Cancer-Associated Thrombosis
Laurent Bertoletti, Olga Madridano, David Jiménez, Alfonso Muriel, Behnood Bikdeli, Cihan Ay, Javier Trujillo‐Santos, Marijan Bosevski, Patricia Sigüenza, Manuel Monréal
Abstract
Despite advances in cancer and venous thromboembolism (VTE) management, the epidemiology of cancer-associated thrombosis management over time remains unclear. We analyzed data from the RIETE registry spanning 2001 and 2020 to investigate temporal trends in clinical characteristics and treatments for cancer-associated thrombosis. Using multivariable survival regression, we examined temporal trends in risk-adjusted rates of symptomatic VTE recurrences, major bleeding, and death within 30 days after incident VTE. Among the 17,271 patients with cancer-associated thrombosis, there was a progressive increase in patients presenting with pulmonary embolism (from 44% in 2001-2005 to 55% in 2016-2020; p <0.001 for trend), lung (from 12.7% to 18.1%; p <0.001), or pancreatic cancer (from 3.8% to 5.6%; p=0.003), and the utilization of immunotherapy (from 0 to 7.4%; p <0.001). Conversely, there was a decline in patients with prostate cancer (from 11.7% to 6.6%; p <0.001) or carcinoma of unknown origin (from 3.5% to 0.7%; p <0.001). At 30-day follow-up, a reduction was observed in the proportion of patients experiencing symptomatic VTE recurrences (from 3.1% to 1.1%; p <0.001), major bleeding (from 3.1% to 2.2%; p=0.004), and death (from 11.9% to 8.4%; p <0.001). Multivariable analyses revealed a decreased risk over time for VTE recurrence (adjusted subdistribution hazard ratio [asHR]: 0.94 per year; 95%CI: 0.92-0.98), major bleeding (asHR: 0.98; 95%CI: 0.96-0.99), and death (aHR: 0.97; 95%CI: 0.96-0.98). In this multicenter study of cancer patients with VTE, there was a decline in thrombotic, hemorrhagic, and fatal events from 2001 to 2020.