Skip to main content

Advertisement

SpringerLink
Log in

Incidence and predictors of venous thromboembolism in medically ill hospitalized elderly cancer patients: a prospective observational study

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to estimate the incidence and predictors of venous thromboembolism (VTE) in medically ill hospitalized elderly cancer patients in a single Korean tertiary hospital.

Methods

Patients were examined for deep vein thrombosis (DVT) by duplex and color Doppler ultrasonography (DUS) of both legs between days 5 and 14 of their hospital stays. The primary endpoint was the incidence of VTE by day 14, which was determined via a composite of DVT detected by routine DUS and symptomatic VTE.

Results

A total of 140 patients with 31 hematologic and 109 nonhematologic malignancies were analyzed. The median age was 73 years, and 45.7% of the patients were female. The median length of hospital stay was 12 days. The modified Padua prediction score (PPS) ≥ 4 was 92.9%. The incidence of VTE by day 14 was 7.1%, including six proximal and four distal DVT cases. Being female, having a length of hospital stay of ≥ 13 days, and having a modified Padua prediction score of ≥ 6 were risk factors of VTE in univariate analysis. The incidence of VTE was 2.3%, 7.3%, and 41.7% in patients with 0–1, 2, and 3 of these risk factors, respectively.

Conclusion

The incidence of VTE in medically ill hospitalized elderly cancer patients was lower in Korean patients than in Western patients. However, the risk of VTE in those with more than two risk factors (female, long length of hospitalization, and high PPS) increased considerably, and pharmacologic thromboprophylaxis is warranted in these cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gussoni G, Frasson S, La Regina M, Di Micco P, Monreal M (2013) Three-month mortality rate and clinical predictors in patients with venous thromboembolism and cancer. Findings from the RIETE registry. Thromb Res 131:24–30. https://doi.org/10.1016/j,thromres.2012.10.007

    Article  CAS  PubMed  Google Scholar 

  2. White RH, Zhou H, Murin S, Harvey D (2005) Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost 93:298–305. https://doi.org/10.1160/TH04-08-0506

    Article  CAS  PubMed  Google Scholar 

  3. Blom JW, Vanderschoot JP, Oostindier MJ, Osanto S, van der Meer FJ, Rosendaal FR (2006) Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost 4:529–535. https://doi.org/10.1111/j.1538-7836.2006.01804.x

    Article  CAS  PubMed  Google Scholar 

  4. Walker AJ, Card TR, West J, Crooks C, Grainge MJ (2013) Incidence of venous thromboembolism in patients with cancer - a cohort study using linked United Kingdom databases. Eur J Cancer 49:1404–1413. https://doi.org/10.1016/j.ejca.2012.10.021

    Article  PubMed  Google Scholar 

  5. Naess IA, Christiansen SC, Romundstad P, Cannegieter SC, Rosendaal FR, Hammerstrom J (2007) Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 5:692–699. https://doi.org/10.1111/j.1538-7836.2007.02450.x

    Article  CAS  PubMed  Google Scholar 

  6. Streiff MB et al (2017) NCCN clinial practice guidelines in oncology: cancer-associated venous thromboembolic disease. https://www.nccn.org/professionals/physician_gls/default.aspx#vte. Accessed 23 June, 2017

  7. Lyman GH, Bohlke K, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, Clarke JM, Flowers CR, Francis CW, Gates LE, Kakkar AK, Key NS, Levine MN, Liebman HA, Tempero MA, Wong SL, Somerfield MR, Falanga A, American Society of Clinical Oncology (2015) Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014. J Clin Oncol 33:654–656. https://doi.org/10.1200/JCO.2014.59.7351

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Mandala M, Falanga A, Roila F, Group EGW (2011) Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 22(Suppl 6):vi85–vi92. https://doi.org/10.1093/annonc/mdr392

    Article  PubMed  Google Scholar 

  9. Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, Cook DJ, Balekian AA, Klein RC, Le H et al (2012) Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e195S–e226S. https://doi.org/10.1378/chest.11-2296

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, Huang W, Zayaruzny M, Emery L, Anderson FA Jr (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371:387–394. https://doi.org/10.1016/S0140-6736(08)60202-0

    Article  PubMed  Google Scholar 

  11. Kahn SR, Panju A, Geerts W, Pineo GF, Desjardins L, Turpie AG, Glezer S, Thabane L, Sebaldt RJ (2007) Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 119:145–155. https://doi.org/10.1016/j.thromres.2006.01.011

  12. Seddighzadeh A, Shetty R, Goldhaber SZ (2007) Venous thromboembolism in patients with active cancer. Thromb Haemost 98:656–661

