Risk Factors Associated with Venous Thromboembolism in Cancer Patients

Su Jung Lee; Nam Cho Kim

doi:10.5388/aon.2015.15.3.171

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Lee and Kim: Risk Factors Associated with Venous Thromboembolism in Cancer Patients

Original Article

Asian Oncology Nursing 2015; 15(3): 171-177.

Published online: 30 September 2015

DOI: https://doi.org/10.5388/aon.2015.15.3.171

Risk Factors Associated with Venous Thromboembolism in Cancer Patients

Su Jung Lee¹, Nam Cho Kim²

¹Graduate School of Nursing, The Catholic University of Korea, Seoul, Korea.

²College of Nursing, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to: Kim, Nam Cho. College of Nursing , The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel: +82-2-2258-7405, Fax: +82-2-2258-7772, kncpjo@catholic.ac.kr

Received 10 July 2015 Revised 17 August 2015 Accepted 21 September 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to investigate clinical characteristics of venous thromboembolism (VTE) in cancer patients.

Methods

We retrospectively analyzed clinical characteristics in patients with VTE confirmed with cancer. Multivariable logistic regression was used to identify differences associated with the development, between the pulmonary embolism (PE) and deep vein thrombosis (DVT) groups.

Results

From January 2009 to December 2014, a total of 103 patients with VTE were included in the final analysis: mean age, 70.6±11.8 years; female, 56.3%. Most of the patients had a solid cancer (95.1%), and half of all patients had distant metastasis (50.5%). Proportion of patients with VTE who received chemotherapy within a year was 64.1%. Central venous catheters were applied to 59 patients within 6 weeks before the diagnosis of VTE. The proportion of patients with DVT only among VTE patients was 21.4%. In logistic regression analysis, central venous catheter insertion (OR=2.66, 95% CI=1.09, 6.49; p=.032), as well as lung metastasis (OR=2.94; 95% CI=1.06, 8.18; p=.039) were significant predictors for PE rather than DVT only.

Conclusion

VTE developed in patients with advanced stage cancer. Further studies analyzing the effects of prophylactic anticoagulation in patients with cancer in regards to development of VTE are recommended.

Keywords: Neoplasms, Venous Thromboembolism, Risk Factors

Figures and Tables

Table 1

General Characteristics of Participants (N=103)

Characteristics	Categories	n (%) or M ± SD
Age (year)		70.6 ± 11.8
Gender	Male	45 (43.7)
Gender	Female	58 (56.3)
BMI (kg/m²)		22.2 ± 4.1
ECOG PS (score)	0	2 (1.9)
	1	37 (35.9)
	2	26 (25.3)
	3	37 (35.9)
	4	1 (1.0)
Comorbidities^*	Hypertension	41 (39.8)
	Diabetes mellitus	24 (23.3)
	Coronary heart disease	14 (13.6)
	Atrial fibrillation	7 (6.8)
	Pneumonia	31 (30.1)
	Other infections^†	18 (17.5)
	None	8 (7.8)
Types of cancer	Hematologic malignancy	5 (4.9)
	Solid cancer	98 (95.1)
	Colorectal	19 (18.4)
	Lung	18 (17.5)
	Pancreatobiliary	17 (16.5)
	Urogenital	16 (15.5)
	Upper gastrointestine	10 (9.8)
	Breast	5 (4.8)
	Others	13 (12.6)
Solid cancer stage^‡	1	9 (9.2)
	2	18 (18.4)
	3	19 (19.4)
	4	52 (53.0)

^*Multiple response; ^†Other infection included urinary tract infection, hepatobiliary, infection, peritonitis; ^‡n=98; BMI=Body mass index; ECOG PS=Eastern cooperative oncology group scale of performance status.

Table 2

Clinical Characteristics of VTE (N=103)

Characteristics	Categories	n (%)
Types of VTE	PE without DVT	44 (42.7)
	PE with DVT	22 (21.4)
	DVT only	37 (35.9)
Symptoms^*	Dyspnea	56 (54.4)
	Leg swelling	52 (50.5)
	Leg pain	27 (26.2)
	Chest discomfort	19 (18.4)
	Absent	8 (7.8)
Interval diagnosis of VTE from cancer (month)	<6	44 (42.7)
	6~12	39 (37.9)
	>12	20 (19.4)
Interval diagnosis of VTE from CVC insertion^† (week)		33 (56.0)
	6~12	6 (10.0)
	>12	20 (34.0)

^*Multiple response; ^†Patients with CVC insertion (n=59); VTE=Venous thromboembolism; DVT=Deep vein thromboembolism; PE=Pulmonary thromboembolism; CVC=Central venous catheter.

