Proceedings of the 12th International Conference on Thrombosis and Hemostasis Issues in Cancer, 2024
Vol. 3 No. s1 (2024)
Trends and updates on the epidemiology of cancer-associated thrombosis: a systematic review
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 31 January 2024
Accepted: 29 February 2024
Accepted: 29 February 2024
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For cancer patients, cancer-associated thrombosis (CAT) is a serious complication. An updated epidemiology of CAT over the last ten years is summarized in this review. A comprehensive analysis of pertinent population cohort research released between 2011 and 2024 was carried out. In patients with unselected cancers, the 12-month incidence of CAT is roughly 3-5% (9-fold increase vs to the matched non-cancer population); however, in patients with advanced cancers requiring systemic therapy, the risk rises to 6-8% (20-fold increase vs. to the matched non-cancer population). Anticoagulation use and adherence have improved, but the risk of recurrence is still high, at 5-8% at 6 months and 7-15% at 12 months. The type, stage, and treatment of cancer, a history of venous thromboembolism (VTE), prolonged hospitalization or immobilization, and obesity are significant clinical predictors of the development of CAT. The modified Vienna-CATS and EHR-CAT have the best performance (area under the curve 0.68-0.71) among the clinical risk prediction scores for CAT using the original Khorana score backbone that has been externally validated. However, additional research is required to guarantee appropriate implementation and utilization of these models. Even with contemporary antineoplastic treatments, CAT is still a major complication for cancer patients. We encourage interdisciplinary partnerships among hematologists, data scientists, epidemiologists, and oncologists to guarantee the integration of customized VTE risk evaluation into standard oncologic treatment.
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Center for Disease Control and Prevention. Venous Thromboembolism (Blood Clots) and Cancer. Available from: https://www.cdc.gov/ncbddd/dvt/index.html
Khorana AA, Francis CW, Culakova E, et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb. Haemost 2007;5: 632-4. DOI: https://doi.org/10.1111/j.1538-7836.2007.02374.x
Lyman GH, Eckert L, Wang Y, et al. Venous thromboembolism risk in patients with cancer receiving chemotherapy: a real-world analysis. Oncologist 2013;18:1321-9. DOI: https://doi.org/10.1634/theoncologist.2013-0226
Datta T, Brunson A, Mahajan A, et al. Racial disparities in cancer-associated thrombosis. Blood Adv 2022;6:3167-77. DOI: https://doi.org/10.1182/bloodadvances.2021006209
Cohen AT, Katholing A, Rietbrock S, et al. Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A population-based cohort study. Thromb Haemost 2017;117:57-65. DOI: https://doi.org/10.1160/TH15-08-0686
Yu Y-B, Gau J-P, Liu C-Y, et al. A nation-wide analysis of venous thromboembolism in 497,180 cancer patients with the development and validation of a risk-stratification scoring system. Thromb Haemost 2012;108:225-35. DOI: https://doi.org/10.1160/TH12-01-0010
Shang H, Jiang J, Guffey D, et al. Natural history of cancer-associated splanchnic vein thrombosis. J Thromb Haemost 2024:1-12. DOI: https://doi.org/10.1182/blood-2023-179631
da Costa WL, Guffey D, Oluyomi A, et al. Patterns of venous thromboembolism risk, treatment, and outcomes among patients with cancer from uninsured and vulnerable populations. Am J Hematol 2022;97:1044-54. DOI: https://doi.org/10.1002/ajh.26623
Martens KL, Li A, La J, et al. Epidemiology of Cancer-Associated Venous Thromboembolism in Patients With Solid and Hematologic Neoplasms in the Veterans Affairs Health Care System. JAMA Netw Open 2023;6:e2317945. DOI: https://doi.org/10.1001/jamanetworkopen.2023.17945
Mulder FI, Horváth-Puhó E, van Es N, et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood 2021;137:1959-69. DOI: https://doi.org/10.1182/blood.2020007338
Mahajan A, Brunson A, Adesina O, et al. The incidence of cancer-associated thrombosis is increasing over time. Blood Adv 2022;6:307-20. DOI: https://doi.org/10.1182/bloodadvances.2021005590
