Clinical and Cancer-Related Predictors for Venous Thromboembolism in Cancer Patients Presenting to the Emergency Department.

Abstract

The accurate detection of cancer-associated venous thromboembolism (VTE) can avoid unnecessary diagnostic imaging or laboratory tests. We sought to determine clinical and cancer-related risk factors of VTE that can be used as predictors for oncology patients presenting to the emergency department (ED) with suspected VTE. We retrospectively analyzed all consecutive patients who presented with suspicion of VTE to The University of Texas MD Anderson Cancer Center ED between January 1, 2009, and January 1, 2013. Logistic regression models were used to identify risk factors that were associated with VTE. The ability of these factors to predict VTE was externally validated using a second cohort of patients who presented to King Hussein Cancer Center ED between January 1, 2009, and January 1,2016. Cancer-related covariates associated with the occurrence of VTE were high-risk cancer type (odds ratio [OR] 3.64 [95% confidence interval {CI} 2.37-5.60], p<0.001), presentation within 6months of the cancer diagnosis (OR 1.92 [95% CI 1.62-2.28], p<0.001), active cancer (OR 1.35 [95% CI 1.10-1.65], p=0.003), advanced stage (OR 1.40 [95% CI 1.01-1.94], p=0.044), and the presence of brain metastasis (OR 1.73 [95% CI 1.32-2.27], p<0.001). When combined, these factors along with other clinical factors showed high prediction performance for VTE in the external validation cohort. Cancer risk group, presentation within 6months of cancer diagnosis, active and advanced cancer, and the presence of brain metastases along with other related clinical factors can be used to predict VTE in patients with cancer presenting to the ED.