Key result
Incident cancer linked to ~120% greater 6-month risk of arterial thromboembolism.
Why the study?
The risk of arterial thromboembolism in patients with cancer was incompletely understood.
Does an incident cancer diagnosis increase the risk of arterial thromboembolism in Medicare enrollees?
Cohort (n=559,438)
Does an incident cancer diagnosis increase the risk of arterial thromboembolism in Medicare enrollees?
Hazard Ratio: 2.2 (95% CI 2.1–2.3)
Absolute Event Rate: 4.7% vs 2.2%
Patients with incident cancer have a substantially increased short-term risk of arterial thromboembolism, including myocardial infarction and ischemic stroke, which correlates with cancer stage and generally resolves by 1 year.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Compared to an age and sex matched control group they found a cumulative incidence of arterial thromboembolism of 4.7% in all cancer patients vs. 2.2% at 6 months. The risk is higher in some types of tumours such as lung, gastric, and pancreatic. Advance stage was associated with increased ATEs risk, with stage IV patients having a >10-fold increase in ATE in the first month after diagnosis of cancer.”
“Cancer is associated with a 2-fold risk of ATE including myocardial infarction and stroke. The risk of ATE is higher in older men and in patients with lung or kidney cancer.”
May inform anticoagulation decisions in high-risk cancer patients; hypothesis-generating and requires randomized confirmation before practice change.
Background The risk of arterial thromboembolism in patients with cancer is incompletely understood. Objectives The authors aimed to better define this epidemiological relationship, including the effects of cancer stage. Methods Using the Surveillance Epidemiology and End Results-Medicare linked database, we identified patients with a new primary diagnosis of breast, lung, prostate, colorectal, bladder, pancreatic, or gastric cancer or non-Hodgkin lymphoma from 2002 through 2011. They were individually matched by demographics and comorbidities to a Medicare enrollee without cancer, and each pair was followed through 2012. Validated diagnosis codes were used to identify arterial thromboembolism, defined as myocardial infarction or ischemic stroke. Cumulative incidence rates were calculated using competing risk survival statistics. Cox hazards analysis was used to compare rates between groups at discrete time points. Results We identified 279,719 pairs of patients with cancer and matched controls. The 6-month cumulative incidence of arterial thromboembolism was 4.7% (95% confidence interval [CI]: 4.6% to 4.8%) in patients with cancer compared to 2.2% (95% CI: 2.1% to 2.2%) in controls (HR: 2.2; 95% CI: 2.1 to 2.3). The 6-month cumulative incidence of myocardial infarction was 2.0% (95% CI: 1.9% to 2.0%) in patients with cancer compared with 0.7% (95% CI: 0.6% to 0.7%) in controls (HR: 2.9; 95% CI: 2.8 to 3.1). The 6-month cumulative incidence of ischemic stroke was 3.0% (95% CI: 2.9% to 3.1%) in patients with cancer compared to 1.6% (95% CI: 1.6% to 1.7%) in controls (HR: 1.9; 95% CI: 1.8 to 2.0). Excess risk varied by cancer type (greatest for lung), correlated with cancer stage, and generally had resolved by 1 year. Conclusions Patients with incident cancer face a substantially increased short-term risk of arterial thromboembolism.
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Navi et al. (2017) conducted a cohort in Cancer (n=559,438). Incident cancer vs. Matched controls without cancer was evaluated on Arterial thromboembolism (myocardial infarction or ischemic stroke) at 6 months (HR 2.2, 95% CI 2.1 to 2.3). Incident cancer was associated with a significantly increased 6-month risk of arterial thromboembolism compared to matched controls without cancer (4.7% vs 2.2%; HR 2.2; 95% CI 2.1-2.3).
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