by Ella Grilz, Ingrid Pabinger, Cihan Ay
Cancer is a well-known risk factor for the occurrence of venous thromboembolism. In contrast, little research has been conducted into arterial thromboembolism (i.e. myocardial infarction, stroke, peripheral artery disease) in patients with cancer. Most data regarding arterial thrombosis in patients with cancer originate from retrospective studies or from small groups of cancer patients.
Recently, the first prospective study regarding the risk of arterial thrombosis in patients with cancer was published. Researchers of the Medical University of Vienna investigated the incidence, the risk factors, and the impact on mortality of arterial thrombosis in 1880 patients with cancer (54.3% male; median age: 61 years). This analysis was performed within the framework of the Vienna Cancer and Thrombosis Study (CATS). Since 2003, patients with newly diagnosed malignant disease or progression of disease after remission are included in CATS. During the 2-year observational period 48 patients (2.6%) developed arterial thromboembolism. The cumulative 3-, 6-, 12-, and 24-month risks of arterial thromboembolism were 0.9%, 1.1%, 1.7%, and 2.6%, respectively. Independent risk factors for arterial thrombosis in patients with cancer were: male sex (subdistribution hazard ratio [SHR]=2.9, 95%CI: 1.5-5.6), age (SHR per 10 year increase=1.5, 1.2-1.7), hypertension (SHR=3.1, 1.7-5.5), and smoking (SHR=2.0, 1.1-3.7). Furthermore, the risk of arterial thrombosis varied by cancer type, with kidney cancer (8.9%) having the highest and breast cancer (0.0%) having the lowest risk.
The study also showed that those patients who develop arterial thromboembolism are at a 3-fold increased risk of mortality (hazard ratio=3.2, 95%CI: 2.2- 4.8).
Of course, these results need to be confirmed in further studies, but the study provides subject-level data regarding the epidemiology of arterial thrombosis in patients with cancer in a well-characterized cancer cohort and supports the concept of shared risk factors and pathobiology between cancer and arterial thrombosis.
Ella Grilz et al. Frequency, risk factors, and impact on mortality of arterial thromboembolism in patients with cancer. Haematologica 2018 May 24. pii: haematol.2018.192419. doi: 10.3324/haematol.2018.192419. [Epub ahead of print]