Incidental vs symptomatic venous thrombosis in cancer patients: Analysis of a prospective observational series

Abstract

20604 Background: Clinical significance and management of ‘incidental’ venous thrombosis (IVT) is controversial.The aim of this study is to assess clinical characteristics and outcome in cancer patients (pts) with IVT compared to symptomatic venous thrombosis (SVT). Methods: A prospective observational study enrolling consecutive pts with solid tumors and venous thromboembolic disease including deep vein thrombosis (DVT) and pulmonary embolism (PE) is currently conducted in our department of Medical Oncology since May 2006.All episodes were confirmed with an objective radiological test (doppler ultrasonography, CT scan, lung scan and/or angiography).Diagnosis of IVT were based on significative vascular replection deffects in deep veins or pulmonary arteries found in spiral CT scans performed for routine tumor evaluation. Unless active bleeding anticoagulation therapy was routinely indicated in all pts and were followed- up until death or when they were derived to a palliative centre. Data analysis was performed in December 2007 of pts included up September 2007. Results: 186 consecutive cancer pts were included (106 men, mean age 61.6 yr); 47 of whom (25.3%) had IVT (27 PE, 10 in femoroiliac territory, 8 cava vein thrombosis,1 brachicephalic and 1 port-a-cath thrombosis). No differences in age, sex, cardiovascular risk factors, tumor type, stage of disease, treatment received (major surgery, chemo-hormono-radiotherapy) were found between IVT and SVT. Pts with IVT had more proportion of PE (57.4% vs 20.9%, p< 0.05), more cava vein thrombosis (17% vs 2.2%) and less proportion of DVT in limbs (21.3% vs 62.6%, p< 0.05). Less actuarial venous rethrombosis were diagnosed in IVT vs SVT (log-rank p<0.05). Relevant bleeding was observed in 2 of 47 IVT pts (4.3%) vs 19 of 139 (13.7%) in SVT (p NS). Outpatient management was more frequent in IVT pts (37/47, 78.7%) vs SVT (76/139, 54.7%) (p=0.002). Actuarial survival in pts with metastatic disease was increased in IVT vs SVT (log-rank p<0.05). Conclusions: IVT was frequent in cancer pts. Using the same therapeutic approach, less venous rethrombosis were observed in IVT pts without significative differences in relevant bleeding. Overall survival since venous thrombosis was longer in IVT pts with metastatic disease. No significant financial relationships to disclose.