David Spirk1, Tim Sebastian2, Stefano Barco2,3, Martin Banyai2, Jürg H Beer4, Lucia Mazzolai5, Thomas Baldi6,7, Drahomir Aujesky8, Daniel Hayoz9, Rolf P Engelberger9, Thomas Kaeslin10, Wolfgang Korte11, Robert Escher12, Marc Husmann2, Marc Blondon13, Nils Kucher2. 1. Institute of Pharmacology, University of Bern, Bern, Switzerland. 2. Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland. 3. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany. 4. Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland. 5. Clinic of Angiology, Lausanne University Hospital, Lausanne, Switzerland. 6. Department of Internal Medicine, University Hospital Basel, Basel, Switzerland. 7. Department of Internal Medicine, Limmattal Hospital, Schlieren, Switzerland. 8. Division of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland. 9. Division of Angiology, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland. 10. Department of Internal Medicine, Cantonal Hospital Obwalden, Sarnen, Switzerland. 11. Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 12. Department of Internal Medicine, Regional Hospital Burgdorf, Burgdorf, Switzerland. 13. Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
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. Thieme. All rights reserved.
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. Thieme. All rights reserved.
Authors: David Spirk; Tim Sebastian; Jürg Hans Beer; Lucia Mazzolai; Drahomir Aujesky; Daniel Hayoz; Rolf Peter Engelberger; Wolfgang Korte; Nils Kucher; Stefano Barco Journal: Intern Emerg Med Date: 2021-11-03 Impact factor: 5.472
Authors: Marc Carrier; Normand Blais; Mark Crowther; Petr Kavan; Grégoire Le Gal; Otto Moodley; Sudeep Shivakumar; Deepa Suryanarayan; Vicky Tagalakis; Cynthia Wu; Agnes Y Y Lee Journal: Curr Oncol Date: 2021-12-18 Impact factor: 3.677