Venous Thromboembolism In Lung Cancer Patients Research Articles

Development and validation of a nomogram model for predicting venous thromboembolism risk in lung cancer patients treated with immune checkpoint inhibitors: A cohort study in China.

Venous thromboembolism (VTE) poses a significant threat to lung cancer patients, particularly those receiving treatment with immune checkpoint inhibitors (ICIs). We aimed to develop and validate a nomogram model for predicting the occurrence of VTE in lung cancer patients undergoing ICI therapy. The data for this retrospective cohort study was collected from cancer patients admitted to Chongqing University Cancer Hospital for ICI treatment between 2019 and 2022. The research data is divided into training and validation sets using a 7:3 ratio. Univariate and multivariate analyses were employed to identify risk factors for VTE. Based on these analyses, along with clinical expertise, a nomogram model was crafted. The model's predictive accuracy was assessed through receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis, clinical impact curve, and other relevant metrics. The initial univariate analysis pinpointed 13 potential risk factors for VTE. The subsequent stepwise multivariate regression analysis identified age, Karnofsky performance status, chemotherapy, targeted, platelet count, lactate dehydrogenase, monoamine oxidase, D-dimer, fibrinogen, and white blood cell count as significant predictors of VTE. These 10 variables were the foundation for a predictive model, illustrated by a clear and intuitive nomogram. The model's discriminative ability was demonstrated by the ROC curve, which showed an area under the curve of 0.815 (95% CI 0.772-0.858) for the training set, and 0.753 (95% CI 0.672-0.835) for the validation set. The model's accuracy was further supported by Brier scores of 0.068 and 0.080 for the training and validation sets, respectively, indicating a strong correlation with actual outcomes. We have successfully established and validated a nomogram model for predicting VTE risk in lung cancer patients treated with ICIs.

Stratification of Risk Factors of Lung Cancer-Associated Venous Thromboembolism and Determining the Critical Point for Preemptive Intervention: A Systematic Review With Meta-analysis.

Several biomarkers or risk factors have been identified and several prediction models exist. The major limitations inherent in these models include cost-ineffectiveness and lack of systematic stratification of risk factors resulting in the inclusion of clinically insignificant biomarkers in the models. This review aimed to systematically stratify the risk factors of lung cancer-associated venous thromboembolism (VTE) and determine the critical point for preemptive intervention. This systematic review was structured as per the Preferred Reporting Item for Systematic Reviews and Meta-analyses. We searched MEDLINE, PubMed, Cochrane Library, CINAHL, Academic Search Complete, and PsycINFO from the onset to June 2022. We included studies that reported the risk factors of lung cancer-associated VTE and corresponding risk estimates, irrespective of treatment status but studies were excluded if patients were on anti-VTE medications. We employed random effects models of meta-analysis and computed risk stability index and risk weight (Rw) to achieve the review objectives. The review protocol is registered with PROSPERO (CRD42022336476). The clinically significant risk factors of VTE in lung cancer patients were D-dimer (odds ratio [OR] = 5.510, 95% CI = 2.6-11.7; Rw = 5.0), albumin (OR = 2.2, 95% CI = 1.0-4.8; Rw = 1.79), leukocyte (OR = 2.48, 95% CI = 1.9-3.2; Rw = 1.77), histological type (OR = 1.69 , 95% CI = 1.2-2.4; Rw = 1.3), age (OR = 1.56; Rw = 0.99), and hemoglobin (OR = 1.85, 95% CI = 1.3-2.6; Rw = 0.92). Based on the distribution of Rw across risk factors, the critical point (upper third of the upper quartile class) was 4.5 and may mark the point at which preemptive intervention should be commenced. Targeted screening for VTE in lung cancer patients could be patient-specific and should be based on a combination of the most significant risk factors required to meet the critical point, provided that such a combination is affordable as illustrated in the ALBAH model. The review protocol is registered with PROSPERO (ID: CRD42022336476).

