Venous Thromboembolism Rate in Patients With Bladder Cancer According to the Type of Treatment: A Systematic Review.

Omar Abdullah,Annie M Young,Deepak Parashar,Israa J Mustafa

doi:10.7759/cureus.22945

Abstract

Bladder cancer (BC) is classified as a high-risk tumour type for venous thromboembolism (VTE). VTE presents an extra challenge in the management of patients with cancer, given the increase in morbidity and mortality on having both conditions.To summarise the contemporary evidence on the VTE rate in patients with BC according to the stage, type of anti-cancer treatment and highlight VTE rate in the UK and other countries. A systematic review was carried out, and an electronic search for publications between January 2000 and November 2021 was done. Studies recording VTE in BC patients were included, whilst paediatric patients, case reports, studies reporting on a mix of arterial and venous thrombosis, studies reporting DVT or PE only and recorded hospitalised VTE only were excluded. The rate of VTE, country of origin, risk factors and thromboprophylaxis duration for VTE in BC patients were identified.A total of 38 papers met the search criteria. All publications were original research papers (cohort studies). The overall VTE rate in patients with BC was estimated at 1.9% to 4.7%. For those patients undergoing cystectomy, the VTE rate ranged from 3% to 17.6%; however, the VTE rate in the metastatic stage of BC patients ranged from 3.1% to 5.1%.The rates of VTE in BC patients are high, further increased by interventions such as surgery and chemotherapy. Thromboprophylaxis measures should be optimised. This review highlighted the fact that the VTE rate in BC varies between studies due to the heterogeneity of risk factors reported.

Highlights

BackgroundVenous thromboembolism (VTE) is a disorder in which a thrombus forms, mostly in the deep veins of the lower or upper limbs, and is called deep vein thrombosis (DVT)
Inclusion criteria included (a) Primary research that confirmed the diagnosis of DVT and/or pulmonary embolism (PE) in Bladder cancer (BC) patients; (b) Papers in the English language; (c) Papers published from January 2000 until November 2021
Exclusion criteria included: (a) Case reports; (b) Studies reporting DVT or PE only; (c) Studies that recorded in-hospital venous thromboembolism (VTE) only; (d) Studies occasionally reporting on VTE as one of the adverse effects of surgery or chemotherapy; (e) Studies reporting on a mix of arterial and venous thrombosis as a composite endpoint or lack of clarity on venous thrombosis only

Summary

Introduction

Venous thromboembolism (VTE) is a disorder in which a thrombus forms, mostly in the deep veins of the lower or upper limbs, and is called deep vein thrombosis (DVT). Cancer is an independent risk factor for VTE [1], and VTE is a major cause of morbidity and mortality in patients with cancer [2]. VTE negatively affects the quality of life and increases the risk of further complications such as recurrent VTE and bleeding [3]. The utilisation of health care resources in cancer patients who have VTE is high [3]. Cancer patients have a five to six-fold increased risk of developing VTE compared with the general population; this can reach seven-fold for cancers of the brain, ovary and pancreas [4]. The pathogenesis of VTE in cancer patients is complex, related to the interaction between the procoagulant properties of the malignant cells themselves, the haemostatic system and characteristics of the patient [5]

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