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Cited by 1,949Venous Thromboembolism Diagnosis and ManagementBlood Coagulation and Thrombosis MechanismsCerebral Venous Sinus Thrombosis

Malignancies, prothrombotic mutations, and the risk of venous thrombosis

Blom, Jeanet W.·2005·JAMA
DOI 10.1001/jama.293.6.715
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Abstract

CONTEXT: Venous thrombosis is a common complication in patients with cancer, leading to additional morbidity and compromising quality of life. OBJECTIVE: To identify individuals with cancer with an increased thrombotic risk, evaluating different tumor sites, the presence of distant metastases, and carrier status of prothrombotic mutations. DESIGN, SETTING, AND PATIENTS: A large population-based, case-control (Multiple Environmental and Genetic Assessment [MEGA] of risk factors for venous thrombosis) study of 3220 consecutive patients aged 18 to 70 years, with a first deep venous thrombosis of the leg or pulmonary embolism, between March 1, 1999, and May 31, 2002, at 6 anticoagulation clinics in the Netherlands, and separate 2131 control participants (partners of the patients) reported via a questionnaire on acquired risk factors for venous thrombosis. Three months after discontinuation of the anticoagulant therapy, all patients and controls were interviewed, a blood sample was taken, and DNA was isolated to ascertain the factor V Leiden and prothrombin 20210A mutations. MAIN OUTCOME MEASURE: Risk of venous thrombosis. RESULTS: The overall risk of venous thrombosis was increased 7-fold in patients with a malignancy (odds ratio [OR], 6.7; 95% confidence interval [CI], 5.2-8.6) vs persons without malignancy. Patients with hematological malignancies had the highest risk of venous thrombosis, adjusted for age and sex (adjusted OR, 28.0; 95% CI, 4.0-199.7), followed by lung cancer and gastrointestinal cancer. The risk of venous thrombosis was highest in the first few months after the diagnosis of malignancy (adjusted OR, 53.5; 95% CI, 8.6-334.3). Patients with cancer with distant metastases had a higher risk vs patients without distant metastases (adjusted OR, 19.8; 95% CI, 2.6-149.1). Carriers of the factor V Leiden mutation who also had cancer had a 12-fold increased risk vs individuals without cancer and factor V Leiden (adjusted OR, 12.1; 95% CI, 1.6-88.1). Similar results were indirectly calculated for the prothrombin 20210A mutation in patients with cancer. CONCLUSIONS: Patients with cancer have a highly increased risk of venous thrombosis especially in the first few months after diagnosis and in the presence of distant metastases. Carriers of the factor V Leiden and prothrombin 20210A mutations appear to have an even higher risk.

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Authors
Blom, J. W.
Affiliations
Leiden University Medical Center (NL)
Corresponding author
Blom, Jeanet W.
ORCID
Blom, Jeanet W.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2005-02-09
Volume
293
Issue
6
Pages
715
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.293.6.715
OpenAlex
W2007086823
Cited by
1,949
References
26
Citations by year
2026: 49 · 2025: 66 · 2024: 96 · 2023: 89 · 2022: 123 · 2021: 124 · 2020: 106 · 2019: 112 · 2018: 121 · 2017: 106 · 2016: 98 · 2015: 122 · 2014: 92 · 2013: 96 · 2012: 100
FWCI
48.38
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • University of Twente Research Information (publishedVersion)
  • University of Twente Research Information (submittedVersion)
Topics
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
  • Health Sciences › Medicine › Neurology › Cerebral Venous Sinus Thrombosis
Keywords
venous thrombosis, cancer-associated thrombosis, prothrombotic mutations, factor V Leiden, deep vein thrombosis, pulmonary embolism, hematologic malignancies, lung cancer, gastrointestinal cancer, distant metastasis, thrombosis risk factors, cancer survivors, anticoagulation clinic, MEGA
MeSH terms
Adult, Aged, Factor V, Female, Humans, Male, Middle Aged, Mutation, Neoplasm Metastasis, Neoplasms, Prothrombin, Pulmonary Embolism, Risk, Case-Control Studies, Venous Thrombosis

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