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1269 Venous Thromboembolism Outcomes Among Cancer and Non-Cancer Patients Managed with Patient-Centric Guideline-Driven Protocol

Program: Oral and Poster Abstracts
Session: 332. Thrombosis and Anticoagulation: Clinical and Epidemiological: Poster I
Hematology Disease Topics & Pathways:
Research, Anticoagulant Drugs, Non-Biological therapies, Clinical Research, health outcomes research, Therapies, registries, Adverse Events, survivorship, Study Population, Human
Saturday, December 9, 2023, 5:30 PM-7:30 PM

Claire E. Cassianni, MSc1*, Robert D. McBane, MD2*, Danielle T. Vlazny, PA-C2*, David O. Hodge3*, Ana I. Casanegra, MD2*, Damon E. Houghton, MD, MS2,4 and Waldemar E. Wysokinski, MD, PhD2*

1Mayo Clinic Alix School of Medicine, Rochester, MN
2Gonda Vascular Center, Mayo Clinic, Rochester, MN
3Mayo Clinic, Jacksonville, FL
4Department of Cardiovascular Diseases, Division of Vascular Medicine & Dept of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN

Purpose/Introduction: Patients with cancer and venous thromboembolism (VTE) have higher complication rates including thrombosis recurrence and bleeding. Real world prospective clinical outcome estimates of VTE management comparing cancer and non-cancer patients are limited. To assess VTE recurrence, major bleeding, and clinically relevant non-major bleeding (CRNMB) in patients with cancer and without cancer, the prospective Mayo Clinic Thrombophilia Clinic Registry was analyzed.

Methods: Upon recruitment, consecutive patients with confirmed acute VTE (03/01/2013 - 04/30/2023) were treated in a standardized, guideline-sanctioned, protocol driven strategy incorporating shared patient-decision making. Patients were divided into groups based on cancer status. After enrollment, patients were actively followed at 3 month intervals, in person whenever feasible, by mailed questionnaire or scripted phone interview to assess vital status, medication compliance, VTE recurrence, major bleeding and CRNMB.

Results: Over the study time-frame, 2,064 patients (53.8% male, 46.2% female) with a cancer and 2,647 patients (54.9% male, 45.1% female) without cancer were enrolled. The most common cancers were gastrointestinal (n=423, 20.5%), pancreatic (n=287, 13.9%), genitourinary (n=198, 9.6%), hematologic (n=171, 8.3%), and lung cancer (n=170, 8.2%). Patients with cancer were older, had lower weight and lower platelet counts compared to non-cancer patients (Table1). Pulmonary embolism (PE, 52.6% vs 43.7%, p<0.001), upper extremity DVT (9.1% vs 6.0%, p<0.001), and splanchnic DVT (11.1% vs 6.9%, p<0.001) were more frequent among cancer patients. In contrast, leg DVT was more frequent among non-cancer patients (65.4% vs.47.2%, p<0.001). While mean duration of anticoagulation was similar between groups, notable differences in 3 month and > 9 month durations were evident as were initial anticoagulant choices (Table 1). Despite a well-organized protocol driven and guideline sanctioned management strategy, patients with active cancer experienced a 2.2-fold higher rate of VTE recurrence (p<0.001) and a 1.8 fold higher rate of major bleeding (p<001) compared to non-cancer patients (Table 2). CRNMB rates did not differ by cancer status.

Conclusions: In this large prospective, guideline-driven and patient-centric registry of VTE management, patients with cancer had significantly higher rate of VTE recurrence and major bleeding, compared to non-cancer patients. These data provide important estimates for power calculations for future randomized trials of VTE treatment.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH