Venous Thromboembolism (VTE) complicates the management of cancer and is associated with increased morbidity and mortality.VTE is the 2nd most common cause of mortality among cancer patients after cancer itself. The one year survival of patients with cancer who were diagnosed with VTE is one third that of patients with cancer who do not have VTE. Font.C.et.al reported 28% Incidental VTE in a cohort of 340 patients.We intended to look into the burden of VTE among the patients presenting to our institute.
This is a Prospective Observational study of 507 newly diagnosed patients with cancer enrolled consecutively from May 2014 to July 2015. All newly diagnosed patients were subjected to bilateral lower limb venous Doppler to detect Cancer associated silent VTE. Also, included were patients with thrombus detected during imaging as part of staging.
92(18.14%) among 507 patients were detected to have VTE. 12.22% (62) of the enrolled patients had Incidental VTE in contrast to that of symptomatic VTE which was 5.91% (30).
When analysed according to the type of cancer, 86.6% (13 out of 15) patients of Hepatocellular cancer developed VTE in comparison to only 16.6% (13 out of 78) of Gastric cancer patients .Similarly 75% ( 9 out of 12) pancreatic cancer patients developed VTE. Lung cancer and Colorectal cancers were associated with VTE in 12.9% (8 /62 patients) and 14.5% (7/48 patients) respectively.
Incidental VTE was seen in 21% (13) of HCC, followed by Stomach cancer with 10(16.1%) patients and pancreatic cancer with 11.3% (7) patients. Symptomatic VTE was seen in lung and ovarian cancers with 16.7% (5) each followed by colorectal cancer with 13.3% (4) patients.
Site of the index VT event was predominantly femoropopliteal constituting 39.2% (36), followed by portal vein thrombosis in 27.3% (25) and Inferior Vena caval thrombosis in 19.6% (18). There were 4 cases (4.4%) each of pulmonary thromboembolism, Superior mesenteric vein thrombosis and splenic vein thrombosis as well.
The burden of venous thromboembolism is much higher and often underestimated. Though thromboprophylaxis in cancer patients is challenging in view of bleeding complications, screening for VTE and primary prophylaxis in eligible patients might actually improve clinical outcomes.
Clinical trial identification
All authors have declared no conflicts of interest.