Growth Differentiation Factor-15: A Novel Biomarker for Predicting Risk of Venous Thromboembolism and Bleeding in Patients with Cancer

Growth Differentiation Factor-15, High-Sensitivity Cardiac Troponin T, and N-Terminal pro-B-type Natriuretic Peptide for Predicting Risk of Venous Thromboembolism in Ambulatory Cancer Patients Receiving Chemotherapy

Risk of venous thromboembolism (VTE) is elevated in patients with cancer[1] and based on the findings from the CASSINI and AVERT trials, guidelines now suggest primary thromboprophylaxis also in ambulatory cancer patients with intermediate to high risk for VTE and no apparent risk for bleeding. However, the risk-to-benefit ratio of primary thromboprophylaxis in unselected patients with cancer is marginal and not routinely implemented in current clinical practice. Optimization of VTE and bleeding risk stratification in cancer patients could therefore improve patient management by better selecting patients who would benefit from primary thromboprophylaxis.

In this edition of Thrombosis and Haemostasis, Roy et al[2] investigated biomarkers, primarily used in the cardiovascular setting, for their predictive ability for risk of VTE in the study population of the AVERT trial, a cancer cohort with intermediate to high risk for developing VTE. Roy and colleagues report a positive association of growth differentiation factor-15 (GDF-15), a marker for oxidative stress and inflammation, and high-sensitivity cardiac troponin T (hs-TnT) with future risk of VTE. In a previous analysis on the same cohort, GDF-15 was also associated with major bleeding in cancer patients.[3] However, GDF-15 and hs-TnT were not tested for their independent predictive value when compared with important risk stratifiers such as cancer type and stage or other biomarkers including D-dimer.

GDF-15 is currently not available in clinical routine, but evidence for its predictive nature for cardiovascular events and bleeding is building up in various disease settings. This study adds to previous literature on GDF-15 also being an important biomarker in the setting of venous thrombosis. Future studies need to evaluate the additional predictive value of GDF-15 and/or hs-TnT to currently existing risk prediction scores (Khorana, Vienna CATScore, CT-BLEED) to optimize VTE and bleeding risk prediction in patients with cancer.

Publication History

Received: 06 April 2022

Accepted: 08 April 2022

Accepted Manuscript online:
18 April 2022

Article published online:
10 June 2022

• References

• 1 Grilz E, Posch F, Nopp S. et al. Relative risk of arterial and venous thromboembolism in persons with cancer vs. persons without cancer-a nationwide analysis. Eur Heart J 2021; 42 (23) 2299-2307
• 2 Roy DC, Wang T-F, Mallick R. et al. Growth differentiation factor-15, high-sensitivity cardiac troponin T, and N-terminal pro-B-type natriuretic peptide for predicting risk of venous thromboembolism in ambulatory cancer patients receiving chemotherapy. Thromb Haemost 2022; 122 (05) 1169-1176
• 3 Mulder FI, Bosch FTM, Carrier M. et al. Growth differentiation factor-15 for prediction of bleeding in cancer patients. J Thromb Haemost 2022; 20 (01) 138-144