Management and outcomes in patients with tumor thrombus: a retrospective cohort study.

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2024-10-12 DOI:10.1016/j.jtha.2024.10.002

Sean Hui, Khalid Zeid, Roger Kou, Ranjeeta Mallick, Marc Carrier, Tzu-Fei Wang

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引用次数: 0

Abstract

Background: Tumor thrombus can be associated with an increased risk of venous thromboembolism (VTE) and poor prognosis. The risks and benefits of anticoagulation remain unclear.

Objectives: To evaluate the role of anticoagulation and associated outcomes in patients with tumor thrombus.

Methods: We conducted a single-center retrospective cohort study in patients with tumor thrombus from 2019 to 2022. All patients were followed for 12 months from the diagnosis of tumor thrombus or until death if death occurred earlier. The primary outcome was the percentage of patients prescribed any dose of anticoagulation for tumor thrombus (or concurrent bland thrombus/VTE). The secondary outcomes included new thrombosis, major bleeding, clinically relevant nonmajor bleeding, and mortality. We calculated the 6- and 12-month cumulative incidence of outcomes with 95% CI and compared those given anticoagulation vs not, considering death as a competing risk.

Results: We included 211 patients, among whom 106 (50.2%; 95% CI, 47.9%-52.6%) were given anticoagulation for tumor thrombus or concurrent VTE (present in 21.8%). The most common type of cancer was hepatocellular carcinoma (28%). Splanchnic veins were the most commonly involved (49.3%). Anticoagulation was more likely used if tumor thrombus involved the inferior vena cava and/or the heart, with concurrent VTE, or if thrombosis service was consulted. The overall 12-month incidence of new VTE was 11.4% (95% CI, 7.3%-16.5%), that of major bleeding + clinically relevant nonmajor bleeding was 36.6% (95% CI, 29.6%-43.5%), and mortality of 52.5% (95% CI, 44.8%-59.6%), with no significant differences among groups given anticoagulation or not.

Conclusion: Patients with tumor thrombus carry high risks of VTE, bleeding, and mortality. The impact of anticoagulation remains unclear.

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肿瘤血栓患者的管理和预后：回顾性队列研究

背景：肿瘤血栓可导致静脉血栓栓塞症（VTE）风险增加和预后不良。抗凝治疗的风险和益处尚不明确：我们在2019-2022年对肿瘤血栓患者进行了一项单中心回顾性队列研究。所有患者自肿瘤血栓确诊起随访 12 个月，如果死亡时间较早，则随访至死亡。主要结果是因肿瘤血栓（或并发白血栓/VTE）而被处以任何剂量抗凝治疗的患者比例。次要结果包括新的血栓形成、大出血（MB）、临床相关性非大出血（CRNMB）和死亡率。我们计算了结果的 6 个月和 12 个月累积发生率及 95% 的置信区间 (CI)，并比较了给予抗凝治疗与未给予抗凝治疗的患者，将死亡视为竞争风险：我们纳入了 211 名患者，其中 106 人（50.2%）（95% CI：47.9-52.6）因肿瘤血栓或并发 VTE（21.8%）而接受了抗凝治疗。最常见的癌症类型是肝细胞癌（28%）。最常累及的是脾静脉（49.3%）。如果肿瘤血栓累及下腔静脉、心脏、并发 VTE 或咨询过血栓服务，则更有可能使用抗凝治疗。12个月内新发VTE的总发生率为11.4%（95% CI 7.3-16.5），MB + CRNMB的发生率为36.6%（95% CI 29.6-43.5），死亡率为52.5%（95% CI 44.8-59.6），抗凝与否在各组间无显著差异：结论：肿瘤血栓患者发生 VTE、出血和死亡的风险很高。结论：肿瘤血栓患者具有很高的 VTE、出血和死亡风险，抗凝治疗的影响仍不明确。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.