Abstract Number: PB2176
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Cancer Associated Thrombosis
Background: Distal deep vein thrombosis (D-DVT, infra-popliteal DVT without pulmonary embolism (PE)) is usually considered as a minor form of venous thromboembolism (VTE). it is associated with a much lower rate of adverse outcomes (death, VTE recurrence or bleeding) than proximal DVT (P-DVT). Cancer-associated thrombosis (CAT) is associated with poorer outcomes than thrombosis developing in the absence of cancer. Few data are available on the clinical presentation and prognosis of CAT D-DVT.
Aims: To assess clinical presentation and prognosis of CAT D-DVT.
Methods: Multicentre, international, observational RIETE registry of patients with objectively confirmed VTE. We compare clinical presentation and rates of adverse outcomes during anticoagulant treatment of patients with CAT D-DVT vs. CAT P-DVT or vs. non-CAT D-DVT.
Results: 755 patients with CAT D-DVT, 4,798 patients with CAT P-DVT and 5,218 patients with non-CAT D-DVT were available for analysis. Their median duration of follow-up was 148 days (95% confidence interval (93-294)), 156 days (90-339) and 193 days (110-392) respectively. Their clinical characteristics are depicted in Table 1. As compared with patients with CAT P-DVT, those with CAT D-DVT had less frequently metastatic diseases (56% vs. 47%, p< 0.001). However there was no marked differences in terms of tumor site (all p values>0.001 except for bladder cancer, twice more frequent in case of CAT P-DVT), time elapsed between cancer diagnosis and DVT (>3 months in 66% and 58% of cases, p>0.05) and proportion of patients on chemotherapy at time of DVT diagnosis (50% vs. 51%, p>0.05). Rates of adverse outcomes of patients with CAT D-DVT were higher than for patients with non-CAT D-DVT and similar to patients with CAT P-DVT (Table 2).
Conclusions: Whereas non-CAT D-DVT appears to have a relatively favorable prognosis, CAT D-DVT shares the same poor prognosis as CAT P-DVT and presents overall similar clinical presentation.
| CAT Distal DVT | CAT Proximal DVT | Non-CAT Distal DVT | |
| Age (years), mean ±SD | 67±12 | 68±13 | 60±18 |
| Male sex, n (%) | 391 (52%) | 2,529 (53%) | 2,553 (49%) |
| Weight, mean (±SD) | 72±15 | 71±14 | 77±16 |
| Inpatient status, % (n) | 240 (33%) | 1,280 (27%) | 1,185 (23%) |
| Surgery, n (%) | 162 (22%) | 588 (12%) | 770 (15%) |
| Immobilization, n (%) | 114 (15%) | 959 (20%) | 1,280 (25%) |
| History of VTE, n (%) | 81 (11%) | 616 (13%) | 782 (15%) |
| Severe renal impairment, n (%) | 37 (4.9%) | 393 (8.2%) | 168 (3.2%) |
| Recent major bleeding, n (%) | 17 (2.3%) | 157 (3.3%) | 101 (1.9%) |
[Table 1: Clinical characteristics of patients with CAT D-DVT (n=755), non-CAT Distal DVT (N=5,218) and CAT P-DVT (n=4,798); indicates p < 0.001]
| CAT Distal DVT N, %PY (95%CI) | CAT Proximal DVT N, %PY (95%CI) | Non-CAT Distal DVT N, %PY (95%CI) | |
| Median duration of follow-up: days (IQR) | 199±327 | 221±336 | 247±409 |
| Death | 163, 40.0 (34.1-46.6) | 1361, 47.1 (44.6 – 49.7)* | 64, 1.8 (1.4-2.3) |
| Fatal PE | 0, – | 23, 0.8(0.5 – 1.2) | 3, 0.1 (0.02 – 0.3) |
| Fatal bleeding | 2, 0.5 (0.1 – 1.8) | 44, 1.5 (1.1 – 2.1) | 3, 0.1 (0.02 – 0.3) |
| Recurrent DVT | 34, 8.3 (5.8 – 11.6) | 204, 7.1(5.8 – 11.6) | 117, 3.3 (2.8 – 4.0) |
| Recurrent PE | 14, 3.4 (1.9 – 5.8) | 119, 4.1(3.4 – 4.9) | 36, 1.0 (0.7 – 1.4) |
| Major Bleeding | 20, 4.9 (3.00 – 7.58) | 229, 7.9 (6.9 – 9.0)* | 51, 1.5 (1.1 – 1.9) |
| Comparisons between patients with Distal DVT and cancer (ref) vs. proximal DVT and cancer and vs. distal DVT without cancer: | *p <0.05; p <0.01; p < 0.001. |
[Table 2: Clinical outcomes on anticoagulant therapy of patients with CAT D-DVT (n=755), non-CAT Distal DVT (N=5,218) and CAT P-DVT (n=4,798)]
To cite this abstract in AMA style:
Galanaud J-, Trujillo-Santos J, Bikdeli B, Rosa V, Visona A, Nieto JA, Mazzolai L, Soler S, Monreal M, RIETE Investigators . Clinical Presentation and Outcomes of Cancer-associated Distal Deep Vein Thrombosis: Data from the RIETE Registry [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/clinical-presentation-and-outcomes-of-cancer-associated-distal-deep-vein-thrombosis-data-from-the-riete-registry/. Accessed September 29, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/clinical-presentation-and-outcomes-of-cancer-associated-distal-deep-vein-thrombosis-data-from-the-riete-registry/