PO35 | A MULTICENTRE AUDIT OF CURRENT TUMOUR THROMBOSIS MANAGEMENT IN THE UNITED KINGDOM
A.A. Bhatti1, L. Tafesh1, A. Waton1, M. Thomas3, N. Prasannan3, A. Bhide3, R. Walsh3, T. Lucas3, K. White4, T. Bariana4, O. Tsiamita4, S. Soman4, P. Woolley5, I. Lacej5, K. Musgrave1|2 | 1Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; 2Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; 3University College London Hospitals NHS Foundation Trust, London, UK; 4Barts Health NHS Trust, London, UK; 5Imperial College Healthcare NHS Trust, London, UK
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Background. Tumor thrombus is the extension of a tumor into the intravascular space; its management remains uncertain. This UK-wide audit examined current anticoagulation practice and patient outcomes.
Methods. A multicenter audit was conducted across four hospital trusts. Data were collected via review of electronic patient records. VTE events were defined as new bland thrombosis non-contiguous with the tumor. Progression of tumor thrombus was recorded separately. Outcomes were compared using Fisher’s exact test with significance set at p < 0.05.
Results. Between January 2023 and December 2024, 156 individuals were identified with a mean age of 62.6 years (range 2-99) and 55% male. The commonest primary cancer sites were hepatopancreatobiliary (32%), renal (18%) and gastrointestinal (12%). Metastatic disease was present in 109 (70%). Tumor thrombus most frequently involved the splanchnic veins (40%), pulmonary vasculature (24%), inferior vena cava (22%) and renal veins (17%). Radiological reports identified associated bland thrombosis in 27 patients (17%). At baseline, non-contiguous VTE was present in 14 patients (9%). Ninety patients (58%) received anticoagulation. 81 (52%) individuals were given therapeutic anticoagulation, 9 (6%) received prophylactic anticoagulation and 66 (42%) received no anticoagulation. Low-molecular-weight heparin was the most common anticoagulant, used in 72 (80%) of anticoagulated patients. Surgical thrombectomy was performed in 13 cases (8%). At six months, a new or recurrent VTE event occurred in 8 individuals (10%) receiving therapeutic anticoagulation, 1 (11%) receiving prophylactic anticoagulation and 2 (3%) without anticoagulation (p>0.05). Major or clinically relevant non-major bleeding was observed in 17 (21%), 1 (11%), and 7 (11%) patients, respectively (p > 0.05). Tumor thrombus progression occurred in 20 (25%) on therapeutic anticoagulation, none on prophylactic anticoagulation, and 10 (15%) without anticoagulation (p > 0.05). Overall six-month mortality 45% (70/156). Mortality differed significantly between groups: 31% (25/81) on therapeutic anticoagulation, 78% (7/9) on prophylactic anticoagulation and 58% (38/66) without anticoagulation (p<0.05).
Conclusions. Our results show no difference in VTE rate or bleeding events between different treatment approaches. Mortality rates were lower for individuals who received therapeutic anticoagulation, but these may have been a fitter population. Prospective clinical trials are needed.
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