Sharman Moser S, Spectre G, Raanani P, et al. Cancer-associated venous thromboembolism in Israel: Incidence, risk factors, treatment, and health care utilization in a population based cohort study. Res Pract Thromb Haemost 2022;6: e12653. DOI: https://doi.org/10.1002/rth2.12653
Ohashi Y, Ikeda M, Kunitoh H, et al. One-year incidence of venous thromboembolism, bleeding, and death in patients with solid tumors newly initiating cancer treatment: Results from the Cancer-VTE Registry. Thromb Res 2022;213:203-13. DOI: https://doi.org/10.1016/j.thromres.2021.09.012
Englisch C, Moik F, Nopp S, et al. ABO blood group type and risk of venous thromboembolism in patients with cancer. Blood Adv 2022;6:6274-81. DOI: https://doi.org/10.1182/bloodadvances.2021006283
van Es N, Di Nisio M, Cesarman G, et al. Comparison of risk prediction scores for venous thromboembolism in cancer patients: A prospective cohort study. Haematologica 2017;102: 1494-501. DOI: https://doi.org/10.3324/haematol.2017.169060
Verzeroli C, Giaccherini C, Russo L, et al. Utility of the Khorana and the new-Vienna CATS prediction scores in cancer patients of the HYPERCAN cohort. J Thromb Haemost 2023;21:1869-81. DOI: https://doi.org/10.1016/j.jtha.2023.03.037
Khorana AA, Kuderer NM, Culakova E, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008;111:4902-7. DOI: https://doi.org/10.1182/blood-2007-10-116327
Ashrani AA, Gullerud RE, Petterson TM, et al. Risk factors for incident venous thromboembolism in active cancer patients: A population based case-control study. Thromb Res 2016;139:29-37. DOI: https://doi.org/10.1016/j.thromres.2016.01.002
Li A, May SB, La J, et al. Venous thromboembolism risk in cancer patients receiving first-line immune checkpoint inhibitor versus chemotherapy. Am J Hematol 2023;1-9. DOI: https://doi.org/10.1182/blood-2022-162658
Khorana AA, Palaia J, Rosenblatt L, et al. Venous thromboembolism incidence and risk factors associated with immune checkpoint inhibitors among patients with advanced non-small cell lung cancer. J Immunother Cancer 2023;11. DOI: https://doi.org/10.1136/jitc-2022-006072
Mahajan A, Brunson A, White R, Wun T. The epidemiology of cancer-associated venous thromboembolism: An update. Semin Thromb Hemost 2019;45:321-5. DOI: https://doi.org/10.1055/s-0039-1688494
Raskob GE, Wendelboe AM, Campbell J, et al. Cancer-associated venous thromboembolism: Incidence and features in a racially diverse population. J Thromb Haemost 2022;20: 2366-78. DOI: https://doi.org/10.1111/jth.15818
Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv 2021;5:927-74. DOI: https://doi.org/10.1182/bloodadvances.2021004734
Ay C, Dunkler D, Marosi C, et al. Prediction of venous thromboembolism in cancer patients. Blood 2010;116:5377-82. DOI: https://doi.org/10.1182/blood-2010-02-270116
Verso M, Agnelli G, Barni S, et al. A modified Khorana risk assessment score for venous thromboembolism in cancer patients receiving chemotherapy: the Protecht score. Intern Emerg Med 2012;7:291-2. DOI: https://doi.org/10.1007/s11739-012-0784-y
Gerotziafas GT, Taher A, Abdel-Razeq H, et al. A Predictive Score for Thrombosis Associated with Breast, Colorectal, Lung, or Ovarian Cancer: The Prospective COMPASS–Cancer-Associated Thrombosis Study. Oncologist 2017;22: 1222-31. DOI: https://doi.org/10.1634/theoncologist.2016-0414
Pabinger I, van Es N, Heinze G, et al. A clinical prediction model for cancer-associated venous thromboembolism: a development and validation study in two independent prospective cohorts. Lancet Haematol 2018;5:e289-e298. DOI: https://doi.org/10.1016/S2352-3026(18)30063-2
Muñoz A, Ay C, Grilz E, et al. A Clinical-Genetic Risk Score for Predicting Cancer-Associated Venous Thromboembolism: A Development and Validation Study Involving Two Independent Prospective Cohorts. J Clin Oncol 2023;41:2911-25. DOI: https://doi.org/10.1200/JCO.22.00255
Li A, La J, May SB, et al. Derivation and Validation of a Clinical Risk Assessment Model for Cancer-Associated Thrombosis in Two Unique US Health Care Systems. J Clin Oncol 2023;JCO2201542.
