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Coagulation & its Disorders
Frequency, risk factors, and impact on mortality of arterial thromboembolism in patients with cancer
Ella Grilz,1 Oliver Königsbrügge,1 Florian Posch,1,2 Manuela Schmidinger,3 Robert Pirker,3 Irene M. Lang,4 Ingrid Pabinger1 and Cihan Ay1
1Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna; 2Division of Oncology, Department of Internal Medicine, Medical University of Graz; 3Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna and 4Clinical Division of Cardiology, Department of Medicine II, Medical University of Vienna, Austria
ABSTRACT
In contrast to venous thromboembolism, little is known about arte- rial thromboembolism in patients with cancer. The aim of this study was to quantify the risk and explore clinical risk factors of arterial thromboembolism in patients with cancer, and investigate its potential impact on mortality. Patients with newly-diagnosed cancer or progres- sion of disease after remission were included in a prospective observa- tional cohort study and followed for two years. Between October 2003 and October 2013, 1880 patients (54.3% male; median age 61 years) were included. During a median follow up of 723 days, 48 (2.6%) patients developed arterial thromboembolism [20 (41.7%) myocardial infarction, 16 (33.3%) stroke and 12 (25.0%) peripheral arterial events], 157 (8.4%) developed venous thromboembolism, and 754 (40.1%) patients died. The cumulative 3-, 6-, 12-, and 24-month risks of arterial thromboembolism were 0.9%, 1.1%, 1.7%, and 2.6%, respectively. Male sex (subdistribution hazard ratio=2.9, 95%CI: 1.5-5.6; P=0.002), age (subdistribution hazard ratio per 10 year increase=1.5, 1.2-1.7; P<0.001), hypertension (3.1, 1.7-5.5; P<0.001), smoking (2.0, 1.1-3.7; P=0.022), lung cancer (2.3, 1.2-4.2; P=0.009), and kidney cancer (3.8, 1.4-10.5; P=0.012) were associated with a higher arterial thromboem- bolism risk. Furthermore, the occurrence of arterial thromboembolism was associated with a 3.2-fold increased risk of all-cause mortality (hazard ratio=3.2, 95%CI: 2.2-4.8; P<0.001). Arterial thromboem- bolism is a less common complication in patients with cancer than venous thromboembolism. The risk of arterial thromboembolism is high in patients with lung and kidney cancer. Patients with cancer who develop arterial thromboembolism are at a 3-fold increased risk of mor- tality.
Introduction
Cancer is associated with a hypercoagulable state which leads to an increased risk of venous thromboembolism (VTE).1,2 The risk of VTE varies significantly among different cancer types and is associated with an increased risk of mortality.3,4 In contrast to VTE, much less is known on the epidemiology of arterial throm- boembolism (ATE) in patients with cancer.5–7
It is important to identify an association between ATE and cancer because car- diovascular diseases and cancer are becoming more prevalent in an aging popula- tion and may share common risk factors and pathobiology related to inflammation.8,9 Furthermore, recent advances in screening, diagnosis and therapy have improved the survival of many cancers, implying that the population of patients with cancer now lives longer and develops a risk for cardiovascular com- plications.10,11 The risk of ATE in cancer may also be associated with anti-neoplastic treatments, known for the risk of arterial complications.12
Ferrata Storti Foundation
Haematologica 2018 Volume 103(9):1549-1556
As data on the epidemiology, risk and burden of ATE in patients with cancer are
Correspondence:
cihan.ay@meduniwien.ac.at
Received: March 1, 2018. Accepted: May 17, 2018. Pre-published: May 24, 2018.
doi:10.3324/haematol.2018.192419
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/103/9/1549
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