Three-Month Outcomes in Cancer Patients with Superficial or Deep Vein Thrombosis in the Lower Limbs: Results from the RIETE Registry
by
, , , ,
Philippe Debourdeau
1,*,
Laurent Bertoletti
2,
Carme Font
3,
Juan José López-Núñez
4,5,
Covadonga Gómez-Cuervo
6,
Isabelle Mahe
7
,
Remedios Otero-Candelera
8,
Maria Dolores Adarraga
9,
Patricia López-Miguel
10,
Manuel Monreal
4,11 and
RIETE Investigators
† 1
Centre Hospitalier Joseph Imbert, BP 80195, 13637 Arles, France
2
Département of Médecine Vasculaire et Thérapeutique, CIC 1408, SAINBIOSE U1059, INSERM, CHU Saint-Étienne, Mines Saint-Etienne, Université Jean Monnet Saint-Étienne, 42000 Saint-Etienne, France
3
Department of Medical Oncology, Hospital Clínic, 08036 Barcelona, Spain
4
Department of Internal Medicine, Hospital Germans Trias i Pujol, 08916 Barcelona, Spain
5
Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
6
Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
7
Department of Internal Medicine, University Paris 7, Hôpital Louis Mourier, 92700 Colombes, France
8
Department of Pneumonology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
9
Department of Internal Medicine, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
10
Department of Pneumonology, Hospital General Universitario de Albacete, 02008 Albacete, Spain
11
Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM—Universidad Católica San Antonio de Murcia, Universidad Autónoma de Barcelona, 08193 Barcelona, Spain
*
Author to whom correspondence should be addressed.
†
Members of the RIETE registry are listed in Supplementary File S1.
Cancers 2023, 15(7), 2034; https://doi.org/10.3390/cancers15072034
Submission received: 2 March 2023
/
Revised: 21 March 2023
/
Accepted: 27 March 2023
/
Published: 29 March 2023
(This article belongs to the Special Issue Treatment of Cancer-Associated Thrombosis 2.0)
Simple Summary
The natural history of isolated lower-limb superficial vein thrombosis (SVT) in cancer patients is not well understood. To address this gap, we analyzed data from the RIETE registry, which included 110 cancer patients with isolated SVT, 1695 cancer patients with isolated deep vein thrombosis (DVT), and 1030 non-cancer patients with SVT. Compared to cancer patients with DVT, cancer patients with lower-limb SVT received lower doses of anticoagulants, had similar rates of subsequent pulmonary embolism (PE), DVT or SVT, were less likely to have metastases and had a lower mortality rate. However, cancer patients with lower-limb SVT had a higher rate of subsequent PE, DVT or SVT than non-cancer patients with SVT. Additionally, in cancer patients with lower-limb SVT, almost all recurrences and bleeding occurred within the first three months.
Abstract
Background: The clinical characteristics and outcomes of cancer patients with lower-limb isolated superficial vein thrombosis (SVT) have not been consistently evaluated. Methods: We used data in the RIETE registry to compare the clinical characteristics and 90-day outcomes for patients with: (1) active cancer and lower-limb SVT; (2) active cancer and lower-limb deep vein thrombosis (DVT); (3) lower-limb SVT without cancer. The primary outcomes included subsequent symptomatic SVT, DVT or pulmonary embolism (PE). Secondary outcomes were major bleeding and death. Results: From March 2015 to April 2021, there were 110 patients with cancer and SVT, 1695 with cancer and DVT, and 1030 with SVT but no cancer. Most patients in all subgroups (93%, 99% and 96%, respectively) received anticoagulants, while those with SVT received lower daily doses of low-molecular-weight heparin (114 ± 58, 163 ± 44, and 106 ± 50 IU/kg, respectively). During the first 90 days, 101 patients (3.6%) developed subsequent VTE (PE 47, DVT 41, SVT 13), whereas 72 (2.5%) had major bleeding and 282 (9.9%) died. Among the three groups, 90-day events were, respectively: VTE at rates of 7.3%, 4.0% and 2.4%; major bleeding at rates of 2.7%, 3.9% and 0.3%; mortality at rates of 8.2%, 16% and 0.3%. Between D90 and D180, only one SVT recurrence and one death occurred in SVT cancer patients. In multivariable analysis, cancer was associated with subsequent VTE (HR = 2.04; 1.15–3.62), while initial presentation as SVT or DVT were not associated with a different risk. Conclusions: The risk for subsequent VTE (including symptomatic SVT, DVT or PE) was similar in cancer patients with isolated SVT than in those with isolated DVT.
