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J Am Coll Cardiol. 2017 Aug 22;70(8):926-938. doi: 10.1016/j.jacc.2017.06.047.

Risk of Arterial Thromboembolism in Patients With Cancer.

Author information

1
Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: ban9003@med.cornell.edu.
2
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
3
Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York.
4
Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York, New York.
5
Department of Neurology, Columbia College of Physicians and Surgeons, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
6
Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York.

Abstract

BACKGROUND:

The risk of arterial thromboembolism in patients with cancer is incompletely understood.

OBJECTIVES:

The authors aimed to better define this epidemiological relationship, including the effects of cancer stage.

METHODS:

Using the Surveillance Epidemiology and End Results-Medicare linked database, the authors identified patients with a new primary diagnosis of breast, lung, prostate, colorectal, bladder, pancreatic, or gastric cancer or non-Hodgkin lymphoma from 2002 to 2011. They were individually matched by demographics and comorbidities to a Medicare enrollee without cancer, and each pair was followed through 2012. Validated diagnosis codes were used to identify arterial thromboembolism, defined as myocardial infarction or ischemic stroke. Cumulative incidence rates were calculated using competing risk survival statistics. Cox hazards analysis was used to compare rates between groups at discrete time points.

RESULTS:

The authors identified 279,719 pairs of patients with cancer and matched control patients. The 6-month cumulative incidence of arterial thromboembolism was 4.7% (95% confidence interval [CI]: 4.6% to 4.8%) in patients with cancer compared with 2.2% (95% CI: 2.1% to 2.2%) in control patients (hazard ratio [HR]: 2.2; 95% CI: 2.1 to 2.3). The 6-month cumulative incidence of myocardial infarction was 2.0% (95% CI: 1.9% to 2.0%) in patients with cancer compared with 0.7% (95% CI: 0.6% to 0.7%) in control patients (HR: 2.9; 95% CI: 2.8 to 3.1). The 6-month cumulative incidence of ischemic stroke was 3.0% (95% CI: 2.9% to 3.1%) in patients with cancer compared with 1.6% (95% CI: 1.6% to 1.7%) in control patients (HR: 1.9; 95% CI: 1.8 to 2.0). Excess risk varied by cancer type (greatest for lung), correlated with cancer stage, and generally had resolved by 1 year.

CONCLUSIONS:

Patients with incident cancer face a substantially increased short-term risk of arterial thromboembolism.

KEYWORDS:

ischemic stroke; myocardial infarction; thrombosis

PMID:
28818202
PMCID:
PMC5667567
DOI:
10.1016/j.jacc.2017.06.047
[Indexed for MEDLINE]
Free PMC Article

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