Clinical Characteristics of Cancer Patients Presenting with Venous thromboembolism – Report of a Real-World Experience

Background: Malignancy is a well-known risk factor for venous thromboembolism (VTE). The prevalence of VTE among cancer patients is 15% and pulmonary-embolism (PE) is estimated to be the second leading cause of death. Recently, the guidelines for management of cancer associated PE was amended to include DOAC`s in the treatment and preventing recurrent VTE. Our aim was to determine the characteristics, treatment and clinical outcomes of cancer PE patients presenting to a large tertiary medical center.

Results: Overall, A total of 566 patients with prospectively confirmed VTE between the years 2016-2019 were evaluated. 221 (39%) had cancer with higher prevalence of active smoking (28.7% vs 14.8%, p<0.001), increased heart rate (96.7±19.9 vs 92.3±20.12) and peak CRP levels (120 vs 83, p-0.03) at presentation. No difference was observed in clinical symptoms upon presentation. Cancer patients had lower prevalence of signs of RV involvement upon CT (IVS shift: 39.2% vs 22.4%, p<0.001; enlarged RV 31.9% vs 20.8%, p-0.007; IVC backflow 36.5% vs 20.9%, p<0.001) without difference in echocardiography parameters between the two groups. There was no difference in the in-hospital course as reflected by the incidence of hemodynamic instability or shock, need for mechanical ventilation, and or CPR (21% vs. 18%, p=0.5), yet patients with cancer had higher in-hospital (16% vs. 6%, p<0.001), 30-days (21% vs 10%, p<0.001) and 1 year mortality (47% vs. 17%, p<0.001). In 12 months follow up cancer patients treated with DOAC (17%) as compared to those treated with LMWH/ warfarin had comparable episodes of recurrent VTE (0% vs. 5%, p=0.9) and lower mortality (6% vs 46%, p=0.008). No significant bleeding occurred in both groups.

Conclusion: Despite expanding therapeutic repertoire in VTE, cancer is still a major challenge with grave prognosis. The use of DOAC appears to be safe in cancer patients with VTE.