The Incidence and Risk Of Venous thromboembolism in patients with Active Malignancy and Isolated Superficial Venous Thrombosis: A systematic review and meta-analysis. (The IROVAM-iSVT review).

Abstract

Background: The management of cancer-associated isolated superficial venous thrombosis (iSVT) remains controversial as cancer patients are at higher risk of bleeding and venous thromboembolism (VTE).

Objectives: We performed a systematic review and meta-analysis to determine the incidence and risk of VTE in patients with iSVT and active malignancy.

Methods: Medline, Embase, Web of Science and the Cochrane Library were searched from inception to December 2nd, 2024 to identify studies investigating VTE rates in adult patients with iSVT and active malignancy. The incidence of VTE in patients with active malignancy and iSVT was pooled by meta-analysis and compared to patients with iSVT without active malignancy. Secondary outcomes included the incidence of major bleeding, clinically relevant non major bleeding (CRNMB), hospitalization, and all-cause death.

Results: 8 full-text studies were included comprising 5998 iSVT patients and 448 with active malignancy. Patients with cancer-associated iSVT had an overall incidence of VTE of 18.2 events per 100 patient years (95%CI [5.2-31.2], I²=76%), and a higher rate of VTE compared to patients with iSVT without active malignancy (RR 2.57, 95%CI [1.78-3.71], I²=0%, P<0.001). There were 2 major bleeding events per 100 patient years (95%CI [0 to 6.7], I²=59%) and 22.8 deaths per 100 patient years (95%CI [0 to 58.7], I² = 73%) for cancer-associated iSVT. Only one study reported on CRNMD and hospitalization rates, respectively.

Conclusions: Patients with iSVT and active malignancy have high rates of VTE despite treatment. Future studies should investigate the role of extended duration anticoagulation on VTE rates in this population.