    Article  CAS  PubMed  Google Scholar 

  13. Zwicker JI, Rojan A, Campigotto F, Rehman N, Funches R, Connolly G, Webster J, Aggarwal A, Mobarek D, Faselis C, Neuberg D, Rickles FR, Wun T, Streiff MB, Khorana AA (2014) Pattern of frequent but nontargeted pharmacologic thromboprophylaxis for hospitalized patients with cancer at academic medical centers: a prospective, cross-sectional, multicenter study. J Clin Oncol 32:1792–1796. https://doi.org/10.1200/JCO.2013.53.5336

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lee LH, Gallus A, Jindal R, Wang C, Wu CC (2017) Incidence of venous thromboembolism in Asian populations: a systematic review. Thromb Haemost 117:2243–2260. https://doi.org/10.1160/TH17-02-0134

  15. Hong J, Lee JH, Yhim HY, Choi WI, Bang SM, Lee H, Oh D (2013) Incidence of venous thromboembolism in Korea from 2009 to 2013. PLoS One 13:e0191897. https://doi.org/10.1371/journal.pone.0191897

    Article  CAS  Google Scholar 

  16. White RH, Keenan CR (2009) Effects of race and ethnicity on the incidence of venous thromboembolism. Thromb Res 123(Suppl 4):S11–S17. https://doi.org/10.1016/S0049-3848(09)70136-7

    Article  CAS  PubMed  Google Scholar 

  17. Yhim HY, Lee J, Lee JY, Lee JO, Bang SM (2017) Pharmacological thromboprophylaxis and its impact on venous thromboembolism following total knee and hip arthroplasty in Korea: a nationwide population-based study. PLoS One 12:e0178214. https://doi.org/10.1371/journal.pone.0178214

  18. Lee J, Kim SC, Kim SJ, Oh JY, Lee HK, Yum HK, Kim YK, Hong SB, Park MS, Hwang SC, Yoon HK, Kim HR, Cho JH, Park S, Yoo CG (2014) Prevention of venous thromboembolism in medical intensive care unit: a multicenter observational study in Korea. J Korean Med Sci 29:1572–1576. https://doi.org/10.3346/jkms.2014.29.11.1572

    Article  PubMed  PubMed Central  Google Scholar 

  19. World Health Organization Western Pacific Region (2010) The Asia-Pacific perspective: redefining obesity and its treatment. http://www.wpro.who.int/nutrition/documents/docs/Redefiningobesity.pdf Accessed February 2017

  20. Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, De Bon E, Tormene D, Pagnan A, Prandoni P (2010) A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 8:2450–2457. https://doi.org/10.1111/j.1538-7836.2010.04044.x

    Article  CAS  PubMed  Google Scholar 

  21. Decousus H, Tapson VF, Bergmann JF, Chong BH, Froehlich JB, Kakkar AK, Merli GJ, Monreal M, Nakamura M, Pavanello R, Pini M, Piovella F, Spencer FA, Spyropoulos AC, Turpie AG, Zotz RB, Fitzgerald G, Anderson FA, IMPROVE Investigators (2011) Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest 139:69–79. https://doi.org/10.1378/chest.09-3081

    Article  PubMed  Google Scholar 

  22. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:e419S–e496S. https://doi.org/10.1378/chest.11-2301

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Cohen AT, Davidson BL, Gallus AS, Lassen MR, Prins MH, Tomkowski W, Turpie AG, Egberts JF, Lensing AW (2006) Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ 332:325–329. https://doi.org/10.1136/bmj.38733.466748.7C

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Leizorovicz A, Cohen AT, Turpie AG, Olsson CG, Vaitkus PT, Goldhaber SZ (2004) Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 110:874–879. https://doi.org/10.1161/01.CIR.0000138928.83266.24

    Article  CAS  PubMed  Google Scholar 

  25. Samama MM, Cohen AT, Darmon JY, Desjardins L, Eldor A, Janbon C, Leizorovicz A, Nguyen H, Olsson CG, Turpie AG, Weisslinger N (1999) A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in medical patients with enoxaparin study group. N Engl J Med 341:793–800. https://doi.org/10.1056/NEJM199909093411103

    Article  CAS  PubMed  Google Scholar 

  26. Alikhan R, Cohen AT, Combe S, Samama MM, Desjardins L, Eldor A, Janbon C, Leizorovicz A, Olsson CG, Turpie AG (2003) Prevention of venous thromboembolism in medical patients with enoxaparin: a subgroup analysis of the MEDENOX study. Blood Coagul Fibrinolysis 14:341–346

