Thromb Haemost 2021; 121(05): 641-649
DOI: 10.1055/s-0040-1720977
Stroke, Systemic or Venous Thromboembolism

Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

David Spirk
1  Institute of Pharmacology, University of Bern, Bern, Switzerland
,
Tim Sebastian
2  Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
,
2  Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
3  Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
,
Martin Banyai
2  Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
,
Jürg H. Beer
4  Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
,
Lucia Mazzolai
5  Clinic of Angiology, Lausanne University Hospital, Lausanne, Switzerland
,
Thomas Baldi
6  Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
7  Department of Internal Medicine, Limmattal Hospital, Schlieren, Switzerland
,
Drahomir Aujesky
8  Division of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
,
Daniel Hayoz
9  Division of Angiology, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
,
Rolf P. Engelberger
9  Division of Angiology, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
,
Thomas Kaeslin
10  Department of Internal Medicine, Cantonal Hospital Obwalden, Sarnen, Switzerland
,
Wolfgang Korte
11  Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
,
Robert Escher
12  Department of Internal Medicine, Regional Hospital Burgdorf, Burgdorf, Switzerland
,
Marc Husmann
2  Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
,
Marc Blondon
13  Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
,
Nils Kucher
2  Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
› Author Affiliations
Funding This analysis was supported by the International Society on Thrombosis and Haemostasis (ISTH) 2007 Presidential Fund, Switzerland. SWIVTER was funded by the International Society on Thrombosis and Haemostasis (ISTH) 2007 Presidential Fund, Sanofi-Aventis (Suisse) SA, Vernier, Bayer (Schweiz) AG, Zurich, Pfizer AG, Zurich, and Bristol-Myers Squibb AG, Cham, Switzerland. The work of S.B. is supported by the German Federal Ministry of Education and Research (BMBF 01EO1003 and 01EO1503).

Abstract

Objective In patients with cancer-associated venous thromboembolism (VTE), the risk of recurrence is similar after incidental and symptomatic events. It is unknown whether the same applies to incidental VTE not associated with cancer.

Methods and Results We compared baseline characteristics, anticoagulation therapy, all-cause mortality, and VTE recurrence rates at 90 days between patients with incidental (n = 131; 52% without cancer) and symptomatic (n = 1,931) VTE included in the SWIss Venous ThromboEmbolism Registry (SWIVTER). After incidental VTE, 114 (87%) patients received anticoagulation therapy for at least 3 months. The mortality rate was 9.2% after incidental and 8.4% after symptomatic VTE for hazard ratio (HR) 1.10 (95% confidence interval [CI] 0.49–2.50). After adjustment for competing risk of death, recurrence rate was 3.1 versus 2.8%, respectively, for sub-HR 1.07 (95% CI 0.39–2.93). These results were consistent among cancer (mortality: 15.9% vs. 12.6%; HR 1.32, 95% CI 0.67–2.59; recurrence: 4.8% vs. 4.7%; HR 1.02, 95% CI 0.30–3.42) and noncancer patients (mortality: 2.9% vs. 2.1%; HR 1.37, 95% CI 0.33–5.73; recurrence: 1.5% vs. 2.3%; HR 0.63, 95% CI 0.09–4.58). Patients with incidental VTE who received anticoagulation therapy for at least 3 months had lower mortality (4% vs. 41%) and recurrence rate (1% vs. 18%) compared with those who did not.

Conclusion In SWIVTER, more than half of incidental VTE events occurred in noncancer patients who often received anticoagulation therapy. Among noncancer patients, early mortality and recurrence rates were similar after incidental versus symptomatic VTE. Our findings suggest that anticoagulation therapy for incidental VTE may be beneficial regardless of the presence of cancer.

Supplementary Material



Publication History

Received: 08 June 2020

Accepted: 25 September 2020

Publication Date:
17 November 2020 (online)

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