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Heliyon. 2017 Jan 16;3(1):e00229. doi: 10.1016/j.heliyon.2016.e00229. eCollection 2017 Jan.

Analysis of clinical factors affecting the rates of fatal pulmonary embolism and bleeding in cancer patients with venous thromboembolism.

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Department of Internal Medicine, Hospital General Universitario Santa Lucía, Calle Mezquita, s/n. 30202 Cartagena, Murcia, Spain.
Department of Medical Oncology, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clínic, Carrer de Villarroel, 170, 08036 Barcelona, Spain.
Department of Internal Medicine and Pathology, Hôpital Saint-Louis, Avenue Claude Vellefaux, 1, 75010 Paris, France.
Department of Internal Medicine, Hospital Universitario Virgen de Arrixaca, Ctra. Madrid-Cartagena, s/n. 30120, Murcia, Spain.
Department of Internal Medicine, Hospital Universitario de La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain.
Department of pneumonology, Complejo Hospitalario San Pedro, Calle Piqueras, 98, 26006 Logroño, La Rioja, Spain.
Department of Internal Medicine, Hospital de la Agencia Valenciana de Salud Vega Baja, Ctra. Orihuela-Almoradi, s/n. 03314 Orihuela, Alicante, Spain.
Department of Internal Medicine, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, s/n. 28040 Madrid, Spain.
Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Carretera de Canyet, s/n. 08916 Badalona, Barcelona, Universidad Católica de Murcia, Spain.



In cancer patients with symptomatic venous thromboembolism (VTE) (deep-vein thrombosis (DVT) and/or pulmonary embolism (PE)), clinical factors that influence the benefit-risk balance of anticoagulation need to be identified so treatment intensity and duration can be optimally adjusted for the individual patient.


Using clinical data for cancer patients with VTE obtained from the RIETE registry, we compared how rates of fatal PE and fatal bleeding during and after anticoagulation vary depending on patients' clinical characteristics.


Data were analysed from the 10,962 cancer patients with VTE (5,740 with PE with or without DVT; 5,222 with DVT alone) in RIETE registry as of March 2016. Fatal PE occurred in 2.18% of patients, while fatal bleedings occurred in 1.55%. During the 12 months from initial VTE, fatal PE was the most common cause of death, after disseminating cancer, and bleeding the fourth most common. In patients initially presenting with PE, fatal PE during anticoagulation was 4-fold more frequent than fatal bleeding (204 vs 51 deaths) and occurred mostly during the first month of treatment (196/223, 88%). In patients initially presenting with DVT, fatal PE was 3-fold lower than fatal bleeding during (25 vs 85 deaths) and after anticoagulation treatment (8 vs 37 deaths). During the 12-month follow-up, other characteristics of cancer patients with VTE were identified as more common in fatal cases of PE and/or bleeding than in surviving cases.


Baseline clinical characteristics may determine anticoagulation outcomes in cancer patients with VTE and should be further investigated as possible factors for guiding changes in current practices of anticoagulation, such as adjusting anticoagulation intensity and duration in selected patients.


Health Sciences; Medicine

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