title: Influence of recent immobilization or surgery on mortality in cancer patients with venous thromboembolism.
abstract: BACKGROUND
  The influence of recent immobilization or surgery on mortality in cancer patients with venous thromboembolism (VTE) has not been thoroughly studied.
  
  
  METHODS
  We used the RIETE Registry data to compare the 3-month mortality rate in cancer patients with VTE, with patients categorized according to the presence of recent immobilization, surgery or neither. The major outcomes were fatal pulmonary embolism (PE) and fatal bleeding within the first 3 months.
  
  
  RESULTS
  Of 6,746 patients with active cancer and acute VTE, 1,224 (18%) had recent immobilization, 1,055 (16%) recent surgery, and 4,467 (66%) had neither. The all-cause mortality was 23.4% (95% CI: 22.4-24.5), and the PE-related mortality: 2.5% (95% CI: 2.1-2.9). Four in every ten patients dying of PE had recent immobilization (37%) or surgery (5.4%). Only 28% of patients with immobilization had received prophylaxis, as compared with 67% of the surgical. Fatal PE was more common in patients with recent immobilization (5.0%; 95% CI: 3.9-6.3) than in those with surgery (0.8%; 95% CI: 0.4-1.6) or neither (2.2%; 95% CI: 1.8-2.6). On multivariate analysis, patients with immobilization were at an increased risk for fatal PE (odds ratio: 1.8; 95% CI: 1.2-2.5).
  
  
  CONCLUSIONS
  One in every three cancer patients dying of PE had recent immobilization for ≥ 4 days. Many of these deaths could have been prevented with adequate thromboprophylaxis.
authors.affiliation: Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Trujillo-Santos
authors.affiliation: Department of Clinical Research, FADOI Foundation, Milan, Italy.
authors.forename: Gualberto
authors.initials: G
authors.lastname: Gussoni
authors.affiliation: Department of Haematology, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil.
authors.forename: Telma
authors.initials: T
authors.lastname: Gadelha
authors.affiliation: Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Sänchez Muñoz-Torrero
authors.affiliation: Department of Pneumonology, Hospital San Pedro, Logroño, La Rioja, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Barron
authors.affiliation: Department of Internal Medicine, Hospital Provincial Reina Sofía, Córdoba, Spain.
authors.forename: Luciano
authors.initials: L
authors.lastname: Lopez
authors.affiliation: Department of Internal Medicine, Hospital de Fuenlabrada, Madrid, Spain.
authors.forename: Justo
authors.initials: J
authors.lastname: Ruiz-Ruiz
authors.affiliation: Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernandez-Capitan
authors.affiliation: Department of Internal Medicine, Hospital Vega Baja, Alicante, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Lorente
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. Electronic address: mmonreal.germanstrias@gencat.cat.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D007103:Immobilization / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality* / Q000601:surgery*; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D012042:Registries / Q000706:statistics & numerical data; D054556:Venous Thromboembolism / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: Cancer; Death; Immobilization; Pulmonary embolism; Surgery; Venous thromboembolism