Thromb Haemost 2020; 120(05): 847-856
DOI: 10.1055/s-0040-1709527
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Variation in the Association between Antineoplastic Therapies and Venous Thromboembolism in Patients with Active Cancer

1  Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Perugia, Italy
Antonio Curcio
2  Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Calabria, Italy
Bob Weijs
3  Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Limburg, The Netherlands
4  Division of Neurology, Vancouver Stroke Program, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
Saulius Sudikas
5  Department of Surgery, Kantons Hospital Winterthur, Zurich, Switzerland
Anja Katholing
6  Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
Christopher Wallenhorst
6  Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
Jeffrey I. Weitz
7  Department of Medicine, McMaster University and the Thrombosis & Atherosclerosis Research Institute, Hamilton, Canada
Carlos Martinez
6  Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
Alexander T. Cohen
8  Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
› Author Affiliations
Funding The initial work on this study was supported in part by Bayer Pharma AG, Germany. The financial sponsor did not contribute to the conception of the study and had no role in the design, execution, analysis, interpretation of data, or writing of the manuscript. This study was supported by Bayer Thrombosis Academy for Learning Education and Networking Training Program (unrestricted educational grant).
Further Information

Publication History

15 October 2019

08 March 2020

Publication Date:
05 May 2020 (online)


Background Venous thromboembolism (VTE) is a major cause of death in cancer patients. Although patients with cancer have numerous risk factors for VTE, the relative contribution of cancer treatments is unclear.

Objective The objective of this study is to evaluate the association between cancer therapies and the risk of VTE.

Methods From UK Clinical Practice Research Datalink, data on patients with first cancer diagnosis between 2008 and 2016 were extracted along with information on hospitalization, treatments, and cause of death. Primary outcome was active cancer-associated VTE. To establish the independent effects of risk factors, adjusted subhazard ratios (adj-SHR) were calculated using Fine and Gray regression analysis accounting for death as competing risk.

Results Among 67,801 patients with a first cancer diagnosis, active cancer-associated VTE occurred in 1,473 (2.2%). During a median observation time of 1.2 years, chemotherapy, surgery, hormonal therapy, radiation therapy, and immunotherapy were given to 71.1, 37.2, 17.2, 17.5, and 1.4% of patients with VTE, respectively. The active cancers associated with the highest risk of VTE—as assessed by incidence rates—included pancreatic cancer, brain cancer, and metastatic cancer. Chemotherapy was associated with an increased risk of VTE (adj-SHR: 3.17, 95% confidence interval [CI]: 2.76–3.65) while immunotherapy with a not significant reduced risk (adj-SHR: 0.67, 95% CI: 0.30–1.52). There was no association between VTE and radiation therapy (adj-SHR: 0.91, 95% CI: 0.65–1.27) and hormonal therapies.

Conclusion VTE risk varies with cancer type. Chemotherapy was associated with an increased VTE risk, whereas with radiation and immunotherapy therapy, an association was not confirmed.

Authors' Contributions

M.G., A.C., S.S., B.W., T.S.F., J.I.W, C.M., and A.T.C. carried out conception and design of the study. M.G., A.C., S.S., B.W., and T.S.F. dedicated in drafting of the article. J.I.W., C.M., and A.T.C. defined the general scope of the manuscript. A.K., C.W., and C.M. contributed in the acquisition of data, analysis, and interpretation of data. All authors revised successive manuscript versions for important intellectual content.

Supplementary Material