Risk of arterial thromboembolism in patients with cancer Journal Article


Authors: Navi, B. B.; Reiner, A. S.; Kamel, H.; Iadecola, C.; Okin, P. M.; Elkind, M. S. V.; Panageas, K. S.; DeAngelis, L. M.
Article Title: Risk of arterial thromboembolism in patients with cancer
Abstract: 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, the authors identified patients with a new primary diagnosis of breast, lung, prostate, colorectal, bladder, pancreatic, or gastric cancer or non-Hodgkin lymphoma from 2002 to 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 The authors identified 279,719 pairs of patients with cancer and matched control patients. 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 with 2.2% (95% CI: 2.1% to 2.2%) in control patients (hazard ratio [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 control patients (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 with 1.6% (95% CI: 1.6% to 1.7%) in control patients (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. © 2017 American College of Cardiology Foundation
Keywords: thrombosis; myocardial infarction; ischemic stroke
Journal Title: Journal of the American College of Cardiology
Volume: 70
Issue: 8
ISSN: 0735-1097
Publisher: Elsevier Science, Inc.  
Date Published: 2017-08-22
Start Page: 926
End Page: 938
Language: English
DOI: 10.1016/j.jacc.2017.06.047
PROVIDER: scopus
PUBMED: 28818202
PMCID: PMC5667567
DOI/URL:
Notes: Article -- Export Date: 5 September 2017 -- Source: Scopus
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MSK Authors
  1. Anne S Reiner
    122 Reiner
  2. Katherine S Panageas
    331 Panageas
  3. Babak Navi
    15 Navi