Caiano, Lucia, Carrier, Marc, Marshall, Andrea, Young, Annie M., Ageno, Walter, Delluc, Aurélien and Wang, Tzu‐Fei (2021) Outcomes among patients with cancer and incidental or symptomatic venous thromboembolism : a systematic review and meta‐analysis. Journal of Thrombosis and Haemostasis, 19 (10). pp. 2468-2479. doi:10.1111/jth.15435 ISSN 1538-7933.

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Abstract

Background:
Patients with cancer have an increased risk of venous thromboembolism (VTE) and it is commonly detected incidentally. The outcomes and optimal management for patients with cancer and incidental VTE remain debated.

Objectives:
We conducted a systematic review and meta-analysis to evaluate the outcomes in patients with cancer and incidentally detected VTE compared to those with symptomatic events.

Patients/Methods:
We searched the electronic databases and included randomized controlled trials (RCTs) and observational studies reporting recurrent VTE, major bleeding events, and mortality in patients with cancer and incidental VTE compared to symptomatic VTE.

Results:
We included 23 studies for the systematic review: 3 RCTs and 20 observational studies. The meta-analysis of the 3 RCTs showed a significantly lower rate of VTE recurrence at 6 months in patients with incidental VTE compared to those with symptomatic VTE (relative risk [RR] 0.62, 95% confidence interval [CI] 0.44–0.87). The risk of major bleeding events at 6 months was numerically higher with incidental VTE compared to symptomatic VTE (RR 1.47, 95% CI 0.99–2.20). There was no difference in overall mortality.

Conclusions:
Among patients with cancer, incidental VTE was associated with a lower rate of VTE recurrence compared to symptomatic VTE, with a trend in increased major bleeding events. The risk-benefit ratio of anticoagulation may differ between incidental and symptomatic events and should be considered in patient management.

Item Type:	Journal Article
Subjects:	R Medicine > RB Pathology R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Thrombophlebitis, Tumors -- Growth , Hemorrhage
Journal or Publication Title:	Journal of Thrombosis and Haemostasis
Publisher:	Wiley-Blackwell Publishing Ltd.
ISSN:	1538-7933
Official Date:	October 2021
Dates:	Date Event October 2021 Published 12 July 2021 Available 21 June 2021 Accepted
Volume:	19
Number:	10
Page Range:	pp. 2468-2479
DOI:	10.1111/jth.15435
Status:	Peer Reviewed
Publication Status:	Published
Reuse Statement (publisher, data, author rights):	This is the peer reviewed version of the following article: Caiano, L, Carrier, M, Marshall, A, et al. Outcomes among patients with cancer and incidental or symptomatic venous thromboembolism: A systematic review and meta-analysis. J Thromb Haemost., which has been published in final form at https://doi.org/10.1111/jth.15435. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	5 August 2021
Date of first compliant Open Access:	23 June 2022

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