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Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study

  1. Alok A. Khorana M.D.1,†,*,
  2. Charles W. Francis M.D.1,
  3. Eva Culakova Ph.D.1,2,
  4. Gary H. Lyman M.D., M.P.H.1,2

Article first published online: 13 NOV 2005

DOI: 10.1002/cncr.21496

Issue

Cancer

Cancer

Volume 104, Issue 12, pages 2822–2829, 15 December 2005

Additional Information

How to Cite

Khorana, A. A., Francis, C. W., Culakova, E. and Lyman, G. H. (2005), Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study. Cancer, 104: 2822–2829. doi: 10.1002/cncr.21496

Author Information

  1. 1

    James P. Wilmot Cancer Center and the Department of Medicine, University of Rochester, Rochester, New York

  2. 2

    Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York

  1. †

    Fax: (585) 273-1042

*601 Elmwood Ave, Box 704, Rochester, NY 14642

Publication History

  1. Issue published online: 8 DEC 2005
  2. Article first published online: 13 NOV 2005

Funded by

  • James P. Wilmot Cancer Research Fellowship
  • The Awareness of Neutropenia in Cancer (ANC) Study Group Registry is funded by Amgen, Inc.

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Keywords:

  • venous thromboembolism;
  • cancer;
  • chemotherapy

Symptomatic venous thromboembolism is a frequent complication of chemotherapy. An elevated prechemotherapy platelet count is associated with a nearly threefold greater risk of developing venous thromboembolism.

Abstract

BACKGROUND

The incidence of venous thromboembolism (VTE) is increased in cancer, but little information is available about risk factors in cancer patients on chemotherapy.

METHODS

We analyzed data from a prospective, multicenter observational study to determine the frequency and risk factors for VTE in ambulatory cancer patients initiating a new chemotherapy regimen. The association of VTE with clinical variables was characterized using univariate and multivariate analysis.

RESULTS

Among 3003 patients treated with at least one cycle of chemotherapy, VTE occurred in 58 (1.93%) over a median follow-up of 2.4 months (0.8%/mo). The incidence varied significantly by site of cancer (P = 0.01) with highest rates in upper gastrointestinal (2.3%/mo) and lung cancer (1.2%/mo), and lymphoma (1.1%/mo). An elevated prechemotherapy platelet count was significantly associated with an increased rate of VTE (P for trend = 0.005). The incidence of VTE was 3.98% (1.66%/mo) for patients with a prechemotherapy platelet count ≥ 350,000, compared with 1.25% (0.52%/mo) for patients with platelet counts of < 200,000 (P for trend=0.0003). In multivariate analysis, a prechemotherapy platelet count of ≥ 350,000/mm3 (adjusted OR 2.81, 95% CI 1.63–4.93, P = 0.0002), site of cancer, hemoglobin < 10g/dL or use of erythropoietin, and use of white cell growth factors in high-risk sites of cancer were significantly associated with VTE.

CONCLUSIONS

Symptomatic VTE is a frequent complication of chemotherapy. The prechemotherapy platelet count is a unique risk factor and can help identify high-risk patients for future trials of thromboprophylaxis. Cancer 2005. © 2005 American Cancer Society.

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