Venous thromboembolism in patients with cancer and factor XI deficiency

Factor (F)XI deficiency is associated with reduced venous thromboembolism (VTE) risk without increased spontaneous bleeding in the general population. Factor XI inhibitors show promise in preventing VTE in orthopedic surgery and are currently being investigated in cancer-associated VTE. However, there currently are no data regarding the potential efficacy of FXI inhibition for the management of hypercoagulability in cancer.

This study aimed to evaluate the incidence of VTE among patients with cancer and FXI deficiency compared with that of a matched control population.

This is a retrospective study performed at Memorial Sloan Kettering Cancer Center evaluating VTE incidence in patients with cancer and FXI deficiency (n = 73) and matched controls with cancer and normal partial thromboplastin time (n = 185). Index date was the date of first visit at Memorial Sloan Kettering Cancer Center for cancer evaluation. Patients were followed up until VTE, death or last follow-up, whichever occurred first. Patients from the 2 cohorts were matched for age, sex, surgery within 30 days from index date, primary cancer site and stage, and platelet and hemoglobin levels at index.

At 12 months, the cumulative incidence of VTE in the cohort with FXI deficiency was 4.1% (95% CI, 1.1%-11%) compared with 10.6% (95% CI: 6.6%-16%; Gray test, P = .052) in the matched controls. Major surgery-related bleeding occurred in 12.9% of patients with FXI deficiency undergoing surgery from the index date through the end of follow-up, compared with 2.1% in the control cohort.

Factor XI deficiency appears to be associated with reduced VTE risk in individuals with cancer.