Clinical characteristics and outcomes of incidental venous thromboembolism in cancer patients: Insights from the Caravaggio study

被引：24

作者：

Giustozzi, Michela ^{[1
]}

Connors, Jean M. ^{[2
]}

Ruperez Blanco, Ana Belen ^{[3
]}

Szmit, Sebastian ^{[4
]}

Falvo, Nicolas ^{[5
]}

Cohen, Alexander T. ^{[6
]}

Huisman, Menno ^{[7
]}

Bauersachs, Rupert ^{[8
]}

Dentali, Francesco ^{[9
]}

Becattini, Cecilia ^{[1
]}

Agnelli, Giancarlo ^{[1
]}

机构：

[1] Univ Perugia, Internal Vasc & Emergency Med Stroke Unit, Via G Dottori 1, I-06126 Perugia, Italy

[2] Harvard Med Sch, Brigham & Womenss Hosp, Boston, MA 02115 USA

[3] Complejo Hosp Toledo Castilla La Mancha, Med Oncol Serv, Toledo, Spain

[4] European Hlth Ctr, Ctr Postgrad Med Educ, Dept Pulm Circulat Thromboembol Dis & Cardiol, Otwock, Poland

[5] CHU Dijon, Serv Explorat Vasc & Phlebol Intervent, Dijon, France

[6] Kings Coll London, Guys & St Thomas NHS Fdn Trust, London, England

[7] Leiden Univ Med Ctr, Dept Thrombosis & Hemostasis, Leiden, Netherlands

[8] Klinikum Darmstadt, Dept Vasc Med, Darmstadt, Germany

[9] Insubria Univ, ASST Settelaghi, Dept Med & Surg, Varese, Italy

来源：

JOURNAL OF THROMBOSIS AND HAEMOSTASIS | 2021年 / 19卷 / 11期

关键词：

apixaban; cancer; incidental venous thromboembolism; symptomatic venous thromboembolism; venous thromboembolism; PULMONARY-EMBOLISM; AMERICAN SOCIETY; RISK;

D O I：

10.1111/jth.15461

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Clinical guidelines advise similar anticoagulant treatment for symptomatic and incidental cancer-associated venous thromboembolism (VTE). We investigated clinical features and outcomes of cancer patients with incidental or symptomatic VTE randomized in the Caravaggio study. Objectives We performed a predefined sub-analysis of the Caravaggio study in order to investigate the clinical features and outcomes of incidental and symptomatic VTE in patients with cancer. The relative efficacy and safety of apixaban and dalteparin in patients with incidental and symptomatic VTE was also assessed. Methods The Caravaggio study compared apixaban to dalteparin for the 6-month treatment of cancer-associated VTE. The primary efficacy and safety outcomes were recurrent VTE and major bleeding. Results Two hundred thirty patients (20%) had incidental and 925 (80%) symptomatic VTE. Pulmonary embolism with or without deep vein thrombosis as index event, colorectal cancer, Eastern Cooperative Oncology Group (ECOG) score of 0, and locally advanced or metastatic cancer were more frequent in patients with incidental VTE. Deep vein thrombosis as index event, hematological cancer, and ECOG score of 2 were more frequent in patients with symptomatic VTE. Ten patients (4.3%) with incidental and 68 (7.4%) with symptomatic VTE had recurrent VTE (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.29-1.10). Major bleeding occurred in 12 (5.2%) patients with incidental VTE and in 33 (3.6%) patients with symptomatic VTE (HR 1.43, 95% CI 0.74-2.77). When comparing apixaban to dalteparin in patients with symptomatic and incidental VTE, the HR for recurrence was 0.73 (95% CI 0.45-1.19) and 0.41 (95% CI 0.11-1.56), respectively, and the HR for major bleeding 0.93 (95% CI 0.47-1.83) and 0.96 (95% CI 0.31-2.96), respectively. Conclusions Compared to cancer patients with symptomatic VTE, those with incidental VTE have different clinical features at presentation, with a numerically lower incidence of recurrent VTE and a numerically higher incidence of major bleeding.

引用

页码：2751 / 2759

页数：9

共 16 条

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