CC-BY 4.0 · TH Open 2018; 02(02): e210-e217
DOI: 10.1055/s-0038-1656542
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Clinical Characteristics and Outcomes of Patients with Lung Cancer and Venous Thromboembolism

Pedro Ruiz-Artacho
Department of Emergency, Hospital Clínico San Carlos, Madrid, Spain
,
Javier Trujillo-Santos
Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain
,
Luciano López-Jiménez
Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
,
Carme Font
Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
,
María del Carmen Díaz-Pedroche
Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
,
Juan Francisco Sánchez Muñoz-Torrero
Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain
,
Maria Luisa Peris
Department of Internal Medicine, Consorcio Hospitalario Provincial de Castellón, CEU Cardenal Herrera University, Castellón, Spain
,
Andris Skride
Department of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
,
Ana Maestre
Department of Internal Medicine, Hospital Universitario de Vinalopó, Elche, Alicante, Spain
,
Manuel Monreal
Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
,
the RIETE Investigators› Author Affiliations
Further Information

Publication History

07 March 2018

23 April 2018

Publication Date:
01 June 2018 (online)

Abstract

Background The natural history of patients with lung cancer and venous thromboembolism (VTE) has not been consistently evaluated.

Methods We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the clinical characteristics, time course, and outcomes during anticoagulation of lung cancer patients with acute, symptomatic VTE.

Results As of May 2017, a total of 1,725 patients were recruited: 1,208 (70%) presented with pulmonary embolism (PE) and 517 with deep vein thrombosis (DVT). Overall, 865 patients (50%) were diagnosed with cancer <3 months before, 1,270 (74%) had metastases, and 1,250 (72%) had no additional risk factors for VTE. During anticoagulation (median, 93 days), 166 patients had symptomatic VTE recurrences (recurrent DVT: 86, PE: 80), 63 had major bleeding (intracranial 11), and 870 died. The recurrence rate was twofold higher than the major bleeding rate during the first month, and over threefold higher beyond the first month. Fifty-seven patients died of PE and 15 died of bleeding. Most fatal PEs (84%) and most fatal bleeds (67%) occurred within the first month of therapy. Nine patients with fatal PE (16%) died within the first 24 hours. Of 72 patients dying of PE or bleeding, 15 (21%) had no metastases and 29 (40%) had the VTE shortly after surgery or immobility.

Conclusion Active surveillance on early signs and/or symptoms of VTE in patients with recently diagnosed lung cancer and prescription of prophylaxis in those undergoing surgery or during periods of immobilization might likely help prevent VTE better, detect it earlier, and treat it more efficiently.

* A full list of the RIETE investigators is given in Appendix A.