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Variation in the risk of venous thromboembolism in people with colorectal cancer: a population-based cohort study from England.

Walker AJ, West J, Card TR, Humes DJ, Grainge MJ - J. Thromb. Haemost. (2014)

Bottom Line: However, our understanding of which patients are at increased risk, and to what extent, is limited.Rates were compared by the use of Cox regression.However, Dukes B and Dukes C patients receiving postoperative chemotherapy have a longer duration of risk.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Patients with colorectal cancer are at high risk of developing venous thromboembolism(VTE), and recent international guidelines have advised extended prophylaxis for some of these patients following surgery or during chemotherapy. However, our understanding of which patients are at increased risk, and to what extent, is limited.

Objectives: To determine absolute and relative rates of VTE among patients with colorectal cancer according to Dukes stage, surgical intervention,and chemotherapy.

Methods: We analyzed data from four linked databases from 1997 to 2006: the Clinical Practice Research Datalink, linked to Hospital Episode Statistics, Cancer Registry data, and Office for National Statistics cause of death data, all from England. Rates were compared by the use of Cox regression.

Results: There were 10 309 patients with colorectal cancer, and 555 developed VTE (5.4%). The incidence varied by Dukes stage, being three-fold higher among Dukes D patients than among Dukes A patients (hazard ratio [HR] 3.08, 95% confidence interval [CI] 1.95–4.84), and 40% higher for those receiving chemotherapy than for those not receiving chemotherapy(HR 1.39, 95% CI 1.14–1.69). The risk following surgery varied by stage of disease and chemotherapy, with Dukes A patients having a low incidence of VTE (0.74%; 95% CI 0.28–1.95) at 6 months,with all events occurring within 28 days of surgery, as compared with Dukes B and Dukes C patients, whose risk at 6 months was ~ 2%.

Conclusion: Twenty-eight days of prophylaxis following surgery for colorectal cancer is appropriate for Dukes A patients. However, Dukes B and Dukes C patients receiving postoperative chemotherapy have a longer duration of risk.

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Rate of venous thromboembolism by Dukes stage from time of diagnosis.
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fig02: Rate of venous thromboembolism by Dukes stage from time of diagnosis.

Mentions: VTE rate varied substantially by stage (Table2; Fig.2), with Dukes A patients having the lowest absolute rate (7.3 per 1000 person-years, 95% CI 5.0–10.7) and Dukes D patients the highest (41.3 per 1000 person-years, 95% CI 33.4–51.2). We observed that the rates seemed to be similar in the first few months after diagnosis, and then subsequently diverged. The effects of stage were independent of other measured variables, as shown in the multivariate Cox model (Table2), with Dukes D patients having a more than three-fold greater risk of VTE than Dukes A patients (HR 3.1, 95% CI 2.0–4.8). From this analysis, it was apparent there were no statistically significant differences in VTE rate between tumor grades in the multivariate model. Overall, patients undergoing surgery had a similar rate of VTE as those not undergoing surgery (HR 0.97, 95% CI 0.77–1.22). However, this effect varied according to how patients were admitted for the first operation, as patients with an emergency admission had a higher rate of VTE than those with an elective admission (HR 1.43, 95% CI 1.15–1.78). There was a significantly higher rate of VTE in those receiving chemotherapy than in those who not receiving chemotherapy (HR 1.39, 95% CI 1.14–1.69). A number of the other recognized risk factors (smoking, body mass index [BMI], age, and comorbidity) appeared to have relatively little influence on the rate of VTE in this group (Table2). Although there was a slight trend observed for BMI (with the highest rate in morbidly obese patients), this trend was non-significant (P = 0.074).


Variation in the risk of venous thromboembolism in people with colorectal cancer: a population-based cohort study from England.

Walker AJ, West J, Card TR, Humes DJ, Grainge MJ - J. Thromb. Haemost. (2014)

Rate of venous thromboembolism by Dukes stage from time of diagnosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230392&req=5

fig02: Rate of venous thromboembolism by Dukes stage from time of diagnosis.
Mentions: VTE rate varied substantially by stage (Table2; Fig.2), with Dukes A patients having the lowest absolute rate (7.3 per 1000 person-years, 95% CI 5.0–10.7) and Dukes D patients the highest (41.3 per 1000 person-years, 95% CI 33.4–51.2). We observed that the rates seemed to be similar in the first few months after diagnosis, and then subsequently diverged. The effects of stage were independent of other measured variables, as shown in the multivariate Cox model (Table2), with Dukes D patients having a more than three-fold greater risk of VTE than Dukes A patients (HR 3.1, 95% CI 2.0–4.8). From this analysis, it was apparent there were no statistically significant differences in VTE rate between tumor grades in the multivariate model. Overall, patients undergoing surgery had a similar rate of VTE as those not undergoing surgery (HR 0.97, 95% CI 0.77–1.22). However, this effect varied according to how patients were admitted for the first operation, as patients with an emergency admission had a higher rate of VTE than those with an elective admission (HR 1.43, 95% CI 1.15–1.78). There was a significantly higher rate of VTE in those receiving chemotherapy than in those who not receiving chemotherapy (HR 1.39, 95% CI 1.14–1.69). A number of the other recognized risk factors (smoking, body mass index [BMI], age, and comorbidity) appeared to have relatively little influence on the rate of VTE in this group (Table2). Although there was a slight trend observed for BMI (with the highest rate in morbidly obese patients), this trend was non-significant (P = 0.074).

Bottom Line: However, our understanding of which patients are at increased risk, and to what extent, is limited.Rates were compared by the use of Cox regression.However, Dukes B and Dukes C patients receiving postoperative chemotherapy have a longer duration of risk.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Patients with colorectal cancer are at high risk of developing venous thromboembolism(VTE), and recent international guidelines have advised extended prophylaxis for some of these patients following surgery or during chemotherapy. However, our understanding of which patients are at increased risk, and to what extent, is limited.

Objectives: To determine absolute and relative rates of VTE among patients with colorectal cancer according to Dukes stage, surgical intervention,and chemotherapy.

Methods: We analyzed data from four linked databases from 1997 to 2006: the Clinical Practice Research Datalink, linked to Hospital Episode Statistics, Cancer Registry data, and Office for National Statistics cause of death data, all from England. Rates were compared by the use of Cox regression.

Results: There were 10 309 patients with colorectal cancer, and 555 developed VTE (5.4%). The incidence varied by Dukes stage, being three-fold higher among Dukes D patients than among Dukes A patients (hazard ratio [HR] 3.08, 95% confidence interval [CI] 1.95–4.84), and 40% higher for those receiving chemotherapy than for those not receiving chemotherapy(HR 1.39, 95% CI 1.14–1.69). The risk following surgery varied by stage of disease and chemotherapy, with Dukes A patients having a low incidence of VTE (0.74%; 95% CI 0.28–1.95) at 6 months,with all events occurring within 28 days of surgery, as compared with Dukes B and Dukes C patients, whose risk at 6 months was ~ 2%.

Conclusion: Twenty-eight days of prophylaxis following surgery for colorectal cancer is appropriate for Dukes A patients. However, Dukes B and Dukes C patients receiving postoperative chemotherapy have a longer duration of risk.

Show MeSH
Related in: MedlinePlus