C0446: Role of Arterial Cardiovascular Risk Factors in the Pathogenesis of Cancer Related VTE

Abstract

Background: Venous thromboembolism (VTE) is a frequent complication in cancer patients. Most of these complications occurred in the outpatients setting. Recently, risk scores were developed to identify cancer outpatients at high risk for VTE. Unfortunately, current evidences are insufficient to recommend a routine use of antithrombotic prophylaxis even in high risk patients in this setting. Several studies suggested that arterial cardiovascular risk factors may be involved also in the pathogenesis of VTE challenging the concept of arterial and venous thrombolic diseases as two distinct entities. However, to date, no study has properly assessed if these risk factors may have a role also in the pathogenesis of cancer associated VTE. Methods: We assessed the role of cardiovascular risk factors including abdominal obesity, diabetes mellitus (DM), hypertension, smoking and dyslipidemia in the pathogenesis of VTE in a large cohort of consecutive patients with a new diagnosis of cancer evaluated at the ambulatory of the Oncology Clinic of Varese, Italy. VTE incidence was recorded during a 6-month follow-up period. Univariate and subsequent multivariate analyses were performed to identify independent VTE predictors. Results: From June 2010 to June 2013, 1322 ambulatory patients were evaluated for a new diagnosis of cancer; 13 on oral anticoagulation at the moment of enrollment were excluded from the analysis leaving 1309 patients for evaluation. Complete follow up was available for the whole population. The mean age of the study population was 62.3 years, and 63% of patients were men; 897 patients (68.5%) were on chemotherapy At the end of follow up, 66 patients (5.04%) had a VTE. At the univariate analysis among the traditional cardiovascular risk factor smoking and hypertension were significantly associated with an increased VTE risk (OR 2.45, 95%CI 1.31, 4.59 and 1.63, 95%CI 1.00, 2.66 respectively) whereas DM, obesity and dyslipidemia were not. Furthermore, age, previous VTE, very high risk cancer type (stomach and pancreas) and presence of metastasis were significantly or marginally significant associated with an increased risk of VTE (p < 0.10). At the multivariate analysis only previous VTE and very high risk cancer type remained significantly associated with an increased risk of VTE (OR 13.77, 95%CI 6.94, 27.34 and 2.31, 95%CI 1.29, 4.13 respectively) whereas association with all the other variables including smoking and hypertension disappeared. Results of subgroup analyses including only patients undergoing chemotherapy during follow up period gave similar results (data not shown). Conclusions: The role of traditional cardiovascular risk factors in the pathogenesis of cancer related VTE appeared limited. Other studies are necessary to confirm our preliminary findings. COAGULATION AND FIBRINOLYSIS