2020 Volume 31 Issue 1 Pages 45-51
BACKGROUND: Though direct oral anticoagulants are also used for venous thromboembolism (VTE) in patients with cancer, it is unclear for how long patients should be treated and whether the treatment is appropriate for asymptomatic patients.
METHODS: We retrospectively examined data of patients with cancer and VTE between 2016 and 2018. Cumulative incidence of recurrent symptomatic thromboembolism, major bleeding and time to thrombus disappearance were assessed, and risk factors for these were identified by multivariate analysis.
RESULTS: Of 151 consecutive VTE, asymptomatic cases constituted 74.8%. One-year cumulative incidences of thromboembolism and major bleeding were 6.5% and 15.4%, respectively. Significant risk for recurrence was high D-dimer concentration (≥3.0 µg/mL) at diagnosis of VTE [hazard ratio (HR)>10, P=0.003] and concomitant use of anti-platelet drugs [HR 7.59, 95% confidence interval (CI) 1.14–30.80, P=0.039]. The only risk for bleeding was bad performance status (≥ 3) [HR 3.94, 95% CI 1.48–10.66, P=0.007]. Median time to thrombus disappearance was 29 days. Three and six-month cumulative incidence of thrombus disappearance was 71.8% and 74.9%. Risk for residual thrombus was deep vein thrombosis without pulmonary embolism [HR 1.75, 95% CI 1.11–2.80, P=0.015] and recurrent cancer [HR 1.66, 95% CI 1.08–2.58, P=0.021].
CONCLUSION: Asymptomatic patients experienced symptomatic recurrence with the same probability as symptomatic patients and should therefore undergo anti-coagulation therapy. Three quarters of thrombi disappeared within three months. Complete remission of cancer at six months and early termination of treatment were not predictors for recurrence. High D-dimer concentration at diagnosis was a good predictor for symptomatic recurrence.