The Diagnostic Value of the Systemic Immune-Inflammation Index for Venous Thromboembolism in Lung Cancer Patients: A Retrospective Study

Background Venous thromboembolism (VTE) is considered a common complication in lung cancer patients. Despite its widespread use, the Khorana score performed moderately in predicting VTE risk. This study aimed to determine the diagnostic utility of the Systemic Immunoinflammatory Index (SII) and to create a novel nomogram for predicting VTE in patients with pulmonary carcinoma. Materials and Methods The data, like clinical features and laboratory indicators, of inpatients diagnosed with lung cancer from March 2019 to March 2020 were collected and analyzed. Univariate and multivariate logistic analyses were performed to confirm the risk factors and then construct a nomogram model. The calibration curve and clinical decision curve analysis (DCA) were used to assess the model's fitting performance. The receiver-operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to evaluate the diagnostic value of SII and the nomogram. Results This study enrolled 369 lung patients with a VTE morbidity rate of 23.33%. The patients with VTE had higher SII levels than the non-VTE group (1441.47 ± 146.28 vs. 626.76 ± 26.04, P < 0.001). SII is the stronger correlator for VTE among inflammatory markers, of which the optimal cut-off value was 851.51. Univariate and multivariate analysis revealed that the age, metastasis, antitumor treatment, hemoglobin<100 g/L, SII>851.51 × 109/L, and D-dimer>2 folds were independent risk factors for lung cancer-related VTE, and a new prediction nomogram model was constructed based on them. ROC curve analysis showed the AUC of the new model and Khorana score were 0.708 (0.643-0.772) and 0.600 (0.531-0.699). Conclusion The SII was a simple and valuable biomarker for VTE, and the new nomogram model based on it can accurately forecast the occurrence of VTE. They can be utilized in clinical practice to identify those at high risk of VTE in lung cancer patients.

Venous thromboembolism in non-small cell lung cancer patients who underwent surgery after induction therapy

ObjectivesLung cancer patients have been reported to have a high incidence of venous thromboembolism (VTE) and a high recurrence rate of VTE. However, there are no detailed reports of VTE in lung cancer patients who underwent surgery after induction therapy. We examined the incidence and clinical features of VTE in these patients.MethodsWe retrospectively evaluated 89 patients with non-small cell lung cancer who underwent surgery after induction therapy at our department between April 2009 and March 2018. The incidence of VTE, clinical features, and long-term prognosis were retrospectively examined.ResultsAmong the 89 patients, 4 (4.5%) developed VTE, and there was no significant difference in the background characteristics between patients with and without VTE. All four patients developed VTE during preoperative treatment. In the patients with VTE, anticoagulant therapy with oral anticoagulants was administered after heparinization, and the median duration of anticoagulant therapy was 18.7 months. There were no cases of symptomatic VTE recurrence after surgery, regardless of lung cancer recurrence. Although the overall survival (OS) showed no significant difference between patients with and without VTE, the disease-free survival was significantly shorter in patients with VTE than in those without it (median 6.3 vs. 71.6 months, p < 0.01).ConclusionsIn induction cases, the incidence of VTE was 4.5%, and it can at least be stated that no symptomatic VTE developed or recurred after surgery. Patients with VTE in induction therapy had short progression-free survival and required careful follow-up after surgery.

Venous Thromboembolism in Patents With Lung Cancer.

