Thrombosis and Cancer: Case Series of 25 Patients

Abstract

The objective of this paper is to describe the clinical and therapeutic characteristics of thrombosis associated with cancers in patients in charge of the internal medicine-oncology department of the Ibn Sina Military Hospital in Marrakech. This is a retrospective, descriptive and analytical study over a two-year period from January 2013 to December 2014. Among 158 patients with cancer, we identified 25 with thrombosis confirmed by imaging. Characteristics of the population of origin, incidence, risk factors for venous thromboembolic disease (VTE), diagnostic means, distribution of thrombosis, location and histological type of cancer and therapeutic strategy were analyzed. The mean age of our patients was 55.89 years, with female predominance (56% vs 44%). The incidence of venous thrombosis in our series is 15.8% (n = 25) of which 76% (n = 19) are isolated, 12% (n = 3) are on central venous catheter (CVC) and 12% (n = 3) are associated with pulmonary embolism. The lower limbs were the most affected (80.3%), with predominance on the left side. Bilateral involvement was found in 7% of cases. Thrombosis was indicative of cancer in 16% of patients (n = 4). While it complicated the development in 84% of the cases (n = 21). Risk factors for VTE were dominated by females (56%), metastases (64%), chemotherapy (80%), and the presence of a CVC (80%). Solid tumors were the most frequent 72% (n = 18) with predominantly digestive cancers (28%), pulmonary (16%), bladder (16%) and breast (12%). The most predominant histological type was adenocarcinoma in 44% (n = 11). The seven cases of malignant hemopathies are: four non-Hodgkin's lymphomas, two multiple myelomas and one case of chronic myeloid leukemia. The initial curative treatment as a relay used low molecular weight heparin in 92% of patients (n = 23). Unfractionated heparin was used in two patients with severe renal failure, the only ones receiving vitamin K antagonist maintenance therapy. Short-term outcomes were favorable in 92% (n = 23), two deaths Have been attributed to severe pulmonary embolism. Significant progress has been made in the context of cancer-related VTE. Nevertheless, there remains a considerable field of unresolved clinical issues. Numerous studies are underway and may lead to advances not only in the treatment of VTE associated with cancer but also in the treatment of the cancerous disease itself.