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Occult cancer‐related first venous thromboembolism is associated with an increased risk of recurrent venous thromboembolism
Author(s) -
Gran O. V.,
Brækkan S. K.,
Paulsen B.,
Skille H.,
Rosendaal F. R.,
Hansen J.B.
Publication year - 2017
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13714
Subject(s) - medicine , occult , cancer , hazard ratio , confidence interval , incidence (geometry) , proportional hazards model , cumulative incidence , venous thromboembolism , oncology , cohort , pathology , thrombosis , physics , alternative medicine , optics
Essentials Recurrence risk after an occult cancer‐related incident venous thromboembolism (VTE) is unknown. We compared the risk of VTE recurrence in occult‐, overt‐ and non‐cancer related first VTE. Patients with occult‐cancer related first VTE had the highest risk of VTE recurrence. The high recurrence risk in occult cancer is likely due to the advanced cancers.Summary Background Although venous thromboembolism ( VTE ) is associated with a high recurrence rate, the absolute recurrence rates for cancer‐related VTE , particularly occult cancer, are not well known. Objectives To investigate the risk of VTE recurrence in patients with occult and overt cancer‐related VTE . Methods Incident VTE events among participants of the first to sixth Tromsø surveys occurring in the period 1994–2012 were included. Occult cancer was defined as cancer diagnosed within a year following a VTE , and overt cancer was defined as cancer diagnosed within the 2 years before a VTE . Results Among 733 patients with incident VTE , 110 had overt cancer and 40 had occult cancer. There were 95 recurrent VTE events during a median of 3.2 years of follow‐up. The 1‐year cumulative incidence of VTE recurrence was 38.6% in subjects with occult cancer, 15.5% in subjects with overt cancer, and 3.8% in non‐cancer subjects. The 1‐year risk of recurrence was 12‐fold (hazard ratio [ HR ] 12.4, 95% confidence interval [ CI ] 5.9–26.3) higher in subjects with occult cancer and four‐fold ( HR 4.3, 95% CI 2.0–9.2) higher in subjects with overt cancer than in non‐cancer subjects. The occult cancers associated with VTE recurrence were typically located at prothrombotic sites (i.e. lung and gastrointestinal) and presented at advanced stages. The majority (69%) of recurrences in subjects with occult cancer occurred before or shortly after cancer diagnosis, and were therefore not treatment‐related. Conclusion Our findings suggest that the increased risk of recurrence in patients with occult cancer is mainly attributable to the advanced cancers in these patients.