Arterial Ischemic Events Are a Major Complication in Cancer Patients with Venous Thromboembolism

Fecha de publicación: 01/09/2018

Autores de IIS La Fe

Raquel López Reyes

Autor

Participantes ajenos a IIS La Fe

Brenner, B
Bikdeli, B
Tzoran, I
Madridano, O
Surinach, JM
Blanco-Molina, A
Tufano, A
Nunez, JJL
Trujillo-Santos, J
Monreal, M
RIETE Investigators

Grupos

Neumología

Leader

Miguel Ángel Martínez García

Abstract

BACKGROUND: Venous thromboembolism is common in patients with malignancies, affecting up to 10% of this patient population. The association between arterial ischemic events and venous thromboembolism also has been established. However, the influence of arterial ischemic events on outcomes in cancer patients with venous thromboembolism has not been fully determined. METHODS: The current study analyzed clinical characteristics, time course, risk factors, incidence and severity of venous thromboembolism recurrences, arterial ischemic events and major bleeding in 5717 patients with active cancer and venous thromboembolism recruited into RIETE (multi-center prospective registry of patients with objectively confirmed venous thromboembolism). RESULTS: During the anticoagulation course (median 7.3 months), 499 (8.7%) patients developed venous thromboembolism recurrences, 63 (1.1%) developed arterial events, and 346 (6.1%) suffered from major bleeding. Overall, major bleeding and arterial events appeared earlier (median 35 and 36 days, respectively) than venous thromboembolism recurrences (median 97 days). Thirty-day mortality rates after each event were: 20% after recurrent pulmonary embolism, 13% after recurrent deep vein thrombosis, 41% after major bleeding, 40% after myocardial infarction, 64% after ischemic stroke, and 83% after lower limb amputation. Bleeding was the leading cause of death (67 fatal bleeds), whereas cumulative mortality due to arterial ischemic events (n = 27) was similar to that related to pulmonary embolism recurrences (n = 26). CONCLUSIONS: In this study, arterial ischemic events and major bleeding appeared early after venous thromboembolism in patients with active cancer and were among frequent causes of their deaths. The risk and severity of arterial events need to be considered in this clinical setting. (C) 2018 Elsevier Inc. All rights reserved.

Datos de la publicación

ISSN/ISSNe:: 0002-9343, 1555-7162
Tipo:: Article
Páginas:: 1095-1103
DOI:: 10.1016/j.amjmed.2018.04.037
Factor de Impacto:: 1,814 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Brenner, B:: Rambam Hlth Care Campus, Haifa, Israel

Technion, Ruth & Bruce Rappaport Fac Med, Haifa, Israel
Bikdeli, B:: Columbia Univ, Med Ctr, New York Presbyterian Hosp, Div Cardiol,Dept Med, New York, NY USA

Yale Univ, Sch Med, CORE, New Haven, CT USA

CRF, New York, NY USA
Tzoran, I:: Rambam Hlth Care Campus, Haifa, Israel

Technion, Ruth & Bruce Rappaport Fac Med, Haifa, Israel
Madridano, O:: Hosp Univ Infanta Sofia, Dept Internal Med, Madrid, Spain
Lopez-Reyes, R:: Hosp Univ & Politecn La Fe, Dept Pneumonol, Valencia, Spain
Surinach, JM:: Hosp Univ Vall dHebron, Dept Internal Med, Barcelona, Spain
Blanco-Molina, A:: Hosp Univ Reina Sofia, Dept Internal Med, Cordoba, Spain
Tufano, A:: Federico II Univ Hosp, Dept Clin Med & Surg, Reg Reference Ctr Coagulat Disorders, Naples, Italy
Nunez, JJL:: Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Barcelona, Spain
Trujillo-Santos, J:: Hosp Gen Univ Santa Lucia, Dept Internal Med, Murcia, Spain
Monreal, M:: Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Barcelona, Spain