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Posch, F; Riedl, J; Reitter, EM; Kaider, A; Zielinski, C; Pabinger, I; Ay, C.
Hypercoagulabilty, venous thromboembolism, and death in patients with cancer. A Multi-State Model.
Thromb Haemost. 2016; 115(4):817-826
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Autor/innen der Med Uni Graz:
Posch Florian

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Plum Analytics:
Venous thromboembolism (VTE) is a frequent complication of malignancy. The aim of this study was to investigate whether multi-state modelling may be a useful quantitative approach to dissect the complex epidemiological relationship between hypercoagulability, VTE, and death in cancer patients. We implemented a three-state/three-transition unidirectional illness-death model of cancer-associated VTE in data of 1,685 cancer patients included in a prospective cohort study, the Vienna Cancer and Thrombosis Study (CATS). During the two-year follow-up period, 145 (8.6 %) patients developed VTE, 79 (54.5 %) died after developing VTE, and 647 (38.4 %) died without developing VTE, respectively. VTE events during follow-up were associated with a three-fold increase in the risk of death (Transition Hazard ratio (HR)=2.98, 95 % confidence interval [CI]: 2.36-3.77, p< 0.001). This observation was independent of cancer stage. VTE events that occurred later during follow-up exerted a stronger impact on the risk of death than VTE events that occurred at earlier time points (HR for VTE occurrence one year after baseline vs at baseline=2.30, 95 % CI: 1.28-4.15, p=0.005). Elevated baseline D-dimer levels emerged as a VTE-independent risk factor for mortality (HR=1.07, 95 % CI: 1.05-1.08, p< 0.001), and also predicted mortality risk in patients who developed VTE. A higher Khorana Score predicted both the risk for VTE and death, but did not predict mortality after cancer-associated VTE. In conclusion, multi-state modeling represents a very potent approach to time-to-VTE cohort data in the cancer population, and should be used for both observational and interventional studies on cancer-associated VTE.
Find related publications in this database (using NLM MeSH Indexing)
Adolescent -
Adult -
Aged -
Aged, 80 and over -
Austria - epidemiology
Cohort Studies -
Female -
Follow-Up Studies -
Humans -
Male -
Middle Aged -
Neoplasms - epidemiology
Neoplasms - mortality
Proportional Hazards Models -
Prospective Studies -
Risk -
Survival Analysis -
Thrombophilia - epidemiology
Thrombophilia - mortality
Treatment Outcome -
Venous Thromboembolism - epidemiology
Venous Thromboembolism - mortality
Young Adult -

Find related publications in this database (Keywords)
Venous thrombosis
epidemiological studies
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