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DOI: 10.1055/a-2535-7400
Differences in the Outcome of Cancer-Associated Thrombosis Depending on Cancer Type
Authors
Abstract
The outcome of venous thromboembolism in patients with cancer is worse than in patients without cancer, with a higher risk of recurrences, bleeding and death. However, these risks appear to vary depending on the cancer type. While in some tumours the risk of recurrences outweighs the risk of bleeding, in others the risk of major bleeding (MB) during the anticoagulation markedly exceeds the risk of a recurrent event. Balancing these risks could be helpful to tailor the management of cancer-associated thrombosis (CAT) and improve outcomes. In this article, published data from recent randomized clinical trials as well as from some large registries that have reported separated outcomes of CAT depending on cancer type were reviewed. A careful balance of the risk of recurrences and MB events could provide useful insights for clinicians for individualizing treatment strategies in order to improve the outcomes of CAT, as well as for the design of future clinical trials.
Publication History
Received: 26 November 2024
Accepted: 07 February 2025
Accepted Manuscript online:
10 February 2025
Article published online:
05 March 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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References
- 1 Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood 2013; 122 (10) 1712-1723
- 2 Prandoni P, Lensing AW, Piccioli A. et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100 (10) 3484-3488
- 3 Betts MB, Liu X, Junqueira DR. et al. Risk of venous thromboembolism by cancer type: a network meta-analysis. Semin Thromb Hemost 2024; 50 (03) 328-341
- 4 Mulder FI, Horváth-Puhó E, van Es N. et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood 2021; 137 (14) 1959-1969
- 5 Menapace LA, McCrae KR, Khorana AA. Predictors of recurrent venous thromboembolism and bleeding on anticoagulation. Thromb Res 2016; 140 (Suppl. 01) S93-S98
- 6 Louzada ML, Majeed H, Dao V, Wells PS. Risk of recurrent venous thromboembolism according to malignancy characteristics in patients with cancer-associated thrombosis: a systematic review of observational and intervention studies. Blood Coagul Fibrinolysis 2011; 22 (02) 86-91
- 7 Lecumberri R, Ruiz-Artacho P, Trujillo-Santos J. et al; RIETE Investigators. Management and outcomes of cancer patients with venous thromboembolism presenting with thrombocytopenia. Thromb Res 2020; 195: 139-145
- 8 Farge D, Frere C, Connors JM. et al; International Initiative on Thrombosis and Cancer (ITAC) advisory panel. 2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19. Lancet Oncol 2022; 23 (07) e334-e347
- 9 Key NS, Khorana AA, Kuderer NM. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update. J Clin Oncol 2023; 41 (16) 3063-3071
- 10 Falanga A, Ay C, Di Nisio M. et al; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Venous thromboembolism in cancer patients: ESMO clinical practice guideline. Ann Oncol 2023; 34 (05) 452-467
- 11 Mulder FI, van Es N, Kraaijpoel N. et al. Edoxaban for treatment of venous thromboembolism in patient groups with different types of cancer: results from the Hokusai VTE Cancer study. Thromb Res 2020; 185: 13-19
- 12 Young AM, Marshall A, Thirlwall J. et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol 2018; 36 (20) 2017-2023
- 13 Agnelli G, Muñoz A, Franco L. et al. Apixaban and dalteparin for the treatment of venous thromboembolism in patients with different sites of cancer. Thromb Haemost 2022; 122 (05) 796-807
- 14 Kim JH, Yoo C, Seo S. et al. A phase II study to compare the safety and efficacy of direct oral anticoagulants versus subcutaneous dalteparin for cancer-associated venous thromboembolism in patients with advanced upper gastrointestinal, hepatobiliary and pancreatic cancer: priority. Cancers (Basel) 2022; 14 (03) 559
- 15 Vedovati MC, Giustozzi M, Munoz A. et al. Risk factors for recurrence and major bleeding in patients with cancer-associated venous thromboembolism. Eur J Intern Med 2023; 112: 29-36
- 16 Chee CE, Ashrani AA, Marks RS. et al. Predictors of venous thromboembolism recurrence and bleeding among active cancer patients: a population-based cohort study. Blood 2014; 123 (25) 3972-3978
- 17 Mahé I, Chidiac J, Bertoletti L. et al; RIETE investigators. The clinical course of venous thromboembolism may differ according to cancer site. Am J Med 2017; 130 (03) 337-347
- 18 Ruiz-Artacho P, Trujillo-Santos J, López-Jiménez L. et al; RIETE Investigators. Clinical characteristics and outcomes of patients with lung cancer and venous thromboembolism. TH Open 2018; 2 (02) e210-e217
- 19 Ruiz-Artacho P, Lecumberri R, Trujillo-Santos J. et al; The Riete Investigators. Cancer histology and natural history of patients with lung cancer and venous thromboembolism. Cancers (Basel) 2022; 14 (17) 4127