Lung cancer is the leading cause of death from cancer in Japan. Studies in other countries have reported a venous thromboembolism (VTE) rate of 4%–20% in cancer patients. In this study, we aimed to determine the incidence of VTE in lung cancer patients in Japan and compared the characteristics of patients with and without VTE. In this retrospective cohort study, the clinicopathological characteristics of study patients with and without concomitant VTE were compared. Patients with lung cancer treated at Fukui Prefectural Hospital, Japan from 2008 to 2017. Of the 1471 patients with lung cancer studied, 28 developed VTE. Five patients developed pulmonary thromboembolism (PTE) alone, 9 PTE with concomitant deep vein thrombosis, and 14 deep vein thrombosis alone. Compared with patients in the non-VTE group, the VTE group was significantly younger (mean value ± SD 66.3 ± 10.1 vs. 73.0 ± 10.6 years, p = 0.001), contained significantly more patients with stage IIIb–IV disease (p = 0.002), and had a significantly higher rate of chemotherapy (p < 0.001) and radiation therapy (p = 0.007). There was no significant difference in median survival time from lung cancer diagnosis between the VTE and non-VTE groups. The 1-year mortality rate after VTE diagnosis was 60.7%. Lung cancer was the most frequent cause of death, followed by infection and VTE. Several baseline characteristics differed between patients with and without VTE. The prognosis may worsen after development of VTE, suggesting that lung cancer patients should be carefully monitored for it.

Venous thromboembolism and lung cancer: a review

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Retrospective Analysis of Risk Factors for Venous Thromboembolism in 283 Patients with Lung Cancer during Systemic Therapy

背景与目的肺癌患者是静脉血栓栓塞症（venous thrombo-embolism, VTE）的高危人群，合并VTE者具有较高的死亡率。本研究旨在明确接受系统性治疗肺癌患者的VTE发生情况及影响因素。方法回顾性分析2016年1月-2018年12月在北京大学第三医院肿瘤化疗与放射病科接受系统性治疗的283例肺癌患者，卡方检验分析VTE与临床特征间的关系，多因素回归分析影响VTE的高危因素。结果283例肺癌患者中，VTE发生率为12.01%（34/283）。有下肢静脉曲张组的VTE发生率为50.00%（5/10），显著高于无下肢静脉曲张组的9.89%（27/273）（P=0.001）。远处转移患者的VTE发生率为14.05%（26/185），高于带瘤但无远处转移患者的14.00%（7/50），且高于无瘤患者的2.08%（1/48）（P=0.024）。肿瘤活动组的VTE发生率为16.93%（21/124），显著高于稳定组的8.18%（3/159)（P=0.025）。首次药物治疗前白蛋白 < 35g/L组VTE发生率为22.00%（11/50），显著高于≥35 g/L组的9.87%（23/233）（P=0.017）；D-二聚体 > 0.3 μg/mL组VTE发生率为17.93%（26/145），显著高于≤0.3 μg/mL组的5.80%（8/138）（P=0.006）。接受PICC的患者上肢静脉血栓的发生率为9.71%（17/175），显著高于未行PICC组的1.85%（2/108）（P=0.010）。肺癌病理类型、白细胞、血红蛋白、血小板计数及是否接受抗血管生成药物治疗等因素与VTE的发生率无关。多因素分析显示下肢静脉曲张、低白蛋白血症、D-二聚体升高是VTE的独立影响因素。结论有无下肢静脉曲张、血白蛋白和D-二聚体水平或许是预测肺癌患者系统性治疗期间发生VTE更为有效的因子，可进一步建立新的预测模型并进行前瞻性验证。

Occurrence of Venous Thromboembolism in Patients with Lung Cancer and Its Anticoagulant Therapy

目前，肺癌的发病率和死亡率在全世界范围内居首位。静脉血栓栓塞症（venous thromboembolism, VTE）是一种公认的肺癌并发症，也是肺癌患者的主要死因之一。癌症自身因素、患者自身因素以及治疗相关因素都是导致肺癌患者发生VTE的主要原因。肿瘤细胞可产生组织因子（tissue factor, TF）、癌性促凝物质（cancer procoagulant, CP）、炎症因子和细胞因子，从而直接激活凝血；其中TF过度表达是肿瘤患者血栓形成的主要机制之一。2016年美国胸外科医师协会（American College of Chest Physicians, ACCP）发布的第10版肿瘤患者VTE防治指南（AT-10）指出，抗凝治疗是肺癌患者合并VTE的基本治疗措施；其中低分子肝素（low molecular-weight-heparin, LWMH）被认为是首选的抗凝药物，但要注意出血风险。

