Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Department of Internal Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
Am J Cardiol. 2019 Feb 15;123(4):679-683. doi: 10.1016/j.amjcard.2018.11.008. Epub 2018 Nov 24.
Patients with cancer are at increased risk for venous thromboembolism (VTE). However, the relationship of cancer type to the risk of arterial thrombosis in patients with high VTE risk has not been described. The goal of this study is to determine the rate of arterial thrombosis in patients with different types of solid tumors stratified by VTE risk. Using the 2012 National Inpatient Sample, we identified 373,789 hospitalizations involving patients ≥18 years associated with solid tumors, stratified by type. Data were collected on clinical characteristics, VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]), and arterial thrombosis (primary diagnosis of myocardial infarction [MI] and ischemic stroke). Subjects with solid tumors (stages I to IV) were stratified by VTE risk - high versus low. Certain solid tumor types (esophageal, lung, melanoma, ovarian, pancreatic, stomach, and uterine) were found to be associated with a higher rate of VTE compared with other cancer types (6.8% vs 3.9%, p < 0.001). Multivariate analysis applied to the high VTE risk group showed no increased risk for MI (odds ratio [OR] 0.93, p = 0.74), however, the rate of ischemic stroke was increased (OR 1.22, p < 0.001). Those in the high VTE risk group who had metastatic disease were at higher risk for arterial thrombosis (MI OR 1.35, p < 0.001, ischemic stroke OR 2.43, p < 0.001). In conclusion, different cancer types are associated with increased risk of both venous and arterial thrombosis and the risk is further increased by the presence of metastatic disease.
癌症患者发生静脉血栓栓塞症（VTE）的风险增加。然而，高 VTE 风险患者中癌症类型与动脉血栓形成风险的关系尚未描述。本研究的目的是确定不同类型实体瘤患者的 VTE 风险分层下动脉血栓形成的发生率。使用 2012 年国家住院患者样本，我们确定了 373789 例≥18 岁的与实体瘤相关的住院患者，按类型分层。收集了临床特征、VTE（深静脉血栓形成[DVT]和肺栓塞[PE]）和动脉血栓形成（心肌梗死[MI]和缺血性卒中的主要诊断）的数据。根据 VTE 风险-高与低对患有实体瘤（I 期至 IV 期）的患者进行分层。与其他癌症类型相比，某些实体瘤类型（食管、肺、黑色素瘤、卵巢、胰腺、胃和子宫）与更高的 VTE 发生率相关（6.8%比 3.9%，p<0.001）。多变量分析应用于高 VTE 风险组，MI 的风险没有增加（比值比[OR]0.93，p=0.74），但缺血性卒中的发生率增加（OR 1.22，p<0.001）。高 VTE 风险组中患有转移性疾病的患者发生动脉血栓形成的风险更高（MI OR 1.35，p<0.001，缺血性卒中 OR 2.43，p<0.001）。总之，不同的癌症类型与静脉和动脉血栓形成的风险增加相关，而转移性疾病的存在会进一步增加这种风险。