- 20 Zhu VW, Zhao JJ, Gao Y. et al. Thromboembolism in ALK+ and ROS1+ NSCLC patients: a systematic review and meta-analysis. Lung Cancer 2021; 157: 147-155
- 21 Frere C, Trujillo-Santos J, Font C. et al; RIETE Investigators. Clinical course of venous thromboembolism in patients with pancreatic cancer: insights from the RIETE registry. Thromb Haemost 2018; 118 (06) 1119-1122
- 22 Becattini C, Giustozzi M, Portillo J. et al; RIETE Investigators. Acute venous thromboembolism in patients with brain cancer: clinical course. Res Pract Thromb Haemost 2023; 7 (06) 102172
- 23 Zwicker JI, Karp Leaf R, Carrier M. A meta-analysis of intracranial hemorrhage in patients with brain tumors receiving therapeutic anticoagulation. J Thromb Haemost 2016; 14 (09) 1736-1740
- 24 Giustozzi M, Proietti G, Becattini C, Roila F, Agnelli G, Mandalà M. ICH in primary or metastatic brain cancer patients with or without anticoagulant treatment: a systematic review and meta-analysis. Blood Adv 2022; 6 (16) 4873-4883
- 25 Lecumberri R, Ruiz-Artacho P, Tzoran I. et al; RIETE Investigators. Outcome of cancer-associated venous thromboembolism is more favorable among patients with hematologic malignancies than in those with solid tumors. Thromb Haemost 2022; 122 (09) 1594-1602
- 26 Nishimoto Y, Yamashita Y, Morimoto T, Sato Y, Kimura T. COMMAND VTE Registry Investigators. Risk factors of recurrence in patients with cancer-associated venous thromboembolism. Eur J Intern Med 2021; 91: 98-101
- 27 Nishimoto Y, Yamashita Y, Kim K. et al; COMMAND VTE Registry Investigators. Risk factors for major bleeding during anticoagulation therapy in cancer-associated venous thromboembolism- from the COMMAND VTE registry. Circ J 2020; 84 (11) 2006-2014
- 28 Nishimoto Y, Yamashita Y, Morimoto T. et al; COMMAND VTE Registry-2 Investigators. Direct oral anticoagulant-associated bleeding complications in patients with gastrointestinal cancer and venous thromboembolism. Eur J Intern Med 2024; 127: 74-83
- 29 Cohen AT, Wallenhorst C, Choudhuri S, Nassar A, Pollock KG, Martinez C. A novel risk prediction score for clinically significant bleeding in patients anticoagulated for venous thromboembolism with active cancer. Thromb Haemost 2024; 124 (04) 324-336
- 30 Ording AG, Nielsen PB, Skjøth F. et al. Risk of recurrent cancer-associated venous thromboembolism: a Danish nationwide cohort study. Int J Cardiol 2023; 390: 131271
- 31 Wysokinski WE, Houghton DE, Vlazny DT. et al. Influence of primary cancer site on clinical outcomes of anticoagulation for associated venous thromboembolism. Thromb Res 2023; 221: 37-44
- 32 McBane Ii RD, Vlazny DT, Houghton D. et al. Survival implications of thrombus recurrence or bleeding in cancer patients receiving anticoagulation for venous thromboembolism treatment. Thromb Haemost 2023; 123 (05) 535-544
- 33 de Winter MA, Dorresteijn JAN, Ageno W. et al. Estimating bleeding risk in patients with cancer-associated thrombosis: evaluation of existing risk scores and development of a new risk score. Thromb Haemost 2022; 122 (05) 818-829
- 34 Louzada ML, Carrier M, Lazo-Langner A. et al. Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation 2012; 126 (04) 448-454
- 35 Alatri A, Mazzolai L, Font C. et al. Low discriminating power of the modified Ottawa VTE risk score in a cohort of patients with cancer from the RIETE registry. Thromb Haemost 2017; 117 (08) 1630-1636
- 36 Delluc A, Miranda S, Exter PD. et al. Accuracy of the Ottawa score in risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism: a systematic review and meta-analysis. Haematologica 2020; 105 (05) 1436-1442
- 37 Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008; 111 (10) 4902-4907
- 38 Tafur AJ, Caprini JA, Cote L. et al; RIETE Investigators. Predictors of active cancer thromboembolic outcomes. RIETE experience of the Khorana score in cancer-associated thrombosis. Thromb Haemost 2017; 117 (06) 1192-1198
- 39 Lanting VR, Takada T, Bosch FTM. et al. Risk of recurrent venous thromboembolism in patients with cancer: an individual patient data meta-analysis and development of a prediction model. Thromb Haemost 2025; 125 (06) 589-596
- 40 Muñoz AJ, Souto JC, Lecumberri R. et al. Development of a predictive model of venous thromboembolism recurrence in anticoagulated cancer patients using machine learning. Thromb Res 2023; 228: 181-188
- 41 Muñoz Martín AJ, Lecumberri R, Souto JC. et al. Prediction model for major bleeding in anticoagulated patients with cancer-associated venous thromboembolism using machine learning and natural language processing. Clin Transl Oncol 2025; 27 (04) 1816-1825
- 42 Lecumberri R, Alfonso A, Jiménez D. et al; RIETE investigators. Dynamics of case-fatalilty rates of recurrent thromboembolism and major bleeding in patients treated for venous thromboembolism. Thromb Haemost 2013; 110 (04) 834-843