Acquired and inherited risk factors for developing venous thromboembolism in cancer patients receiving adjuvant chemotherapy: a prospective trial.

BACKGROUND Acquired and inherited risk factors for venous thromboembolism (VTE) and the incidence of symptomatic VTE were investigated in patients on adjuvant chemotherapy for breast or gastrointestinal cancer (GI). PATIENTS AND METHODS In a prospective observational study (January 2003 and February 2006), 199 GI (82 women/117 men; age range, 26-84 years) and 182 breast (180 women/2 men; age range, 29-85 years) cancer patients were enrolled and followed-up for symptomatic VTE during adjuvant chemotherapy. The effect of acquired (i.e. age, chemotherapy, tumour histotype, history of thrombosis, body mass index and smoking) and inherited risk factors [i.e. antithrombin, protein C (PC), protein S, homocysteine, activated PC resistance, factor V Leiden (FVL) and prothrombin (PT) mutations) was prospectively evaluated. RESULTS Overall, 30 VTE events (7.87%) were recorded: 28 (7.35%) during treatment and 2 (0.52%) during the subsequent follow-up. Among all the 381 cancer patients, FVL was detected in 14 cases (3.67%) and PT mutation in 10 cases (2.62%). Multivariate analysis showed a significant association between the development of VTE and both thrombocytosis [hazard ratio (HR) 1.65; 95% confidence interval (CI), 1.04-2.637, P <0.0341] and a prior episode of thrombosis (HR 7.6; 95% CI, 1.77-33.1, P <0.006). FVL and PT mutations were not associated with the risk for VTE. CONCLUSION The present data indicate thrombocytosis and history of thrombosis as risk factors for development of a thrombotic event during adjuvant chemotherapy in patients with malignant diseases.

[1]  A. Tripodi,et al.  A new chromogenic assay (HemosIL ThromboPath) is sensitive to major prothrombotic risk factors affecting the protein C pathway. Results of a multicenter study. , 2007, Thrombosis research.

[2]  C. Marosi,et al.  High plasma levels of soluble P-selectin are predictive of venous thromboembolism in cancer patients: results from the Vienna Cancer and Thrombosis Study (CATS). , 2007, Blood.

[3]  Gary H Lyman,et al.  American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  P Prandoni,et al.  Venous thromboembolism and cancer: guidelines of the Italian Association of Medical Oncology (AIOM). , 2006, Critical reviews in oncology/hematology.

[5]  B. Binder,et al.  Identification of patients at low risk for recurrent venous thromboembolism by measuring thrombin generation. , 2006, JAMA.

[6]  H. Chew,et al.  Incidence of venous thromboembolism and its effect on survival among patients with common cancers. , 2006, Archives of internal medicine.

[7]  A. Khorana,et al.  Risk factors for chemotherapy‐associated venous thromboembolism in a prospective observational study , 2005, Cancer.

[8]  S. Ely Potential risk of a common hereditary thrombophilia and adjuvant chemotherapy for low-stage breast cancer. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  F. Rosendaal,et al.  The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality , 2005, Annals of Internal Medicine.

[10]  M. Prins,et al.  Symptomatic venous thromboembolism in cancer patients treated with chemotherapy: an underestimated phenomenon. , 2004, Archives of internal medicine.

[11]  M. Prins,et al.  The clinical usefulness of D-dimer testing in cancer patients with suspected deep venous thrombosis. , 2002, Archives of internal medicine.

[12]  E. Hiller,et al.  Impact of thrombophilic gene mutations on thrombosis risk in patients with gastrointestinal carcinoma , 2002, Cancer.

[13]  M. Levine,et al.  Treatment of Venous Thrombosis in the Cancer Patient , 2001, Acta Haematologica.

[14]  R. Hoffman,et al.  Total-homocysteine enzymatic assay. , 2000, Clinical chemistry.

[15]  Y. Manor,et al.  Risk factors and management of patients with upper limb deep vein thrombosis. , 2000, Chest.

[16]  T. Barbui,et al.  The Effect of Very-low-dose Warfarin on Markers of Hypercoagulation in Metastatic Breast Cancer: Results from a Randomized Trial , 1998, Thrombosis and Haemostasis.

[17]  B. Zee,et al.  Increased thromboembolic complications with concurrent tamoxifen and chemotherapy in a randomized trial of adjuvant therapy for women with breast cancer. National Cancer Institute of Canada Clinical Trials Group Breast Cancer Site Group. , 1996, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  M. Trossaërt,et al.  The Modified APC Resistance Test in the Presence of Factor V Deficient Plasma Can Be Used in Patients without Oral Anticoagulant , 1996, Thrombosis and Haemostasis.

[19]  M. Levine,et al.  Hemostatic alterations in cancer patients. , 1992 .

[20]  R. Gray,et al.  Venous and arterial thrombosis in patients who received adjuvant therapy for breast cancer. , 1991, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  J. Hirsh,et al.  The thrombogenic effect of anticancer drug therapy in women with stage II breast cancer. , 1988, The New England journal of medicine.