Abstract
ObjectivesCancer is frequently complicated by thromboembolic events (TEs). We aimed to determine the incidence of TEs in lung cancer patients treated with platinum-based chemotherapy and study patients’ baseline and treatment attributes correlating with its onset.Materials and methodsAdvanced lung cancer patients started on platinum-based chemotherapy were evaluated at baseline and during routine visits for the development of TEs. The duration of follow-up was 4 weeks from the last chemotherapy. A TE occurring between the first dose of chemotherapy and 4 weeks after the last dose was considered to be chemotherapy associated.ResultsOf the 165 patients on platinum chemotherapy who completed follow-up, TEs occurred in 4.8% (8 out of 165) patients. Among these, three patients had developed venous pulmonary thromboembolism and five patients had developed cerebral infarction, out of which four had arterial cerebral infarction and one patient had a superior sagittal sinus thrombosis. The majority of events (7 out of 8) occurred within 100 days of starting platinum chemotherapy. Overall, the median time until occurrence of TE was 48 days (range, 10–130 days). None of the presumed risk factors were found be associated with the occurrence of TEs on univariate analysis.ConclusionsAdvanced lung cancer patients on platinum chemotherapy are predisposed to thromboembolism due to many factors. Despite its lower incidence in our study, exclusion of patients with prior thrombosis suggests the incidence of de novo thrombosis, and hence raises a valid question of the need of thromboprophylaxis in a selected group of patients.
Highlights
Cancer is a pro-thrombotic condition and its treatment is frequently complicated by thromboembolism which adds to the overall morbidity, mortality and economics of healthcare systems [1]
The primary objective of the study was to determine the incidence of thromboembolic events (TEs) including deep venous thrombosis (DVT), pulmonary embolus (PE), cerebrovascular accident, and unstable angina/myocardial infarction (MI) in the study population patients of lung cancer treated with platinum-based chemotherapy
A total of 188 patients were screened, out of which 21 patients were excluded for the following reasons: receiving antiplatelet drugs (n = 6), history of thromboembolism (n = 10), patient refusal (n = 1) and declared unfit for chemotherapy (n = 4)
Summary
Cancer is a pro-thrombotic condition and its treatment is frequently complicated by thromboembolism which adds to the overall morbidity, mortality and economics of healthcare systems [1]. Thromboembolic events (TEs) occur in 4–20% cancer patients in various studies [2, 3]. Thromboembolic complications are common, with incidences ranging from 10–17 % [5,6,7]. Use of certain concomitant drugs such as steroids, granulocyte colony-stimulating factors has been associated with an increased incidence of TEs in various studies [9]. The Khorana score was recently found to be associated with the increased risk of thromboembolism in lung cancer patients in a retrospective analysis by Moore et al [11] among other risk factors such as sex, age, race, performance status, exposure to erythropoeitin, presence of central venous catheter, type of cancer, prechemotherapy haemoglobin and leukocyte count
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