Risk Factors Associated with Venous Thromboembolism after Lung Cancer Surgery: A Single-center Study

背景与目的肺癌术后静脉血栓栓塞症（venous thromboembolism, VTE）的发生率并非少见，本研究旨在分析肺癌术后VTE相关危险因素，为进一步防治VTE提供临床依据。方法本研究为单中心研究。选择2016年7月-2017年12月在首都医科大学附属北京朝阳医院胸外科接受手术治疗的肺癌患者，除术前常规检查外，所有患者均在手术前后行下肢多普勒超声以明确有无新发下肢深静脉血栓（deep venous thrombosis, DVT）。患者术前术后均未接受预防性抗凝治疗。按照术后是否发生VTE将患者分为VTE组和对照组，比较两组间的基线资料、手术相关资料（手术类型、术式等）、肿瘤病理相关资料（病理分型、血管浸润、病理分期等）。结果按照纳入标准，本研究共对339例接受肺癌手术的患者进行了分析，其中男性166例，女性173例，年龄范围23岁-86岁。术后共39例发生VTE，发生率为11.5%。比较两组年龄、性别、体质量指数（body mass index, BMI）、美国麻醉医师协会（American Society of Anesthesiologists, ASA）、吸烟状况、基础疾病等，除年龄有显著性差异外，其他指标均无显著性差异；比较两组术前血常规、血生化、凝血、肿瘤标记物、肺功能、下肢静脉超声等，术前癌胚抗原（carcinoembryonic antigen, CEA）水平、术前D-二聚体水平、肺功能水平及下肢肌间静脉扩张比率两组有显著性差异，其他指标均无显著性差异；比较两组手术时长、手术方式、出血量、病理类型、病理分期、血管侵犯等，手术时长、手术方式（开胸vs胸腔镜）、出血量等因素有统计学差异，其他指标均无显著性差异。单因素分析结果显示：VTE组在年龄、术前CEA水平、术前D-二聚体水平、肺功能水平、下肢肌间静脉扩张比率、开胸手术比率、手术时长、出血量均与对照组有显著差异（P < 0.05）。而病理分期、病理类型等因素与VTE发生无显著相关性。多因素Logistics回归分析显示，第1秒用力呼气量（forced expiratory volume in one second, FEV1）、手术方式、下肢肌间静脉扩张是肺癌术后合并VTE的独立危险因素（P < 0.05）。结论本研究结果提示患者FEV1、手术方式以及下肢肌间静脉扩张是肺癌术后合并VTE的独立危险因素。

Global Prospective Cohort Study of Factors Associated with Venous Thromboembolism in Patients with Lung Cancer Receiving Cancer Therapy

