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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 in surgical and non-surgical patients, stratified by Dukes stage.
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fig03: Rate of venous thromboembolism in surgical and non-surgical patients, stratified by Dukes stage.

Mentions: When we stratified our analysis by stage of disease and surgical intervention, the influence of surgery on the rate of VTE appeared to vary according to the stage of cancer (Fig.3). In Dukes A patients, the VTE rate was higher in patients undergoing surgery, whereas in Dukes D patients the rate was higher in those not undergoing surgery. Subsequent analyses were all carried out among patients who had undergone surgery with the assumption of curative intent (i.e. Dukes A, B and C patients). These results are presented in Tables3 and 4. When we fitted our model with an interaction term between stage of disease and chemotherapy, there was some evidence of an interaction (likelihood ratio test, P < 0.047). The stratified HRs show that Dukes B and C patients receiving chemotherapy had a two-fold increase in risk of VTE as compared with Dukes B patients not receiving chemotherapy (Table3), whereas Dukes A patients had no increase in risk.


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 in surgical and non-surgical patients, stratified by Dukes stage.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig03: Rate of venous thromboembolism in surgical and non-surgical patients, stratified by Dukes stage.
Mentions: When we stratified our analysis by stage of disease and surgical intervention, the influence of surgery on the rate of VTE appeared to vary according to the stage of cancer (Fig.3). In Dukes A patients, the VTE rate was higher in patients undergoing surgery, whereas in Dukes D patients the rate was higher in those not undergoing surgery. Subsequent analyses were all carried out among patients who had undergone surgery with the assumption of curative intent (i.e. Dukes A, B and C patients). These results are presented in Tables3 and 4. When we fitted our model with an interaction term between stage of disease and chemotherapy, there was some evidence of an interaction (likelihood ratio test, P < 0.047). The stratified HRs show that Dukes B and C patients receiving chemotherapy had a two-fold increase in risk of VTE as compared with Dukes B patients not receiving chemotherapy (Table3), whereas Dukes A patients had no increase in risk.

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