Abstract
Background
Patients with cancer and venous thromboembolism (VTE) have higher complication rates
of anticoagulation. However, studies supporting this data are relatively old reflecting
the era of vitamin K inhibitors.
Methods
To assess VTE recurrence, major bleeding, and clinically relevant non-major bleeding
(CRNMB) in patients (March 1, 2013 to April 30, 2023) with cancer-associated VTE and
patients without cancer, the prospective Mayo Clinic Thrombophilia Clinic Registry
was analyzed.
Results
Over the study period, 4,711 patients with acute VTE were enrolled including 2,064
patients with cancer (mean age 62.5 ± 12.4, 46% female) and 2,647 patients without
cancer (mean age 59.4 ± 16.0, 45% female). The most common cancers were gastrointestinal
(n = 423, 21%), pancreatic (n = 287, 14%), and genitourinary (n = 198, 10%). Direct oral anticoagulants were used in 1,339 (65%) cancer and in 1,952
(74%) non-cancer patients. Among cancer patients, 12-month Kaplan–Meier probability
of VTE recurrence was 2.4-fold greater (7.1% vs. 2.9%, p < 0.001) compared with the non-cancer group, including higher recurrent leg deep
vein thrombosis (3.0% vs. 1.4%; p = 0.002) and pulmonary embolism (3.5% vs. 1.0%, p < 0.001). Patients with cancer also had 2.1-fold greater risk of major bleeding (6.3%
vs. 3.0%; p < 0.001) including bleeding from the gastrointestinal tract (3.0 vs. 1.4, p = 0.01) compared with patients without cancer. Clinically relevant non-major bleeding
events were similar between the groups.
Conclusion
In this large prospective registry of VTE management, patients with cancer had significantly
higher rates of VTE recurrence and major bleeding compared with patients without cancer,
yet the rate of complications are substantially smaller relative to historic values
of a prior vitamin K antagonist era.
Keywords
deep vein thrombosis - thrombosis - venous thrombosis - anticoagulants - cancer
