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Thromb Haemost
DOI: 10.1055/a-2653-6161
Stroke, Systemic or Venous Thromboembolism

Venous Thromboembolism Outcomes Among Cancer and Non-cancer Patients Managed with Patient-centric Guideline-driven Protocol

Claire E. Cassianni 
1   Mayo Clinic Alix School of Medicine, Minnesota, United States
,
Robert D. McBane
2   Department of Vascular Medicine, Gonda Vascular Center, Mayo Clinic, Minnesota, United States
,
Danielle T. Vlazny
2   Department of Vascular Medicine, Gonda Vascular Center, Mayo Clinic, Minnesota, United States
,
David O. Hodge
3   Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, United States
,
Ana I. Casanegra
2   Department of Vascular Medicine, Gonda Vascular Center, Mayo Clinic, Minnesota, United States
,
Damon E. Houghton
2   Department of Vascular Medicine, Gonda Vascular Center, Mayo Clinic, Minnesota, United States
,
Waldemar E. Wysokinski
2   Department of Vascular Medicine, Gonda Vascular Center, Mayo Clinic, Minnesota, United States
› Author Affiliations
Funding This study was supported by a discretionary fund from the Gonda Vascular Center and Vascular Medicine Research Funding, Mayo Clinic Rochester, MN, USA.
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Abstract

Background

Patients with cancer and venous thromboembolism (VTE) have higher complication rates of anticoagulation. However, studies supporting this data are relatively old reflecting the era of vitamin K inhibitors.

Methods

To assess VTE recurrence, major bleeding, and clinically relevant non-major bleeding (CRNMB) in patients (March 1, 2013 to April 30, 2023) with cancer-associated VTE and patients without cancer, the prospective Mayo Clinic Thrombophilia Clinic Registry was analyzed.

Results

Over the study period, 4,711 patients with acute VTE were enrolled including 2,064 patients with cancer (mean age 62.5 ± 12.4, 46% female) and 2,647 patients without cancer (mean age 59.4 ± 16.0, 45% female). The most common cancers were gastrointestinal (n = 423, 21%), pancreatic (n = 287, 14%), and genitourinary (n = 198, 10%). Direct oral anticoagulants were used in 1,339 (65%) cancer and in 1,952 (74%) non-cancer patients. Among cancer patients, 12-month Kaplan–Meier probability of VTE recurrence was 2.4-fold greater (7.1% vs. 2.9%, p < 0.001) compared with the non-cancer group, including higher recurrent leg deep vein thrombosis (3.0% vs. 1.4%; p = 0.002) and pulmonary embolism (3.5% vs. 1.0%, p < 0.001). Patients with cancer also had 2.1-fold greater risk of major bleeding (6.3% vs. 3.0%; p < 0.001) including bleeding from the gastrointestinal tract (3.0 vs. 1.4, p = 0.01) compared with patients without cancer. Clinically relevant non-major bleeding events were similar between the groups.

Conclusion

In this large prospective registry of VTE management, patients with cancer had significantly higher rates of VTE recurrence and major bleeding compared with patients without cancer, yet the rate of complications are substantially smaller relative to historic values of a prior vitamin K antagonist era.

Keywords

deep vein thrombosis - thrombosis - venous thrombosis - anticoagulants - cancer

Note

Presented at 65th ASH Annual Meeting in San Diego, CA, December 2023.


Supplementary Material



Publication History

Received: 06 February 2025

Accepted: 11 July 2025

Article published online:
25 July 2025

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