BACKGROUND: Patients with lung cancer are known to be at increased risk for venous thromboembolism (VTE). However, there have been few studies of risk factors for VTE in lung cancer patients undergoing systemic chemotherapy.METHODS: CANTARISK was a prospective, non-interventional, global cohort study including patients with lung cancer initiating a new chemotherapy regimen. Clinical data were collected at baseline and at 2, 4 and 6 months follow-up. The impact of patient-, disease- and treatment-related factors on the occurrence of VTE in the first 6 months was evaluated in univariable and multivariable Cox regression analyses.RESULTS: A total of 1,980 patients with lung cancer were enrolled from 2011-12 of which 84% were diagnosed with non-small cell lung cancer (NSCLC). Median age was 63 years (range, 25-91) and 63% were male while 82% were active or former smokers. Race was white (70%), Asian (22%), or black (4%) with similar numbers from North America, Europe, and other regions including Asia. Metastatic disease was reported in 70% and ECOG PS was ≥2 in 13%. During the first six months, 121 patients developed a VTE (6.1%), of which 47.1% had pulmonary embolism (PE), 45.5% deep venous thrombosis (DVT), 3.3% catheter-associated thrombosis, and 4.1% visceral thrombosis. Among significant factors in univariable analysis, independent predictors for VTE in multivariable Cox regression analysis included female gender, US geographic region, leg immobilization, and presence of a central venous catheter (Table) with a trend toward greater risk for higher grade histology. Although predictive of early all-cause mortality in this study population (Kuderer et al ASCO 2016), the previously validated risk score for VTE in ambulatory cancer patients (Khorana et al: Blood 2008) was not significantly associated with VTE in either univariable or multivariable analysis.CONCLUSIONS: Several demographic, geographic, and clinical factors are significantly associated with an increased risk of VTE in patients with lung cancer receiving systemic chemotherapy. Future analysis will attempt to assess how novel targeted treatment options might impact the Khorana score's predictive ability across all lung cancer patients. [Display omitted] DisclosuresKuderer:Janssen Scientific Affairs, LLC: Consultancy, Honoraria. Lyman:Amgen: Research Funding. Khorana:Bayer: Consultancy, Honoraria; Leo: Consultancy, Honoraria, Research Funding; Halozyme: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Amgen: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Janssen Scientific Affairs, LLC: Consultancy, Honoraria, Research Funding.

Epidemiology and risk factors for venous thromboembolism in lung cancer.

Cancer is a strong risk factor for venous thromboembolism (VTE). In patients with lung cancer VTE is a significant cause for morbidity and mortality. The purpose of the review is to summarize the epidemiology of thrombotic events, risk factors for VTE and the clinical impact of VTE in patients with lung cancer. The rates of VTE in lung cancer patients vary according to different types of investigations, and reach 7 to 13%, including a significant number of unsuspected pulmonary emboli. Risk factors for VTE in patients with lung cancer can be basically divided into three categories: patient, tumor, and treatment related. In addition, a number of biomarkers have been described to be associated with VTE risk (e.g., D-dimer). Knowledge about the epidemiology, risk factors, and prognostic value of VTE in lung cancer could help to prevent thrombotic complications and improve management of patients with lung cancer.

Venous thromboembolism and lung cancer: a review.

Venous thromboembolism (VTE) is a common complication of malignancies and epidemiological studies suggest that lung cancer belonged to the group of malignancies with the highest incidence rates of VTE. Risk factors for VTE in lung cancer patients are adenocarcinoma, NSCLC in comparison with SCLC, advanced disease, pneumonectomy, chemotherapy including antiangiogenic therapy. Other risk factors are pretreatment platelet counts and increased release of TF-positive microparticles. Elevated D-dimer levels do not necessarily indicate an increased risk of VTE but have been shown to be predictive for a worse clinical outcome in lung cancer patients. Mechanisms responsible for the increase in venous thrombosis in patients with lung cancer are not understood.Currently no biomarker is recognized as a predictor for VTE in lung cancer patients.Although several clinical trials have reported the efficacy of antithrombotic prophylaxis in patients with lung cancer who are receiving chemotherapy, further trials are needed to assess the clinical benefit since these patients are at an increased risk of developing a thromboembolism.

Clinical characteristic and outcomes of lung cancer patients with venous thromboembolism

