title: Factors associated with recurrent venous thromboembolism in patients with malignant disease.
abstract: OBJECTIVE
  The role of prophylactic vena cava filters (VCF) in patients with cancer is debated. Although VCF are often placed in patients with cancer after recurrence of venous thromboembolic events (VTE), identification of this subset of patients has not been well-defined. This study was undertaken to assess factors associated with increased risk for recurrent VTE.
  
  
  METHODS
  All patients with a history of thromboembolism or malignant disease and who required a VCF because of failure of or contraindication to anticoagulation therapy were abstracted from the Michigan Filter Registry. Univariate analysis of potential risk factors for recurrent VTE and logistic regression models were used to identify associations between these variables and recurrent VTE.
  
  
  RESULTS
  Ninety-nine patients (49 men, 50 women) with a mean age of 58 years were included in the study. New metastases occurred in 55% of patients, and 12% of patients had a history of VTE before cancer diagnosis. Corticosteroid agents were used during therapy in 48% of patients. Acute VTE was present in 52% of patients at cancer diagnosis, and in 34% of patients VTE was associated with new metastases. Recurrent VTE occurred in 40% of patients, and significant risk factors included presence of new metastases (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.16-9.09; P =.02) and history of VTE (OR, 10.6; CI, 1.98-57.2; P =.006). Whereas a single episode of neutropenia did not reach significance (OR, 1.1; CI, 0.97-1.35; P =.11), multiple neutropenic episodes were significantly associated with recurrent VTE (P =.04). Smoking, hormone replacement therapy, decreased mobility, post-surgical state, and obesity were not independently associated with increased risk. Mean survival in this series was 30 months, and was significantly worse in patients with VTE at cancer diagnosis and with inability to tolerate anticoagulant therapy in conjunction with VCF.
  
  
  CONCLUSIONS
  Patients with malignant disease may be at increased risk for recurrent VTE after development of new metastases or multiple episodes of neutropenia, especially those patients with a history of VTE. VCF may be a reasonable alternative to long-term anticoagulation therapy in this subgroup of patients at high risk patients, provided their quality of life is reasonable.
authors.affiliation: Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, USA.
authors.forename: Jules
authors.initials: J
authors.lastname: Lin
authors.forename: Mary C
authors.initials: MC
authors.lastname: Proctor
authors.forename: Manu
authors.initials: M
authors.lastname: Varma
authors.forename: Lazar J
authors.initials: LJ
authors.lastname: Greenfield
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D002423:Cause of Death; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology; D009503:Neutropenia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D010314:Partial Thromboplastin Time; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin