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Increasing incidence and declining mortality after cancer-associated venous thromboembolism: a nationwide cohort study

Ording, Anne Gulbech, Skjøth, Flemming, Søgaard, Mette, Højen, Anette Arbjerg, Overvad, Thure Filskov, Noble, Simon, Goldhaber, Samuel Zachary and Larsen, Torben Bjerregaard 2021. Increasing incidence and declining mortality after cancer-associated venous thromboembolism: a nationwide cohort study. American Journal of Medicine 134 (7) , pp. 868-876. 10.1016/j.amjmed.2021.01.031

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Purpose The incidence of cancer-associated venous thromboembolism has increased, but whether short-term mortality after cancer-associated venous thromboembolism has changed remains uncertain. We investigated whether the increasing incidence of venous thromboembolism in cancer patients is associated with a change in mortality. Methods We used administrative medical registries to identify a cohort of all Danish patients diagnosed with a first primary cancer from 2006 to 2017. We examined temporal changes in 1-year risks of venous thromboembolism and in mortality risks at 30 days and 1 year after venous thromboembolism. Cox regression was used to assess changes in mortality rate ratios over time. Results We included 350,272 cancer patients (median age 68 years, 49.1% female), of whom 8167 developed venous thromboembolism within 1 year after cancer diagnosis. The cumulative 1-year risk of venous thromboembolism was 1.8% in 2006-2008, increasing to 2.8% for patients diagnosed in 2015-2017. The 30-day mortality after venous thromboembolism decreased from 15.1% in 2006-2008 to 12.7% in 2015-2017, and the 1-year mortality decreased from 52.4% to 45.8%, equivalent to a hazard ratio (HR) of 0.83 (95% confidence interval [CI], 0.75-0.90). This pattern of declining 1-year mortality was consistent for patients with pulmonary embolism, HR 0.79 (95% CI, 0.69-0.90), and deep venous thrombosis, HR 0.76 (95% CI, 0.67-0.87). Lower mortality over time was evident across all strata of cancer stage, cancer type, and cancer treatment. Conclusions The 1-year risk of venous thromboembolism after a first primary cancer diagnosis in Denmark increased during 2006-2017. This increase was accompanied by declining mortality.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Elsevier
ISSN: 0002-9343
Funders: Obel Family Foundation, Marie Curie MCCC-FCO-11-C/MCCC_/Marie Curie/United Kingdom
Date of First Compliant Deposit: 19 May 2022
Date of Acceptance: 16 January 2021
Last Modified: 25 May 2022 14:51

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