Clinical implications of incidental venous thromboembolism in cancer patients
Randomized controlled trial published in The European respiratory journal (2020)
Abstract
INTRODUCTION: In cancer patients, current guidance suggests similar treatment for incidental and symptomatic venous thromboembolism (VTE), mainly based on retrospective data. We aimed to evaluate anticoagulant therapy in cancer patients with incidental and symptomatic VTE. METHODS: The Hokusai VTE Cancer Study was a randomised controlled trial comparing edoxaban with dalteparin for cancer-associated VTE. The primary outcome was the composite of first recurrent VTE or major bleeding. Secondary outcomes included major bleeding, recurrent VTE and mortality. Outcomes in patients with incidental and symptomatic VTE were evaluated during the 12-month study period. RESULTS: 331 patients with incidental VTE and 679 patients with symptomatic VTE were enrolled, of whom the index event was confirmed by an independent radiologist. Median durations of anticoagulant treatment were 195 and 189 days, respectively. In patients with incidental VTE, the primary outcome occurred in 12.7% of patients, major bleeding in 6.6% of patients and recurrent VTE in 7.9% of patients. Out of the 26 VTE recurrences in patients with incidental VTE, five (31%) were incidental, seven (44%) were symptomatic and four (25%) were deaths for which pulmonary embolism could not be ruled out. In patients with symptomatic VTE, the primary outcome occurred in 13.8% of patients, major bleeding in 4.9% of patients and recurrent VTE in 10.9% of patients. All-cause mortality was similar in both groups. CONCLUSION: Clinical adverse outcomes are substantial in both cancer patients with incidental and symptomatic VTE, supporting current guideline recommendations that suggest treating incidental VTE in the same manner as symptomatic VTE.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
In cancer patients, current guidance suggests similar treatment for incidental and symptomatic venous thromboembolism (VTE), mainly based on retrospective data. We aimed to evaluate anticoagulant therapy in cancer patients with incidental and symptomatic VTE.
Por qué esto importa para la hirudoterapia
Basándose en el ensayo aleatorizado Hokusai VTE Cancer (edoxaban vs dalteparin), este análisis comparó a 331 pacientes oncológicos con VTE incidental y 679 con VTE sintomática, encontrando resultados adversos sustanciales en ambos grupos (compuesto de VTE recurrente o hemorragia mayor 12.7% vs 13.8%) y respaldando la recomendación de las guías clínicas de tratar la VTE incidental como la VTE sintomática. Para la ASH, esto se relaciona con el problema de la trombosis asociada al cáncer, donde el equilibrio entre hemorragia y coagulación es especialmente delicado -- el mismo equilibrio que convierte a los péptidos anticoagulantes derivados de sanguijuelas, mecánicamente distintos, en un interés continuo en el descubrimiento de fármacos. Salvedad honesta: aunque se deriva de datos de RCT, se trata de un análisis de subgrupos secundario que compara dos anticoagulantes farmacéuticos; no involucra sanguijuelas, no formula ninguna afirmación sobre la hirudoterapia y no puede presentarse como evidencia para el tratamiento basado en sanguijuelas.
Citación
Clinical implications of incidental venous thromboembolism in cancer patients.
Mulder FI et al. · The European respiratory journal, 2020
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026