Cancer-related venous thromboembolism: insight into underestimated risk factors

Risk factors for cancer-associated VTE include certain cancer types (e.g. pancreatic adenocarcinoma), chemotherapy, and the use of erythropoiesis-stimulating agents, central venous catheters, and surgery. We studied the risk factors for cancer-associated VTE in our institution.

Retrospective analysis of patients with solid cancers treated with chemotherapy at King Khalid University Hospital from 2000 to 2010.

We assessed risk factors responsible for VTE, including performance status, age, chemotherapy, use of erythropoietin (EPO), stage of disease and use of a central venous catheter. Patients with other co-morbidities such as diabetes were excluded.

Forty of 306 patients were identified as having VTE, including 111 males and 195 females with a median age of 38 years (range, 13-18 years). Thirty-nine patients had proximal deep vein thrombosis (DVT) and, 4 had pulmonary embolism with no evidence of DVT. Of the 43 patients, 40 patients had stage III or IV at the time of VTE. Thirty patients were taking erythropoietin (40 000 units/ week); 25 had a hemoglobin level higher than 12 g/L. All patients were treated with low molecular weight (LMW) heparin and maintained on LMW heparin or warfarin for minimum of 6 months.

VTE imposes a great risk to life in cancer patients. Risk factors include age more than 40 years, advanced cancer stage, chemotherapy, use of EPO for anemia and underuse of DVT prophylaxis.