Prospective assessment of venous thromboembolism in lung cancer patients using a standardized screening protocol

Venous thromboembolism (VTE) is highly prevalent in cancer patients. While its actual incidence remains disparate among studies, specific subpopulations, such as lung cancer patients, might be at an increased risk. We aimed to assess the impact of a screening protocol in determining both the incidence and risk factors for VTE and evaluate the usefulness of predictive biomarkers and risk stratification tools in lung cancer patients. For this purpose, we designed a prospective cohort study including all consecutive, newly diagnosed lung cancer patients between October 2023 and April 2024 in a tertiary center and assessed each patient using a standardized screening protocol. VTE screening included baseline and 3-month reassessment of coagulation tests, D-dimer levels, and imaging (duplex ultrasound of the lower limbs for deep vein thrombosis screening and contrast-enhanced thoracic computed tomography for pulmonary embolism screening). A total of 102 patients were included, of whom 16 (15.7%) were diagnosed with VTE. VTE was more frequent in males (p=0.031), patients with chronic obstructive pulmonary disease (p=0.004), and patients with metastatic disease (p=0.038), particularly those under immunotherapy (p=0.026). Patients with VTE presented a D-dimer concentration more than three times higher at baseline and five-fold the levels observed in non-VTE patients at 3 months (p=0.002). Paired with Khorana scores, D-dimer concentration ≥4.5 mg/L at 3 months improved the predictive capacity of this VTE risk assessment tool in patients under active treatment. Active VTE screening yielded a significant increase in diagnosis, suggesting the incidence of this complication in newly diagnosed lung cancer patients is underestimated. Risk assessment tools can be enhanced by the addition of D-dimer-based parameters.