To explore the clinical characteristics and outcomes of lung cancer patients with venous thromboembolism (VTE). The clinical data of 80 lung cancer patients with VTE hospitalized from January 2003 to April 2013 at our hospital were reviewed. The clinical factors of age, gender, clinical manifestations, pathological type, clinical stage, performance status and therapeutic regimen were recorded and analyzed. And the pulmonary thromboembolism (PTE) patients with deep venous thrombosis (DVT) were enrolled into PTE group. The occurrences, clinical manifestations and prognosis of VTE were evaluated. A total of 80 patients were enrolled. There were 40 males and 40 females with a mean age of (65.8 ± 11.3) years. Adenocarcimoma was identified in 58 (72.5%) patients and advanced lung cancer in 71 (88.8%) patients. Among 37 (46.3%) patients with histodifferentiation results, 89.2% (33/37) of them were moderately and/or poorly differentiated. In 32 (40.0%) patients on chemotherapy, 71.9% (23/32) of them received a platinum-based regimen. There were 35 (43.8%) pulmonary thromboembolism embolism (PTE) and 45 (56.2%) DVT patients. Among PTE patents, 14 (40.0%) were identified incidentally. Dyspnea and swollen of limb were the most common symptoms. Only 20.0% (16/80) patients received VTE prophylaxis. After a definite diagnosis of cancer, 73.8%, 77.5%, 82.5% and 85.0% of patients experienced an event within 3, 6, 9 and 12 months respectively. Up to April 2014, among 53 deceased patients, 77.4% (41/53) died from lung cancer, 9.3% (5/53) PTE while 13.2% (7/53) due to other causes. The cumulative mortality rates within 3, 6, 9 and 12 months after VTE event were 49.1%, 67.9%, 77.4% and 79.2% respectively. Adenocarcimoma, advanced lung cancer, poor histodifferentiation and platinum-based chemotherapy regimen are the risk factors of VTE in lung cancer patients. Most events of VTE occur within 3-6 months after a diagnosis of lung cancer while most mortality cases within 1 year after VTE events.

Clinical models and biochemical predictors of VTE in lung cancer.

Venous thromboembolism (VTE) is a frequent complication of lung cancer and its treatment, especially in the advanced stages of disease. The risk of a pro-thrombotic state might increase through the activation of hemostasis, occurring both via the induction of a pro-coagulant activity and with platelet involvement, ultimately leading to the development of metastases. Despite the acknowledgement of an increased thrombophilic condition in cancer patients, and the experimental evidence that heparin compounds may have direct anticancer benefits, there is no univocal consent regarding VTE prevention in cancer outpatients receiving therapy. Thus, many authors highlighted the need for the development of stratification techniques to identify at-risk patients who might benefit from thromboprophylaxis. Clinical risk models were developed and validated, in order to assign high-risk patients to a proper thromboprophylaxis regimen that, however, might not be justified in all clusters. Besides, efforts have been devoted to identify candidate biomarkers that may be used in VTE risk assessment, although none has been recognized, so far, as a predictor for VTE in lung cancer patients. In this review, we will summarize the latest information concerning this very controversial topic, with focus on some of the proposed strategies to select the appropriate patients for prophylaxis.

Efficacy and safety of adjunctive anticoagulation in patients with lung cancer without indication for anticoagulants: a systematic review and meta-analysis

BackgroundPatients with lung cancer are at high risk of venous thromboembolism (VTE), and VTE predicts a poor prognosis. Anticoagulation therefore might be beneficial for these patients. It is not clear...

The Incidence and Outcome of Venous Thrombo-Embolism (VTE) In Non-Small Cell Lung Cancer Patients with Adenocarcinoma Histology In Comparison with Squamous Histology