    Article  CAS  PubMed  Google Scholar 

  27. Yamashita Y, Shiomi H, Morimoto T, Yoneda T, Yamada C, Makiyama T, Kato T, Saito N, Shizuta S, Ono K, Kimura T (2017) Asymptomatic lower extremity deep vein thrombosis- clinical characteristics, management strategies, and long-term outcomes. Circ J 81:1936–1944. https://doi.org/10.1253/circj.CJ-17-0445

    Article  PubMed  Google Scholar 

  28. Alcalay A, Wun T, Khatri V, Chew HK, Harvey D, Zhou H, White RH (2006) Venous thromboembolism in patients with colorectal cancer: incidence and effect on survival. J Clin Oncol 24:1112–1118. https://doi.org/10.1200/JCO.2005.04.2150

    Article  PubMed  Google Scholar 

  29. Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH (2007) Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer 110:2339–2346. https://doi.org/10.1002/cncr.23062

    Article  PubMed  Google Scholar 

  30. Park LC, Woo SY, Kim S, Jeon H, Ko YH, Kim SJ, Kim WS (2012) Incidence, risk factors and clinical features of venous thromboembolism in newly diagnosed lymphoma patients: results from a prospective cohort study with Asian population. Thromb Res 130:e6–e12. https://doi.org/10.1016/j.thromres.2012.03.019

    Article  CAS  PubMed  Google Scholar 

  31. Oh SY, Kim JH, Lee KW, Bang SM, Hwang JH, Oh D, Lee JS (2008) Venous thromboembolism in patients with pancreatic adenocarcinoma: lower incidence in Asian ethnicity. Thromb Res 122:485–490. https://doi.org/10.1016/j.thromres.2007.12.015

    Article  CAS  PubMed  Google Scholar 

  32. Choi S, Lee KW, Bang SM, Kim S, Lee JO, Kim YJ, Kim JH, Park YS, Kim DW, Kang SB, Kim JS, Oh D, Lee J (2011) Different characteristics and prognostic impact of deep-vein thrombosis / pulmonary embolism and intraabdominal venous thrombosis in colorectal cancer patients. Thromb Haemost 106:1084–1094. https://doi.org/10.1160/TH11-07-0505

    Article  CAS  PubMed  Google Scholar 

  33. Kniffin WD Jr, Baron JA, Barrett J, Birkmeyer JD, Anderson FA Jr (1994) The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 154:861–866

    Article  Google Scholar 

  34. Kang MJ, Ryoo BY, Ryu MH, Koo DH, Chang HM, Lee JL, Kim TW, Kang YK (2012) Venous thromboembolism (VTE) in patients with advanced gastric cancer: an Asian experience. Eur J Cancer 48:492–500. https://doi.org/10.1016/j.ejca.2011.11.016

    Article  PubMed  Google Scholar 

  35. Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J, Christakis N (2003) A systematic review of physicians' survival predictions in terminally ill cancer patients. BMJ 327:195–198. https://doi.org/10.1136/bmj.327.7408.195

    Article  PubMed  PubMed Central  Google Scholar 

  36. Zabrocka E, Wojtukiewicz MZ, Sierko E (2018) Thromboprophylaxis in cancer patients in hospice. Adv Clin Exp Med 27:283–289. https://doi.org/10.17219/acem/64593

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by a grant from Seoul National University Bundang Hospital Research Fund (grant no.04-2012-003).

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea

    Jeong-Ok Lee, Ji Yun Lee, Jin Won Kim, Se Hyun Kim, Yu Jung Kim, Keun-Wook Lee, Jee Hyun Kim, Jong Seok Lee & Soo-Mee Bang

  2. Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

    Eun Ju Chun & Sang Il Choi

Authors
  1. Jeong-Ok Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ji Yun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eun Ju Chun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sang Il Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jin Won Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Se Hyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yu Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Keun-Wook Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jee Hyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jong Seok Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Soo-Mee Bang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Soo-Mee Bang.

Ethics declarations

This study was approved by the Institutional Review Board at SNUBH (IRB number: B-1201-144-007). Written informed consent was obtained from the patients prior to study entry, and this study was conducted in accordance with the principles of the Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, JO., Lee, J.Y., Chun, E.J. et al. Incidence and predictors of venous thromboembolism in medically ill hospitalized elderly cancer patients: a prospective observational study. Support Care Cancer 27, 2507–2515 (2019). https://doi.org/10.1007/s00520-018-4537-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4537-y

Keywords

Search

Navigation