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Clinical characteristics and management of cancer-associated acute venous thromboembolism: findings from the MASTER Registry

¹ Hospital of Piacenza, Piacenza;
² University of Perugia, Perugia;
³ University of Insubria, Varese;
⁴ IRCCS Maggiore Hospital, Milan;
⁵ University of Bologna, Bologna;
⁶ Catholic University, Rome, Italy

Correspondence: Davide Imberti, Thrombosis Center Emergency Department, Piacenza Hospital, via Taverna 49, 29100 Piacenza, Italy. E-mail: d.imberti{at}ausl.pc.it

Background: Clinical characteristics and management of acute deep vein thrombosis and pulmonary embolism (PE) have been reported to be different in patients with and without cancer. The aim of this paper was to provide information on clinical characteristics and management of acute venous thromboembolism in patients with cancer by means of a large prospective registry.

Design and Methods: MASTER is a multicenter registry of consecutively recruited patients with symptomatic, objectively confirmed, acute venous thromboembolism. Information about clinical characteristics and management was collected by an electronic data network at the time of the index event.

Results: A total of 2119 patients were enrolled, of whom 424 (20%) had cancer. The incidence of bilateral lower limb deep vein thrombosis was significantly higher in patients with cancer than in patients without cancer (8.5% versus 4.6%; p<0.01), as were the rates of iliocaval thombosis (22.6% versus 14%; p<0.001), and upper limb deep vein thrombosis (9.9% versus 4.8%; p<0.001). Major bleeding (3.3% versus 1.1%; p=0.001), in-hospital treatment (73.3% versus 66.6%; p=0.02) and inferior vena cava filter implantation (7.3% versus 4.1%; p=0.005) were significantly more frequent in patients with cancer, in whom oral anticoagulants were less often used (64.2% versus 82%; p<0.0001).

Conclusions: The clinical presentation of acute venous thromboembolism is different and often more extensive in cancer patients than in patients free from malignancy. Moreover, the management of the acute phase of venous thromboembolism is more problematic in cancer patients, especially because of a higher rate of major bleeding and the need for implantation of inferior vena cava filters.

Key words: venous thrombosis, pulmonary embolism, cancer.