期刊
EUROPEAN JOURNAL OF CANCER
卷 158, 期 -, 页码 99-110出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.ejca.2021.09.010
关键词
Immune checkpoint inhibitors; Venous thromboembolism; Cardio-oncology; Anticoagulation; Cancer; Vascular medicine
类别
资金
- National Institutes of Health/National Heart, Lung, and Blood Institute [R01HL130539, R01HL137562, K24HL150238]
- National Institutes of Health/Harvard Center for AIDS Research [P30 AI060354]
- U.S. National Institutes of Health/National Heart, Lung, and Blood Institute [T32HL076136]
The study found that the risk of VTE was 7.4% at 6 months and 13.8% at 1 year after starting an ICI, with a significantly increased rate of VTE. Factors such as age, medical history, and underlying diseases can predict the risk of VTE in patients receiving ICIs.
Background: Immune checkpoint inhibitors (ICIs) are widely used cancer treatments. There are limited data on the risk for developing venous thromboembolism (VTE) among patients on an ICI. Methods: This was a retrospective study of 2854 patients who received ICIs at a single academic centre. VTE events, defined as a composite of deep vein thrombosis or pulmonary embolism, were identified by individual chart review and blindly adjudicated using standard imaging criteria. A self-controlled risk-interval design was applied with an 'at-risk period' defined as the two-year period after and the 'control period', defined as the two-year before treatment. The hazard ratio (HR) was calculated using a fixed-effect proportional hazards model. Results: Of the 2854 patients, 1640 (57.5%) were men; the mean age was 64 +/- 13 years. The risk for VTE was 7.4% at 6 months and 13.8% at 1 year after starting an ICI. The rate of VTE was > 4-fold higher after starting an ICI (HR 4.98, 95% CI 3.65-8.59, p < 0.001). There was a 5.7-fold higher risk for deep vein thrombosis (HR 5.70, 95% CI 3.79-8.59, p < 0.001) and a 4.75-fold higher risk for pulmonary embolism (HR 4.75, 95% CI 3.20-7.10, p < 0.001). Comparing patients with and without a VTE event, a history of melanoma and older age predicted lower risk of VTE, while a higher Khorana risk score, history of hypertension and history of VTE predicted higher risk. Conclusions: The rate of VTE among patients on an ICI is high and increases after starting an ICI. 2021 Elsevier Ltd. All rights reserved.
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