Bancel D, Hij A, Mahe I, Merah A, Schellong S, Babalis D, Papadakis M, Tzinieris I, Braester A, Brenner B, Tzoran I, Zeltser D, Amitrano M, Barillari G, Ciammaichella M, Di Micco P, Duce R, Giorgi-Pierfranceschi M, Maida R, Prandoni P, Quintavalla R, Rocci A, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Sá Bastos M, Sousa MS, Rei R, Bosevski M, Kovacevic D, Bounameaux H, Mazzolai L.

Author information

1
Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain.
2
Department of Clinical Research, FADOI Foundation, Milan, Italy.
3
Department of Haematology, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil.
4
Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain.
5
Department of Pneumonology, Hospital San Pedro, Logroño, La Rioja, Spain.
6
Department of Internal Medicine, Hospital Provincial Reina Sofía, Córdoba, Spain.
7
Department of Internal Medicine, Hospital de Fuenlabrada, Madrid, Spain.
8
Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain.
9
Department of Internal Medicine, Hospital Vega Baja, Alicante, Spain.
10
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. Electronic address: mmonreal.germanstrias@gencat.cat.

Abstract

BACKGROUND:

The influence of recent immobilization or surgery on mortality in cancer patients with venous thromboembolism (VTE) has not been thoroughly studied.

METHODS:

We used the RIETE Registry data to compare the 3-month mortality rate in cancer patients with VTE, with patients categorized according to the presence of recent immobilization, surgery or neither. The major outcomes were fatal pulmonary embolism (PE) and fatal bleeding within the first 3 months.

RESULTS:

Of 6,746 patients with active cancer and acute VTE, 1,224 (18%) had recent immobilization, 1,055 (16%) recent surgery, and 4,467 (66%) had neither. The all-cause mortality was 23.4% (95% CI: 22.4-24.5), and the PE-related mortality: 2.5% (95% CI: 2.1-2.9). Four in every ten patients dying of PE had recent immobilization (37%) or surgery (5.4%). Only 28% of patients with immobilization had received prophylaxis, as compared with 67% of the surgical. Fatal PE was more common in patients with recent immobilization (5.0%; 95% CI: 3.9-6.3) than in those with surgery (0.8%; 95% CI: 0.4-1.6) or neither (2.2%; 95% CI: 1.8-2.6). On multivariate analysis, patients with immobilization were at an increased risk for fatal PE (odds ratio: 1.8; 95% CI: 1.2-2.5).

CONCLUSIONS:

One in every three cancer patients dying of PE had recent immobilization for ≥ 4 days. Many of these deaths could have been prevented with adequate thromboprophylaxis.

KEYWORDS:

Cancer; Death; Immobilization; Pulmonary embolism; Surgery; Venous thromboembolism

PMID:
24862142
DOI:
10.1016/S0049-3848(14)50005-9
[Indexed for MEDLINE]

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