New insights on patient-related risk factors for venous thromboembolism in patients with solid organ cancers
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ORIGINAL ARTICLE
New insights on patient‑related risk factors for venous thromboembolism in patients with solid organ cancers Aditya Kotecha1 · Deepa Raghavan2 · Sumeet K. Yadav3 · Anupam A. Sule3 · Camelia Arsene4 Received: 3 February 2020 / Revised: 15 April 2020 / Accepted: 25 June 2020 © Japanese Society of Hematology 2020
Abstract Patient-related risk factors for venous thromboembolism (VTE) are infrequently studied. We compared the role of patientrelated risk factors for VTE in patients with solid organ cancers to their role in patients without cancer using National Inpatient Sample (NIS) data. Patients with cancer: risk of VTE hospitalization; Increased: chronic pulmonary disease (OR 1.172, 95% CI 1.102–1.247), obesity (OR 1.369, 95% CI 1.244–1.506). Decreased: liver disease (OR 0.654, 95% CI 0.562–0.762), chronic kidney disease (CKD) (OR 0.539, 95% CI 0.491–0.593), end-stage renal disease (ESRD) (OR 0.247, 95% CI 0.187–0.326). Patients without cancer: Risk of VTE hospitalization; Increased: age (OR 1.024, 95% CI 1.022–1.025), congestive heart failure (OR 1.221, 95% CI: 1.107–1.346), chronic pulmonary disease (OR 1.372, 95% CI 1.279–1.473), obesity (OR 2.627, 95% CI 2.431–2.838). Decreased: female gender (OR 0.772, 95% CI 0.730–0.816), diabetes (OR 0.756, 95% CI 0.701–0.815), ESRD (OR 0.315, 95% CI 0.252–0.395). In conclusion, chronic pulmonary disease and obesity increase VTE hospitalization risk in patients with and without cancer and the risk decreases in cancer patients with liver disease, CKD or ESRD. Keywords Venous thromboembolism · Risk factors · Cancer · Inpatients · Hospitalization
Introduction
* Camelia Arsene [email protected] Aditya Kotecha [email protected] Deepa Raghavan [email protected] Sumeet K. Yadav [email protected] Anupam A. Sule [email protected] 1
Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
2
University of Michigan College of Literature, Science and the Arts, 500 State Street, Ann Arbor, MI 48109, USA
3
St Joseph Mercy Oakland Hospital, 44405 Woodward Avenue, Pontiac, MI 48341, USA
4
ProMedica Health System, 100 Madison Avenue, Toledo, OH 43604, USA
Venous thromboembolism (VTE) is one of the principal reasons for death in cancer patients [1, 2]. The Khorana score is a validated score that predicts VTE risk in cancer patients [3]. Khorana score includes cancer type, pre-chemotherapy platelet count ≥ 350 × 109/L, hemoglobin 11 × 109/L, and body mass index (BMI) ≥ 35 kg/m. A score ≥ 3 corresponds to a 6.7% VTE risk. The AVERT trial showed that prophylaxis with apixaban in cancer patients starting chemotherapy, with an intermediate to highrisk Khorana score, significantly lowers risk of VTE, with an increased risk of bleeding [4]. American Society of Clinical Oncology (ASCO) guidelines do not endorse routine VTE prophylaxis in ambulatory cancer patients but may be given for handpicked high-risk patients and multiple myeloma patients on antiangiogenesis agents [2, 5]. A population-based retrospective cas
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