Arterial Ischemic Events Are a Major Complication in Cancer Patients with Venous Thromboembolism - 27/09/18
, Behnood Bikdeli, MD c, d, e, Inna Tzoran, MD a, b, Olga Madridano, MD, PhD f, Raquel López-Reyes, MD, PhD g, José María Suriñach, MD, PhD h, Ángeles Blanco-Molina, MD, PhD i, Antonella Tufano, MD, PhD j, Juan José López Núñez, MD k, Javier Trujillo-Santos, MD, PhD l, Manuel Monreal, MD, PhD k, 1for the RIETE Investigators1
Resumen |
• | Arterial events are a major cause of death in cancer patients with venous thrombosis. |
• | Arterial events occur early after venous thrombosis in cancer patients. |
• | The risk of arterial events should be considered in this clinical setting. |
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.
El texto completo de este artículo está disponible en PDF.Keywords : Arterial ischemic events, Bleeding, Cancer, Venous thromboembolism
Esquema
| Funding: B Bikdeli is supported by the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), through grant number T32 HL007854. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. |
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| Conflict of Interest: The authors declare no conflicts of interest relevant to this submission. |
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| Authorship: B Brenner designed research, interpreted the data, wrote the paper, and approved the final version of the paper; B Bikdeli designed research, interpreted the data, wrote the paper, and approved the final version of the paper; IT recruited patients, performed research, interpreted the data, and approved the final version of the paper; OM recruited patients, performed research, and approved the final version of the paper; RL-R recruited patients, performed research, and approved the final version of the paper; JMS recruited patients, performed research, and approved the final version of the paper; ÁB-M recruited patients, performed research, and approved the final version of the paper; AT recruited patients, performed research, and approved the final version of the paper; JJLN recruited patients, performed research, and approved the final version of the paper; JT-S recruited patients, performed research, interpreted the data, and approved the final version of the paper; and MM recruited patients, designed research, interpreted the data, wrote the paper, approved the final version of the paper, and obtained funding. |
Vol 131 - N° 9
P. 1095-1103 - septembre 2018 Regresar al número
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