Upper Extremity Deep Vein Thrombosis in Cancer Patients: Clinical Course by Cancer Site

BACKGROUND: Upper extremity deep vein thrombosis (UEDVT) is common in patients with cancer. Data on recurrence and bleeding after cancer-associated UEDVT are limited.

OBJECTIVES: The objectives were to identify factors associated with venous thromboembolism (VTE) recurrence and bleeding in patients with cancer and UEDVT, overall and by cancer site, during and after anticoagulation.

METHODS: We analyzed patients from the Registro Informatizado de Pacientes con Enfermedad TromboEmbólica (RIETE), an international, prospective, observational registry of objectively confirmed VTE. We estimated cumulative incidence functions at 6, 12, 18, and 24 months and used proportional subdistribution hazard models to assess associations. Analyses were performed during and after discontinuation, using a landmark at the day of discontinuation if anticoagulation was stopped within 180 days or at day 180 if anticoagulation continued more than 180 days.

RESULTS: Of 5,195 patients with UEDVT, 2,210 had cancer. At 24 months, the cumulative incidence of recurrent VTE was 3.9% (95% CI: 3.1-4.9) in patients with cancer vs 2.5% (95% CI: 1.8-3.5) in those without cancer, and the cumulative incidence of bleeding was 6.8% (95% CI: 5.7-8.1) vs 4.3% (95% CI: 3.4-5.3), respectively (both P < 0.001). Among patients with cancer, 24-month recurrence varied by cancer site: lung, 6.4% (95% CI: 4.0-9.5); gastrointestinal, 4.0% (95% CI: 2.6-6.0); genitourinary, 3.6% (95% CI: 1.6-6.8); breast, 2.5% (95% CI: 1.2-4.5); and hematologic, 1.4% (95% CI: 0.5-3.4). During anticoagulation, lung cancer (subdistribution hazard ratio [sHR]: 10.1; 95% CI: 1.31-78.06) and younger age (per-year sHR: 0.97; 95% CI: 0.95-0.99) were associated with recurrence, whereas genitourinary cancer (sHR: 4.95; 95% CI: 1.16-21.17) and transient risk factors (sHR: 1.75; 95% CI: 1.16-2.64) were associated with bleeding. After anticoagulation discontinuation, 91 to 180 days (sHR: 0.49; 95% CI: 0.24-1.00) and more than 180 days (sHR: 0.35; 95% CI: 0.17-0.71) of anticoagulation were associated with lower recurrence vs 30 days or less.

CONCLUSIONS: Cancer-associated UEDVT carries higher risks of recurrence and bleeding than noncancer UEDVT. Lung cancer showed the greatest recurrence during treatment. Anticoagulation beyond 90 days was associated with a lower post-treatment recurrence. (Computerized Registry of Patients With Venous Thromboembolism [RIETE]; NCT02832245).