AbstractAbstract 4221 Background:There have been only limited studies on the incidence and outcome of venous thrombosis in non-small cell lung cancer patients by histology. Patients with adenocarcinoma are believed to have the highest risk of developing venous thrombosis. Objectives:1. To study the incidence and outcome of thrombosis in patients with non- small cell lung cancer. 2. To determine the differences in the venous thrombotic risk between adenocarcinoma and squamous cell carcinoma subtypes. Patients/Methods:we conducted a retrospective chart review analysis of all the non-small cell lung cancer patients diagnosed in 2008 and 2009 at our institution. Patient and tumor characteristics as well as all venous thrombotic events (VTE) in the course of the disease were recorded. Incidence rates of VTE were calculated as both cumulative incidence and as person-time events (events per 1000 patient years of follow-up). We counted person-years of follow-up for each subject from the date of initial lung cancer diagnosis until the date of a thrombotic event, the date of death, or the end of the study period (30 June 2010), whichever occurred first. Analysis of the difference between squamous cell carcinoma and adenocarcinoma histological subgroups was done using Cox proportional Hazards model. For survival and outcome analysis of patients who develop VTE after diagnosis of lung cancer, we again used a Cox proportional Hazards model with the thrombotic event as a time -dependent variable. Results:Among133 patients with non-small cell lung cancer, 86 had adenocarcinoma, 42 had squamous cell histology and 5 were large cell carcinomas (the latter were excluded from the analysis). The mean age of the patients was 66.2 years and their median survival was 377 days (1.04 years).We observed 25 events of VTE over 82.89 years of follow-up for an overall incidence of VTE of 301.6 per 1000 person-years. Among 86 patients with adenocarcinoma histology, we found 21 VTEs (24.4%) Among 42 patients with squamous cell carcinoma, 4 VTE s occurred (9.5 %). The incidence of VTE for patients with adenocarcinoma was 422 per 1000 person-years (95% CI: 282 – 568) and for patients with squamous cell carcinoma 125.97 per 1000 person-years (95 % CI: 36 – 298) resulting in a trend towards higher VTE incidence in patients with adenocarcinoma as compared to patients with squamous cell carcinoma. When the rate ratio between the adenocarcinoma (21/49.7) and squamous cell cancer (4/31.8) are compared, the rate ratio is 3.359 (1.207 – 9.352). The risk of developing a VTE was 2 fold increased for patients with adenocarcinoma vs. squamous cell carcinoma (crude hazard ratio 2.375 [95%CI: 0.664–8.491]) There was a trend towards lower survival time in patients who develop a VTE during the course of their disease compared to patients who did not develop a VTE. (HR 0.992, 95% CI:.449 – 2.193). 5 of the 21 patients in the adenocarcinoma group who had VTE had a second VTE despite anticoagulation. Discussion:Only few studies have described the absolute risk as incidence rates of VTE in lung cancer patients. One study in 2004 reported the incidence of VTE is 20-fold increased in lung cancer patients compared to general population; with 3-fold increase in patients with adenocarcinoma histology. Our study confirms the trend towards increased risk of VTE in adenocarcinoma histology, along with a worse outcome. Also, of interest, is the unusually high incidence of VTE noted in our study cohort compared to the reference studies (20.9% vs. 7.2%). This finding might be due to the enhanced awareness and high clinical suspicion leading to increased testing for VTE in the cancer patients. Based on these findings, prophylactic anticoagulation in these patients may be warranted to prevent development of venous thrombosis. This needs to be studied in a prospective clinical trial in the future. Disclosures:No relevant conflicts of interest to declare.

Risk of venous thromboembolism in lung cancer

To evaluate venous thromboembolism (VTE) risk factors in lung cancer patients. VTE incidence is around 40-100 cases per 1000 person-years in lung carcinoma patients vs. an estimated 1-2 cases per 1000 person-years in the general population. Patients with adenocarcinoma have higher risk of VTE than patients with squamous cell lung carcinoma. VTE risk appears two-fold higher in nonsmall-cell lung cancer than in small-cell lung cancer patients. Other risk factors are pneumonectomy, metastatic disease, use of specific chemotherapeutic drugs in combination with novel targeted drugs, such as antiangiogenic agents, and elevated prechemotherapy platelet counts. Tissue factor (TF), the initiator of the clotting cascade, may be (over)expressed in lung carcinoma cells. Active TF-bearing microparticles, which may originate from the tumour cells themselves, have been found in the circulation of cancer patients. Microparticle-associated TF activity may provide a link between cancer and thrombosis and play a decisive role in the pathogenesis of the prothrombotic state in cancer patients. Risk factors of VTE in lung cancer patients are adenocarcinoma, metastatic disease, pneumonectomy and anticancer therapy including chemotherapy and anti-VEGF targeted drugs. Other risk factors include pretreatment platelet counts and active TF-expressing circulating microparticles.