Table 3

Treatment Modalities Characteristics of VTE (N=103)

Characteristics	Categories	n (%) or Median
Surgical resection	Yes	43 (41.7)
Surgical resection	No	60 (58.3)
Radiotherapy	Yes	26 (25.2)
Radiotherapy	No	77 (74.8)
Chemotherapy	Yes	66 (64.1)
Chemotherapy	No	37 (35.9)
Duration, days (median, IQR)		59 (6~121)
Types of regimen^*	Alkylating agent	5 (7.6)
	Antimetabolites	42 (63.6)
	Platinum-based	42 (63.6)
	Taxen-based	11 (16.7)
	Topoisomerase inhibitors	13 (19.7)
	Anthracyline	9 (13.6)
	Others	12 (18.2)
Presence of venous catheters	Yes	59 (57.3)
	No	44 (42.7)
	Chemoport	13 (12.6)
	PICC	33 (32.0)
	Central perm catheter	13 (12.6)

^*Multiple response (n=66); VTE=Venous thromboembolism; IQR=Interquatile range; PICC=Peripheral insertion central catheter.

Table 4

Baseline Characteristics between Patients with PE and Those with DVT Only (N=103)

Characteristics	Categories	PE (n=66)	DVT only (n=37)	OR (95% CI)	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	OR (95% CI)	p
Age (year)		68.8±11.8	73.7±11.3	0.96 (0.93, 1.00)	.044
Female		35 (53.0)	23 (62.2)	0.69 (0.30, 1.56)	.370
BMI (kg/m²)		23.1±4.3	23.4±3.8	1.00 (1.00, 1.00)	.784
Cancer stage at the diagnosis^*	Stage 4	54 (84.4)	26 (74.3)	1.87 (0.68, 5.16)	.223
Cancer stage at the diagnosis^*	Non-stage 4	10 (15.6)	9 (25.7)	1.00 (referent)	-
Hypertension		24 (36.4)	17 (45.9)	0.67 (0.30, 1.52)	.341
Diabetes mellitus		12 (18.2)	12 (32.3)	0.46 (0.18, 1.17)	.101
Coronary artery disease		10 (15.2)	4 (10.8)	1.47 (0.43, 0.51)	.537
Atrial fibrillation		5 (7.6)	2 (5.4)	1.43 (0.26, 7.79)	.675
Pneumonia		24 (36.4)	7 (18.9)	2.45 (0.93, 6.42)	.064
Other infection		14 (21.2)	4 (10.8)	2.22 (0.67, 7.33)	.182
Lung metastasis	Yes	25 (37.9)	7 (18.9)	2.61 (1.00, 6.83)	.046
Lung metastasis	No	41 (62.1)	30 (81.1)	1.00 (referent)	-
Surgery		28 (42.4)	15 (10.5)	1.08 (0.48, 2.45)	.852
Chemotherapy		44 (66.7)	22 (59.5)	1.36 (0.59, 3.13)	.465
Radiotherapy		18 (27.3)	8 (21.6)	1.36 (0.53, 3.52)	.526
Catheter insertion^†		43 (65.2)	16 (43.2)	2.45 (1.08, 6.00)	.031
D-dimer (median, IQR) ng/mL		3,484 (2,522~6,064)	4,285 (2,847~8,046)	0.66 (0.38, 1.15)^‡	.140

^*Hematologic malignancies (n=5) were excluded; ^†Patients with catheter insertion (n=59); ^‡Univariable analysis was performed with log-transformed D-dimer level; PE=Pulmonary embolism; DVT=Deep vein thrombosis; SD=Standard deviation; OR=Odds ratio; BMR=Body mass index; IQR=Interquatile range.

Table 5

Multivariable Analysis of Predictors for Pulmonary Embolism

Variables	Multivariable OR (95% CI)	p
Age	0.97 (0.94, 1.01)	.189
Catheter insertion	2.66 (1.09, 6.49)	.032
Lung metastasis	2.94 (1.06, 8.18)	.039

OR=Odds ratio CI=Confidence interval.

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