Thrombosis and Cancer (PDF)

months with recurrent venous thromboembolism was highest for patients with a prior thrombotic event and malignancy (0.22), followed by those with malignancy alone (0.14), nonmalignant disease (0.08), and isolated thromboembolism (0.06).

The probability of death among patients with venous thromboembolism and malignancy was much higher than among those with thrombosis and no malignancy: 0.94 versus 0.29 (p=0.001). Recently, Sallah et al3 reported the frequency of venous thromboembolism among 1041 patients with solid tumors hospitalized in three major medical centers. Deep-vein thrombosis, pulmonary embolism, or both were diagnosed on 81 patients (7.8%). These observations need to be compared with the estimated frequency of venous thromboembolism among patients suffering from medical diseases hospitalized in general wards. In the Medenox study, the incidence of asymptomatic peripheral venous thromboembolism was assessed by bilateral ascending contrast venography in a cohort of acutely ill medical patients with intermediate thrombotic risk.

The cohort also included cancer patients.4 Venous thromboembolism was found in 14.9% of these patients. This incidence is higher than the usually reported frequency of venous thromboembolism among cancer patients, but one should not forget that most studies of cancer patients report symptomatic, overt venous thrombosis, while the Medenox study systematically investigated the asymptomatic presence of venous thrombosis. Few clinical studies have estimated the occult prevalence of deepvein thrombosis in the cancer population. Johnson et al5 screened 298 hospice patients with advanced cancer, using light-reflection rheography.

Deep-vein thrombosis was found in 52% of the examined patients, mainly among those with poor mobility, low serum albumin levels, and renal dysfunction. In a retrospective analysis of three prospective studies, Lee et al6 assessed the prevalence of deep-vein thrombosis in a population of 1068 outpatients, using D-dimer testing, impedence plethysmography, compression ultrasonography, or contrast venography. Their results confirm, with a rare degree of similarity, the reports by Johnson et al5 and the Medenox study4—deep-vein thrombosis was found in 48.8% of 121 patients with cancer and in 14.6% of 947 patients without cancer. Patients at greatest risk of venous thromboembolism include those with mucin-secreting tumors (pancreas and gastrointestinal tract); cancer of the lung, kidney, brain, prostate, and ovary; acute promyelocytic leukemia; myeloproliferative disorders; and lymphomas.