Abstract 373P
Background
Pancreatic cancer (PC) is associated with increased risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE occurs in 20% of PC. Guidelines support VTE prophylaxis to reduce morbidity and mortality associated with thrombosis. Study aimed to evaluate VTE burden and the utility of anticoagulation in PC.
Methods
Pancreatic cancer patients diagnosed at University Hospitals of North Midlands in the UK between 2019 and 2024 were studied. Hospital electronic records reviewed for demographics, tumour characteristics, VTE prophylaxis, thrombosis, and bleeding. Patients on chemotherapy with or without prophylaxis having VTE identified. Khorana score was used to stratify risk. Statistical analysis and Kaplan-Meier estimates done.
Results
A total of 91 patients of PC with 56% male and 44% female. Tumour locations were 31% (56) in the head of the pancreas, while (22) 12% and (13) 7% in the body and tail, respectively. 15% (21) of them had VTE within the first 4-6 months of starting chemotherapy. Of these, 13% (17) had VTE who were not on anticoagulation, whereas 4% (5) developed VTE despite anticoagulation, highlighting a 9% improvement with prophylaxis. PE was the prevalent VTE, seen in 9% (10) of patients, followed by DVT at (5) 4%. Incidental visceral vein thrombosis (VVT) and stroke each accounted for 3% of all events. Interestingly, 10 (7%) patients were on prophylactic anticoagulation before starting chemotherapy, and none developed VTE during the one-year follow-up period. One developed non-major clinically relevant (CRNMB) bleeding while on anticoagulation.
Conclusions
13% of pancreatic cancer patients developed VTE who were not on anticoagulation. A 9% improvement in VTE events was seen with primary prophylaxis which is consistent with the results from AVERT and CASSINI trials. Many guidelines support prophylactic anticoagulation if the Khorana score is ≥2 in the absence of bleeding. In this study, the clinical utility of the Khorana score was not seen helpful as all patients had Khorana score ≥2. Given the high incidence of VTE in pancreatic cancer on chemotherapy primary VTE prophylaxis should be considered in the absence of bleeding.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.