Relative risk of arterial and venous thromboembolism in persons with cancer vs. persons without cancer—a nationwide analysis. (26th March 2021)

• Record Type: Journal Article
• Authors: Grilz, Ella; Posch, Florian; Nopp, Stephan; Königsbrügge, Oliver; Lang, Irene M; Klimek, Peter; Thurner, Stefan; Pabinger, Ingrid; Ay, Cihan
• Is Part Of: European heart journal. Volume 42:Number 23(2021)
• Page Start: 2299
• Page End: 2307
• Publication Date: 2021-03-26
• Subjects: Venous thromboembolism -- Arterial occlusive diseases -- Neoplasms -- Thrombosis -- Embolism; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab171
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: An interrelation between cancer and thrombosis is known, but population-based studies on the risk of both arterial thromboembolism (ATE) and venous thromboembolism (VTE) have not been performed. Methods and results: International Classification of Disease 10th Revision (ICD-10) diagnosis codes of all publicly insured persons in Austria (0–90 years) were extracted from the Austrian Association of Social Security Providers dataset covering the years 2006–07 ( n = 8 306 244). Patients with a history of cancer or active cancer were defined as having at least one ICD-10 'C' diagnosis code, and patients with ATE and/or VTE as having at least one of I21/I24 (myocardial infarction), I63/I64 (stroke), I74 (arterial embolism), and I26/I80/I82 (venous thromboembolism) diagnosis code. Among 158 675 people with cancer, 8559 (5.4%) had an ATE diagnosis code and 7244 (4.6%) a VTE diagnosis code. In contrast, among 8 147 569 people without cancer, 69 381 (0.9%) had an ATE diagnosis code and 29 307 (0.4%) a VTE diagnosis code. This corresponds to age-stratified random-effects relative risks (RR) of 6.88 [95% confidence interval (CI) 4.81–9.84] for ATE and 14.91 (95% CI 8.90–24.95) for VTE. ATE proportion was highest in patients with urinary tract malignancies (RR: 7.16 [6.74–7.61]) and lowest in patients with endocrine cancer (RR: 2.49 [2.00–3.10]). The corresponding VTE proportion was highest in cancer of the mesothelium/soft tissue (RR: 19.35 [17.44–21.47]) and lowest in oropharyngeal cancer (RR: 6.62 [5.61–7.81]). Conclusion: The RR of both ATE and VTE are significantly higher in persons with cancer. Our population-level meta-data indicate a strong association between cancer, ATE and VTE, and support the concept of shared risk factors and pathobiology between these diseases. Relative risk of ATE and VTE in persons with a cancer diagnosis code versus persons without a cancer diagnosis code. Graphical Abstract: