Epidemiology of Cancer‐Associated Venous Thromboembolism Across the United States

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Newly diagnosed cancer (n=1628626). Intervention: Newly diagnosed cancer. Primary outcome: Cumulative incidence of venous thromboembolism (VTE) at 12 months (95% CI 3.63-3.69).

Barbara D. Lam; Justine Ryu; Omid Jafari; B. S. Kim; Shengling Ma; Mrinal Ranjan; Jun Yang Jiang; Ang Li

doi:10.1002/ajh.70271

March 8, 2026American Journal of HematologyOpen Access

Epidemiology of Cancer‐Associated Venous Thromboembolism Across the United States

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Key result

Newly diagnosed cancer carries a ~4% 12-month incidence of VTE, rising with active therapy.

95% CI 3.63-3.69
n=1,628,626

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Why the study?

Prior epidemiological studies on cancer-associated venous thromboembolism were limited by homogenous patient populations.

Key Points

To provide an updated evaluation of the epidemiology, risk factors, and mortality impact of cancer-associated venous thromboembolism across a nationwide healthcare dataset.
Retrospective cohort study analyzing N=1 628 626 patients with newly diagnosed cancer between 2018 and 2023 across 173 healthcare systems in the United States Cosmos database.
Primary outcome was incident venous thromboembolism (pulmonary embolism, lower-extremity deep vein thrombosis, or upper-extremity deep vein thrombosis) identified via a validated ICD-10-CM and medication algorithm.
Multivariable Cox proportional hazards regression was performed to identify independent clinical and demographic risk factors.
The cumulative incidence of venous thromboembolism was 2.68% (95% CI, 2.66%–2.70%) at 6 months and 3.66% (95% CI, 3.63%–3.69%) at 12 months overall, rising to 5.68% (95% CI, 5.62%–5.74%) at 12 months among patients receiving systemic therapy within 90 days.
Stage IV cancer carried a higher risk of venous thromboembolism compared to stage I (HR 3.17; 95% CI, 3.02–3.32), with pancreatic cancer demonstrating the highest hazard compared to breast cancer (HR 3.3; 95% CI, 3.1–3.4).
Among patients who developed venous thromboembolism, apixaban prescriptions increased from 24.2% in 2018 to 62.1% in 2023, while low molecular weight heparin use decreased from 29.6% to 8.5%.

Study Design

Type

Cohort (n=1,628,626)

Multicenter

Yes

Structured PICO

P

Population

1,628,626 adults in the US with newly diagnosed solid and hematologic neoplasms, followed for a median of 682 days to assess venous thromboembolism incidence.

O

Outcome

Incident VTE, defined as the first occurrence of acute pulmonary embolism (PE), lower-extremity deep vein thrombosis (LE-DVT), or upper-extremity deep vein thrombosis (UE-DVT) at 6 and 12 months after cancer diagnosishard clinical

In a large, contemporary nationwide US cohort, cancer-associated venous thromboembolism occurred in 3.7% of patients within 12 months of diagnosis and was strongly and independently associated with an increased risk of mortality.

Limitations

Outcomes may be missed if patients received care at non-participating health systems.
Outcome ascertainment relied on administrative codes, which carries a risk of misclassification.
EHR-derived cancer diagnosis dates may not perfectly reflect the true clinical date of diagnosis.
Cancer stage data derived from EHRs had substantial missingness (~50%).
The dataset is not perfectly representative of the US census, with overrepresentation of White patients and underrepresentation of Asian and Hispanic patients.

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Implication

Contemporary VTE burden persists in cancer; extends US epidemiology but leaves optimal prophylaxis open for trials.

Abstract

Prior epidemiological studies on cancer-associated venous thromboembolism (VTE) were limited by homogenous patient populations. We leverage Cosmos, a collaborative dataset of Epic electronic health record systems, to conduct an updated evaluation of cancer-associated VTE in the United States (US). Cosmos includes patients from all 50 states, and the dataset is representative of the US census in terms of age, race, ethnicity, and insurance coverage. We included patients in the US with a new cancer diagnosis between 2018 and 2023. We computed the cumulative incidence of VTE at 6 and 12 months after the diagnosis date and used Cox regression to identify risk factors and examine the association between VTE type within the first year and mortality. We identified 1 628 626 patients, with a cumulative incidence of VTE at 6 months of 2.7% and at 12 months of 3.7%. Major risk factors included prior VTE, cancer type, advanced stage, and chemotherapy-based treatment regimens. The occurrence of VTE within the first year of cancer diagnosis was independently associated with increased mortality.

Discussion

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Cite This Study

Lam et al. (2026) conducted a cohort in Newly diagnosed cancer (n=1,628,626). Newly diagnosed cancer was evaluated on Cumulative incidence of venous thromboembolism (VTE) at 12 months (95% CI 3.63-3.69). In a nationwide cohort of 1,628,626 US adults with newly diagnosed cancer, the cumulative incidence of venous thromboembolism at 12 months was 3.7%, increasing to 5.7% among those receiving therapy.

synapsesocial.com/papers/69b258a396eeacc4fcec876b https://doi.org/10.1002/ajh.70271

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Epidemiology of Cancer‐Associated Venous Thromboembolism Across the United States

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Epidemiology of Cancer‐Associated Venous Thromboembolism Across the United States

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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