Abstract
BackgroundCancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents.MethodsPatients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed group while 200 patients who had received non-Cisplatin based regimens were identified as the non-exposed group. Patients were followed for development of VTE throughout the entire duration of therapy and one month thereafter. Cox proportional hazard model was used to compute relative risks with 95% confidence intervals.ResultsThe baseline characteristics were similar in the two groups. Mean age for the entire cohort was 55.4 ± 10.7 years and male to female ratio was almost 1:1. On univariate analysis, cisplatin based chemotherapy, presence of central venous catheter, female gender, poor performance status, high risk stratification according to the Khorana model and use of granulocyte colony stimulating factor were all significantly associated with the development of VTE. The crude relative risk for the incidence of VTE in cisplatin group was 2.8 (95% CI, 1.4 – 4.2) times compared to the non-Cisplatin group. When the relative risk was adjusted for the above variables in multivariable analysis, it increased to 3.3 (95% CI, 1.6 – 6.8) compared to the control group.ConclusionA high incidence of VTE in patients receiving cisplatin based chemotherapy was demonstrated in this study. Prospective studies are warranted to establish this observation with certainty and to explore the possible use of thromboprophylaxis in patients receiving cisplatin based chemotherapeutic regimens.
Highlights
Cancer related thrombosis increases morbidity and mortality and poses a significant financial burden on health care system
Another recent large retrospective study showed the prevalence of venous thromboembolism (VTE) to be 16.6% in all patients treated with Cisplatin [13] which is significantly higher than 7.3% for VTE in patients treated with any chemotherapy [14]
Prospective randomized controlled trials in patients with advanced esophagogastric junction (EGJ) or gastric adenocarcinoma showed that this thrombogenic effect is not class specific for all the platinum containing chemotherapeutic agents, but only Cisplatin based chemotherapy is associated with a statistically significant greater number of VTE events than Oxaliplatin [15, 16]
Summary
Cancer related thrombosis increases morbidity and mortality and poses a significant financial burden on health care system. Germ cell and non-small cell lung cancer (NSCLC) patients have established a link between Cisplatin and increased incidence of VTE [10,11,12]. Another recent large retrospective study showed the prevalence of VTE to be 16.6% in all patients treated with Cisplatin [13] which is significantly higher than 7.3% for VTE in patients treated with any chemotherapy [14]. A meta-analysis from case series and some pre-clinical trials provided evidence of high risk of VTE in patients receiving Cisplatin based regimens [17]
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