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Am J Med. 2018 Sep;131(9):1095-1103. doi: 10.1016/j.amjmed.2018.04.037. Epub 2018 May 26.

Arterial Ischemic Events Are a Major Complication in Cancer Patients with Venous Thromboembolism.

Author information

1
Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. Electronic address: b_brenner@rambam.health.gov.il.
2
Division of Cardiology, Department of Medicine, Columbia University Medical Center/ New York-Presbyterian Hospital, New York, NY; Center for Outcomes Research & Evaluation (CORE), Yale University School of Medicine, New Haven, Conn; Cardiovascular Research Foundation (CRF), New York, NY.
3
Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
4
Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain.
5
Department of Pneumonology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
6
Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
7
Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain.
8
Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II, University Hospital, Naples, Italy.
9
Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
10
Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain.

Abstract

BACKGROUND:

Venous thromboembolism is common in patients with malignancies, affecting up to 10% of this patient population. The association between arterial ischemic events and venous thromboembolism also has been established. However, the influence of arterial ischemic events on outcomes in cancer patients with venous thromboembolism has not been fully determined.

METHODS:

The current study analyzed clinical characteristics, time course, risk factors, incidence and severity of venous thromboembolism recurrences, arterial ischemic events and major bleeding in 5717 patients with active cancer and venous thromboembolism recruited into RIETE (multi-center prospective registry of patients with objectively confirmed venous thromboembolism).

RESULTS:

During the anticoagulation course (median 7.3 months), 499 (8.7%) patients developed venous thromboembolism recurrences, 63 (1.1%) developed arterial events, and 346 (6.1%) suffered from major bleeding. Overall, major bleeding and arterial events appeared earlier (median 35 and 36 days, respectively) than venous thromboembolism recurrences (median 97 days). Thirty-day mortality rates after each event were: 20% after recurrent pulmonary embolism, 13% after recurrent deep vein thrombosis, 41% after major bleeding, 40% after myocardial infarction, 64% after ischemic stroke, and 83% after lower limb amputation. Bleeding was the leading cause of death (67 fatal bleeds), whereas cumulative mortality due to arterial ischemic events (n = 27) was similar to that related to pulmonary embolism recurrences (n = 26).

CONCLUSIONS:

In this study, arterial ischemic events and major bleeding appeared early after venous thromboembolism in patients with active cancer and were among frequent causes of their deaths. The risk and severity of arterial events need to be considered in this clinical setting.

KEYWORDS:

Arterial ischemic events; Bleeding; Cancer; Venous thromboembolism

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