From the Guidelines
The risk of recurrent venous thromboembolism (VTE) is highest in patients with pancreatic, gastric, lung, gynecological, and brain cancers, with pancreatic cancer showing the greatest risk. According to the most recent guidelines, patients with these types of cancer are at a significantly higher risk of developing recurrent VTE, with a recurrence rate of approximately 20-25% within 6 months 1. The risk of recurrent VTE varies significantly depending on tumor site, with certain cancers posing substantially higher risks than others. Some key points to consider are:
- Patients with pancreatic, gastric, lung, gynecological, and brain cancers face the highest risk of recurrent VTE.
- Colorectal, breast, and prostate cancers generally carry intermediate risk, while hematological malignancies like lymphoma typically have lower recurrence rates.
- For high-risk cancer patients with VTE, extended anticoagulation therapy is recommended, preferably with low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs) 1. The increased recurrence risk in certain cancers relates to their greater production of tissue factor, inflammatory cytokines, and other procoagulant factors that activate the coagulation cascade, as well as mechanical factors such as vascular compression by the tumor mass 1. Treatment should continue for at least 6 months and potentially throughout active cancer, with the goal of reducing morbidity and mortality associated with recurrent VTE 1.
From the Research
Risk of Recurrent VTE per Tumour Site
- The risk of recurrent Venous Thromboembolism (VTE) in patients with cancer, particularly those with pancreatic ductal adenocarcinoma (PDAC), is significant, with studies showing a 10%-25% risk of VTE 2.
- The risk of VTE can be reduced to 5%-10% with thromboprophylaxis, but this does not impact survival 2.
- Patients with gastrointestinal and pancreatobiliary cancer are at high risk of VTE, with a study showing no significant difference in the rate of VTE recurrence between rivaroxaban and low-molecular-weight heparin (LMWH) treatment groups 3.
- Assessing the risk of recurrent VTE is crucial, as extended anticoagulation can lower the risk of recurrence but also increases the risk of major bleeding 4, 5.
- Clinical and laboratory risk factors, such as the presence or absence of VTE risk factors at the time of the index thrombotic event, can provide important information regarding recurrence risk 5.
- Multivariate VTE risk assessment models can combine clinical and laboratory risk factors to allow for personalized anticoagulation therapy tailored to patients' individual recurrence risk 5, 6.