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November 17, 2020Thrombosis and Haemostasis

Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

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Key result

Incidental VTE was associated with similar mortality (9.2% vs 8.4%; HR 1.10, 95% CI 0.49-2.50) and recurrence rates compared to symptomatic VTE in both cancer and noncancer patients.

Why the study?

While recurrence risk is similar after incidental and symptomatic cancer-associated VTE, it was unknown whether this also applies to incidental VTE not associated with cancer.

Do early mortality and recurrence rates differ between incidental and symptomatic VTE in cancer and noncancer patients, and does anticoagulation therapy improve outcomes in incidental VTE?

Population

1,931 patients with VTE in SWIVTER

Comparison

Incidental VTE vs symptomatic VTE

Design

Registry-based cohort study

Authors

DSDavid SpirkUniversity of BernTSTim SebastianUniversity Hospital of ZurichSBStefano BarcoVascular Medicine

Discussion

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Implication

Similar mortality/recurrence after incidental versus symptomatic VTE; supports comparable risk stratification but leaves anticoagulation benefit hypothesis-generating.

Key Points

  • To assess whether early mortality and recurrence rates after incidental venous thromboembolism match those after symptomatic events in patients without cancer.
  • Analyzed N=1,931 patients with venous thromboembolism enrolled in the prospective SWIss Venous ThromboEmbolism Registry (SWIVTER).
  • Compared mortality and recurrence rates between incidental and symptomatic presentations across both cancer and noncancer cohorts, adjusting for the competing risk of death.
  • Overall mortality was 9.2% for incidental versus 8.4% for symptomatic VTE (HR 1.10, 95% CI 0.49–2.50), and adjusted recurrence was 3.1% versus 2.8% (sub-HR 1.07, 95% CI 0.39–2.93).
  • Similar patterns appeared in noncancer patients (mortality: 2.9% vs. 2.1%, HR 1.37, 95% CI 0.33–5.73; recurrence: 1.5% vs. 2.3%, HR 0.63, 95% CI 0.09–4.58) and cancer patients (mortality: 15.9% vs. 12.6%, HR 1.32; recurrence: 4.8% vs. 4.7%, HR 1.02).
  • Patients with incidental VTE who received anticoagulation therapy for at least 3 months had lower mortality (4% vs. 41%) and lower recurrence rates (1% vs. 18%) than untreated patients.

Study Design

Type

Cohort (n=1,931)

Multicenter

Yes

Structured PICO

Do early mortality and recurrence rates differ between incidental and symptomatic VTE in cancer and noncancer patients, and does anticoagulation therapy improve outcomes in incidental VTE?

P
Population
1,931 patients with venous thromboembolism (VTE) included in the SWIss Venous ThromboEmbolism Registry (SWIVTER), including both cancer and noncancer patients.
I
Intervention
Incidental VTE (and anticoagulation therapy for at least 3 months in a subgroup)
C
Comparator
Symptomatic VTE (and no anticoagulation therapy in a subgroup)
O
Outcome
Mortality rate and VTE recurrence ratehard clinical

Main Result

Effect estimate: HR 1.10 (95% CI 0.49-2.50)

Absolute Event Rate: 9.2% vs 8.4%

Early mortality and recurrence rates are similar after incidental versus symptomatic VTE in both cancer and noncancer patients, and anticoagulation therapy for incidental VTE is associated with lower mortality and recurrence.

Cite This Study

Spirk et al. (2020) conducted a cohort in Venous thromboembolism (n=1,931). Incidental VTE vs. Symptomatic VTE was evaluated on Mortality (HR 1.10, 95% CI 0.49-2.50). Incidental VTE was associated with similar mortality (9.2% vs 8.4%; HR 1.10, 95% CI 0.49-2.50) and recurrence rates compared to symptomatic VTE in both cancer and noncancer patients.

synapsesocial.com/papers/6a1c2a79ea84844e355f8968https://doi.org/10.1055/s-0040-1720977
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prognosis of Cancers Associated with Venous Thromboembolism2000 · 1,646 citations
  2. 2Mortality rates and risk factors for asymptomatic deep vein thrombosis in medical patients2004 · 170 citations
  3. 3Clinical implications of incidental venous thromboembolism in cancer patients2019 · 45 citations
  4. 4Treatment and Long-Term Clinical Outcomes of Incidental Pulmonary Embolism in Patients With Cancer: An International Prospective Cohort Study2019 · 114 citations
  5. 5Anticoagulant treatment for subsegmental pulmonary embolism2020 · 37 citations