Li A, De Las Pozas G, Andersen CR, et al. External validation of a novel electronic risk score for cancer-associated thrombosis in a comprehensive cancer center. Am J Hematol 2023;98:1052-7. DOI: https://doi.org/10.1002/ajh.26928
van Es N, Ventresca M, Di Nisio M, et al. The Khorana score for prediction of venous thromboembolism in cancer patients: An individual patient data meta-analysis. J Thromb Haemost 2020;18:1940-51. DOI: https://doi.org/10.1111/jth.14824
Spyropoulos AC, Eldredge JB, Anand LN, et al. External Validation of a Venous Thromboembolic Risk Score for Cancer Outpatients with Solid Tumors: The COMPASS-CAT Venous Thromboembolism Risk Assessment Model. Oncologist 2020;25:e1083-e1090. DOI: https://doi.org/10.1634/theoncologist.2019-0482
Khorana AA. Simplicity versus complexity: an existential dilemma as risk tools evolve. Lancet Haematol 2018;5:e273-e274. DOI: https://doi.org/10.1016/S2352-3026(18)30067-X
Mulder FI, Bosch FTM, Young AM, et al. Direct oral anticoagulants for cancer-associated venous thromboembolism: a systematic review and meta-analysis. Blood 2020;136: 1433-41. DOI: https://doi.org/10.1182/blood.2020005819
Ording AG, Nielsen PB, Skjøth F, et al. Risk of recurrent cancer-associated venous thromboembolism: A Danish nationwide cohort study. Int J Cardiol 2023;390:131271. DOI: https://doi.org/10.1016/j.ijcard.2023.131271
Lecumberri R, Ruiz-Artacho P, Tzoran I, et al. Outcome of Cancer-Associated Venous Thromboembolism Is More Favorable among Patients with Hematologic Malignancies than in Those with Solid Tumors. Thromb Haemost 2022;122: 1594-602. DOI: https://doi.org/10.1055/a-1777-4006
Hwang H-G, Lee JH, Hong J, et al. Recurrence of Cancer-associated Venous Thromboembolism between 2009 and 2013: A Nationwide Korean Study. Clin Exp Thromb Hemost 2021;7:14-9. DOI: https://doi.org/10.14345/ceth.21003
Khorana AA, McCrae K, Milentijevic D, et al. The risk of recurrent VTE and major bleeding in a commercially-insured population of cancer patients treated with anticoagulation. Am J Hematol 2019;94:E58-E61. DOI: https://doi.org/10.1002/ajh.25361
Sørensen HT, Pedersen L, van Es N, et al. Impact of venous thromboembolism on the mortality in patients with cancer: a population-based cohort study. Lancet Reg Heal Eur 2023; 34:100739. DOI: https://doi.org/10.1016/j.lanepe.2023.100739
Martin KA, Lyleroehr MJ, Cameron KA. Barriers and facilitators to preventing venous thromboembolism in oncology practice. Thromb Res 2022;220:21-3. DOI: https://doi.org/10.1016/j.thromres.2022.09.026
Supporting Agencies
This research was partly funded by NIH NHLBI K23 HL159271 and NIH Agreement No. 3OT2OD032581-01S1. AL, a CPRIT Scholar in Cancer Research, was supported by the Cancer Prevention and Research Institute of Texas (RR190104).How to Cite
1.
Li A, Zhou E. Trends and updates on the epidemiology of cancer-associated thrombosis: a systematic review. Bleeding Thromb Vascul Biol [Internet]. 2024 May 16 [cited 2026 Jan. 28];3(s1). Available from: https://www.btvb.org/btvb/article/view/108
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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