Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancer patients undergoing chemotherapy in the United States
Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancer patients undergoing chemotherapy in the United States
复制标题
DOI：
10.1002/cncr.27772
复制
发表时间：
2013-02-01
期刊：
影响因子：
6.2
通讯作者：
Connolly, Gregory C.
中科院分区：
文献类型：
--
作者：
Khorana, Alok A.;Dalal, Mehul;Connolly, Gregory C.
背景技术背景：最近的研究表明，血栓预防是有益的，在预防静脉血栓栓塞症（VTE）的癌症门诊患者，但这并没有被广泛采用，因为不完全了解当代的VTE发病率和出血的关注。因此，作者研究了膀胱癌、结直肠癌、肺癌、卵巢癌、胰腺癌或胃癌患者中VTE的发生率和预测因素。方法：数据提取自2004年至2009年美国商业保险患者的大型医疗保健索赔数据库。对癌症队列（N = 17，284）和年龄/性别匹配的非癌症对照队列的人口统计学和临床特征进行了评价。在开始化疗后3个月至12个月的随访期间记录VTE发生率。进行多变量分析以确定VTE和出血的独立预测因素。结果：研究人群的平均年龄为64岁，51%的患者为女性。开始化疗后12个月内，癌症队列（n = 2170）中有12.6%发生了静脉血栓栓塞，而对照组为1.4%（n = 237; P < .0001）;按癌症类型划分，发生率从19.2%（胰腺癌）到8.2%（膀胱癌）。VTE的预测因素包括癌症类型、合并症（Charlson合并症指数评分或肥胖）和常用的特异性化疗或支持性治疗药物（顺铂、贝伐单抗和促红细胞生成素）。结论：这项大型、当代、真实世界的分析证实了选定的实体瘤患者中静脉血栓栓塞的发生率很高，并表明在现实世界中静脉血栓栓塞的发生率很高。认识到靶向血栓预防的益处可能会导致该人群中VTE负担的临床显著降低。癌症2013年。(C)2012年美国癌症协会
BACKGROUND: Recent studies suggest that thromboprophylaxis is beneficial in preventing venous thromboembolism (VTE) in cancer outpatients, but this is not widely adopted because of incomplete understanding of the contemporary incidence of VTE and concerns about bleeding. Therefore, the authors examined the incidence and predictors of VTE in ambulatory patients with bladder, colorectal, lung, ovary, pancreas, or gastric cancers. METHODS: Data were extracted from a large health care claims database of commercially insured patients in the United States between 2004 and 2009. Demographic and clinical characteristics of the cancer cohort (N = 17,284) and an age/sex-matched, noncancer control cohort were evaluated. VTE incidence was recorded during a 3-month to 12-month follow-up period after the initiation of chemotherapy. Multivariate analyses were conducted to identify independent predictors of VTE and bleeding. RESULTS: The mean age of the study population was 64 years, and 51% of patients were women. VTE occurred in 12.6% of the cancer cohort (n = 2170) over 12 months after the initiation of chemotherapy versus 1.4% of controls (n = 237; P < .0001); incidence ranged by cancer type from 19.2% (pancreatic cancer) to 8.2% (bladder cancer). Predictors of VTE included type of cancer, comorbidities (Charlson Comorbidity Index score or obesity), and commonly used specific antineoplastic or supportive care agents (cisplatin, bevacizumab, and erythropoietin). CONCLUSIONS: This large, contemporary, real-world analysis confirmed high rates of VTE in select patients with solid tumors and suggested that the incidence of VTE is high in the real-world setting. Awareness of the benefits of targeted thromboprophylaxis may result in a clinically significant reduction in the burden of VTE in this population. Cancer 2013. (C) 2012 American Cancer Society.