Anticoagulation in patients with renal cell carcinoma and tumor thrombus may lower 1-year VTE incidence (7.3% vs 20%) compared to no anticoagulation, though evidence remains inconclusive.
Systematic Review (n=659)
Does anticoagulation reduce venous thromboembolism in ambulatory patients with renal cell carcinoma and tumor thrombus?
Anticoagulation in patients with renal cell carcinoma and tumor thrombus may lower VTE risk, but current evidence is inconclusive due to high bleeding risk and study heterogeneity.
Absolute Event Rate: 7.3% vs 20%
BACKGROUND: Patients with renal cell carcinoma (RCC) and tumor thrombus (TT) are at significant risk of venous thromboembolism (VTE). OBJECTIVES: This systematic review aimed to assess the role of anticoagulation in ambulatory patients with RCC and TT. METHODS: Inclusion criteria were diagnosis of RCC with TT, reporting of VTE, major bleeding and/or arterial thromboembolism, as well as exposure to anticoagulation. Studies with <30 patients were excluded. Studies were also excluded if anticoagulation status was not reported per outcome stratum. A comprehensive search was conducted in PubMed and other databases. Risk of bias was assessed in accordance with the Scottish Intercollegiate Guidelines Network bias quality assessment tool. RESULTS: Six observational studies containing 659 patients were included. All studies had considerable risk of bias. Anticoagulation use ranged from 3.9% to 50%. Two studies reported a lower VTE incidence in anticoagulated patients than in non-anticoagulated patients: 7.3% (1.2-21) vs 20% (6.9-37) after 1 year, and 18% (1.5-49) vs 24% (14-36) after 2 years. In anticoagulated patients, major bleeding incidence was 12% (2.8-27) after 1 year and 33% (8.2-60) after 2 years. For non-anticoagulated patients the incidence was 19% (6.6-36) after 1 year and 12% (5.1-22) after 2 years. Importantly, none of the studies were management studies, and confidence intervals of our outcomes were wide. CONCLUSION: Anticoagulation in patients with RCC with TT may lower VTE risk. Bleeding risk is high in both anticoagulated as well as non-anticoagulated patients. Current evidence remains inconclusive due to study heterogeneity and risk of bias.
Akerboom et al. (Wed,) conducted a systematic review in Renal cell carcinoma with tumor thrombus (n=659). Anticoagulation vs. No anticoagulation was evaluated on VTE incidence after 1 year. Anticoagulation in patients with renal cell carcinoma and tumor thrombus may lower 1-year VTE incidence (7.3% vs 20%) compared to no anticoagulation, though evidence remains inconclusive.