Related Experiment Video
Updated: Jun 5, 2026

Venous Thrombosis Assay in a Mouse Model of Cancer
Published on: January 5, 2024
Risk Factors for Developing Venous Thromboembolism in Patients With Advanced ALK-Rearranged NSCLC
Caroline Kamali1,2, Georgios Tsakonas1,2, Rolf Lewensohn1
1Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Introduction:
Patients with NSCLC have an increased risk of developing venous thromboembolism (VTE), a condition associated with a poorer prognosis. Those with ALK rearrangements have a three- to five-fold higher risk of VTE than those with other oncogenic drivers. This study aimed to investigate the incidence, risk factors, and impact of VTE on overall survival.
Methods:
We retrospectively analyzed patients with advanced ALK-positive NSCLC treated at Karolinska University Hospital from 2009 to 2021. VTE events were recorded from 90 days before histologic cancer diagnosis to death or end of follow-up. The impact of VTE on survival was assessed using a time-dependent Cox model, and risk factors were evaluated using Fine-Gray competing risk regression.
Results:
A total of 97 patients were included, of whom 35 (36.1%) developed VTE. Pulmonary embolism accounted for 24 cases (68.6%), with 16 events (45.7%) occurring more than 6 months after treatment initiation. The median time from diagnosis to the first clot was 167 days. Patients with VTE had a 3.43-fold increased risk of death. Competing risk regression analysis revealed that the presence of baseline adrenal metastasis (hazard ratio [HR] = 2.92, 95% confidence interval [CI]: 1.19-7.16), leukocyte count more than 11 × 109/L (HR = 3.74, 95% CI: 1.91-7.31), and hemoglobin less than 10 g/dL (HR = 5.18, 95% CI: 2.07-12.94) significantly increased VTE risk, whereas albumin more than or equal to 3.5 g/dL reduced the risk (HR = 0.24, 95% CI: 0.10-0.56).
Conclusion:
In advanced ALK-positive NSCLC, baseline adrenal metastases, leukocytosis, and anemia were associated with increased VTE risk and may warrant heightened clinical vigilance.
Related Concept Videos
Venous Thrombosis I: Introduction
Venous Thrombosis IV: Nursing Management
Venous Thrombosis III: Interprofessional Care
Varicose Veins I: Introduction
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
Esophageal Varices-I: Introduction