VTE in Solid Tumours: Risk Factors

Risk Factors

The risks of venous thromboembolism (VTE) in cancer1,2

It is estimated that approximately 30% of all first venous thromboembolic events are associated with cancer1.

Cancer patients are up to 7 times more likely to suffer from venous thrombosis compared to patients without neoplasms1,2.

Thrmobotic events are the second leading cause of death in cancer patients after death from cancer itself2.

Information on VTE3

  • VTE is a collective term for deep vein thrombosis (DVT) and pulmonary embolism (PE).
  • VTE is a significant cause of mortality, long-term disability and chronic ill-health problems, many of which are avoidable.
  • The incidence of VTE is 1–2 per 1,000 of the population and the risk increases with age.
  • Approximately half of VTE cases are associated with prior hospitalisation for medical illness or surgery.
  • It has been estimated that the management of hospital associated VTE costs the NHS £millions per year.

VTE prevention is an important patient safety issue3

1 in 20 people will have a VTE at some time in their life and approximately half of the cases are associated with prior hospitalisation for medical illness or surgery

VTE causes a larger number of deaths than the combined mortality due to:4

  • Breast cancer
  • HIV
  • Road traffic accidents

VTE is the most common preventable cause of in-hospital death5

General risk factors6**

The general risk factors associated with the development of VTE

  • Active cancer or cancer treatment
  • Age >60 years
  • Critical care admission
  • Dehydration
  • Known thrombophilias
  • Obesity (body mass index [BMI] >30 kg/m2)
  • One or more significant medical comorbidities (e.g. heart disease; metabolic, endocrine or respiratory pathologies; acute infectious diseases; inflammatory conditions)
  • Personal history or first-degree relative with a history of VTE
  • Use of hormone replacement therapy (HRT)
  • Use of oestrogen-containing contraceptive therapy
  • Varicose veins with phlebitis

**For women who are pregnant or have given birth within the previous 6 weeks, please see section 1.16 of NICE NG89.

Reference

  1. Timp JF et al. Blood 2013;122:1712–1723.
  2. Barsam SJ et al. Br J Haematol 2013;161:764–777.
  3. NHS England. Commissioning Services that deliver High Quality VTE Prevention. Guidance for Commissioners. Available at: https://www.england.nhs.uk/wp-content/uploads/2013/08/vte-prev-guide-may2013-22.7.13.pdf
  4. Dolan G. J R Coll Physicians Edinb 2008;38:338–340.
  5. Cohen AT et al. Lancet 2008;371:387–394.
  6. NICE guideline 89. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. March 2018. Available at: https://www.nice.org.uk/guidance/ng89

*Including, but not limited to: congestive cardiac failure (NYHA class III or IV), acute respiratory failure or acute infection, who also have a predisposing risk factor for VTE such as age over 75 years, obesity, cancer or previous history of VTE.~
†In patients with chronic renal insufficiency or acute renal failure.

PP-FRA-GBR-0144.  June 2019