title: Platelet count measured prior to cancer development is a risk factor for future symptomatic venous thromboembolism: the Tromsø Study.
abstract: BACKGROUND
  Elevated platelet count is associated with risk of venous thromboembolism in cancer patients initiating chemotherapy. It is not known whether this risk by platelet count is causal or merely reflects the malignant disease. We investigated whether pre-cancer platelet count alone or together with high leukocyte count was associated with risk of venous thromboembolism in subjects who did and did not develop cancer during follow-up in a population-based cohort study.
  
  
  METHODS
  Platelet count and other baseline characteristics were measured in 25160 initially cancer-free subjects who participated in the Tromsø Study in 1994-1995. Incident cancer and symptomatic venous thromboembolism events were registered up to December 31st, 2009. Multivariable Cox regression models were used to calculate hazard ratio for venous thromboembolism across categories of platelet count (<40th, 40-80th, and >80th percentile) with 95% confidence interval.
  
  
  RESULTS
  During follow-up, 2082 subjects were diagnosed with cancer. Platelet count was measured on average 8.3 years before the cancer diagnosis. There were 129 venous thromboembolism events in the cancer cohort (13.5 per 1000 person-years) and 377 in the non-cancer cohort (1.2 per 1000 person-years). In cancer patients, pre-cancer platelet count above the 80th percentile (≥295×10(9)/L) was associated with a 2-fold higher risk of venous thromboembolism (Hazard ratio: 1.98, 95% confidence interval 1.21-3.23) compared to platelet count below the 40th percentile (<235×10(9)/L). Concomitant high platelet and leukocyte counts showed a synergistic effect on the VTE risk. In cancer-free subjects, no association was found.
  
  
  CONCLUSIONS
  In conclusion, pre-cancer platelet count was associated with risk of symptomatic venous thromboembolism in cancer patients, but not in cancer-free subjects. Our findings suggest that platelet count and platelet-leukocyte interactions may play a role in the pathogenesis of cancer-related venous thromboembolism.
authors.affiliation: Hematological Research Group, Division of Internal Medicine, Department of Clinical Medicine, University of Tromsø, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Hilde
authors.initials: H
authors.lastname: Jensvoll
authors.affiliation: Hematological Research Group, Division of Internal Medicine, Department of Clinical Medicine, University of Tromsø, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Kristine
authors.initials: K
authors.lastname: Blix
authors.affiliation: Hematological Research Group, Division of Internal Medicine, Department of Clinical Medicine, University of Tromsø, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Sigrid K
authors.initials: SK
authors.lastname: Brækkan
authors.affiliation: Hematological Research Group, Division of Internal Medicine, Department of Clinical Medicine, University of Tromsø, University Hospital of North Norway, Tromsø, Norway.
authors.forename: John-Bjarne
authors.initials: JB
authors.lastname: Hansen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001792:Blood Platelets / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D009664:Norway / Q000453:epidemiology; D010976:Platelet Count; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*
chemical_list: D015415:Biomarkers