Original Article

Journal of General Internal Medicine

, Volume 22, Issue 3, pp 321-326

First online:

The Impact of Venous Thromboembolism on Risk of Death or Hemorrhage in Older Cancer Patients

  • Cary P. GrossAffiliated withSection of General Internal Medicine, Yale University School of MedicineRobert Wood Johnson Clinical Scholars Program, Yale University School of MedicineCenter for Outcomes Research and Evaluation, Yale New Haven Hospital Email author 
  • , Deron H. GalushaAffiliated withCenter for Outcomes Research and Evaluation, Yale New Haven Hospital
  • , Harlan M. KrumholzAffiliated withSection of Cardiovascular Medicine, Yale University School of MedicineRobert Wood Johnson Clinical Scholars Program, Yale University School of MedicineDepartment of Epidemiology and Public Health, Yale University School of MedicineCenter for Outcomes Research and Evaluation, Yale New Haven Hospital

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Background

Among older cancer patients, there is uncertainty about the degree to which venous thromboembolism (VTE) and its treatment increase the risk of death or major hemorrhage.

Objective

To determine the prevalence of VTE in a cohort of older cancer patients, as well as the degree to which VTE increased the risk of death or major hemorrhage.

Methods

We conducted a retrospective cohort study of linked Surveillance, Epidemiology, and End Results cancer registry and Medicare administrative claims data. Patients with any of ten invasive cancers diagnosed during 1995 through 1999 were included; the independent variable was VTE diagnosed concomitantly with cancer diagnosis. Outcomes included major hemorrhage during the first year after cancer diagnosis and all-cause mortality;

Results

Overall, about 1% of patients who were diagnosed with cancer also had a VTE diagnosed concomitantly. After adjusting for sociodemographic factors and cancer stage and grade, concomitant VTE was associated with a relative increase in the risk of death for 8 of the 10 cancer types; the increase in risk tended to range 20–40% across most cancer types. Approximately 16.8% (95% confidence interval [CI] 14.9–18.8%) of patients with a concomitant VTE and 7.9% (95% CI 7.7–8.0%) of patients without a VTE experienced a major hemorrhage during the year after cancer diagnosis (P value <.001). The excess risk of hemorrhage associated with VTE varied substantially across cancer types, ranging from no significant excess (kidney and uterine cancer) to 11.5% (lymphoma).

Conclusion

Concomitant VTE is not only a marker and potential mediator of increased risk of death among older cancer patients, but patients with a VTE have a marked increased risk of major hemorrhage.

Key words

thrombosis cancer hemorrhage epidemiology