Table 8.

Arterial thromboembolic disease (mainly CHD and CVD) in cancer

Study (study duration)	n	Study design	Inclusion criteria	Source of information	ATE rate	Comment(s)
Khorana et al. [41] (1995–2002)	66,106	Multicenter retrospective (115 hospitals)	Hospitalized and chemotherapy‐related neutropenia	Discharge database	1.5%	Arterial events, including CHD (0.8%), CVD (0.5%), and arterial embolism (0.2%) In‐hospital mortality was significantly greater with ATE (OR, 5.04; 95% CI, 4.38–5.79) A 124% increase in arterial events (p < .0001 for trend) over the 8 years of study
Di Nisio et al. [39] (2003–2009)	1,934	Multicenter retrospective	Ambulatory patients with cancer on chemotherapy Patients with a history of CHD/CVD were excluded	Medical records	0.27%	Median age of patients was 61 years All except one event was cardiac Medication‐induced cardiac events highlighted
Zoller et al. [42, 43] (1987–2008)	820,491	Nationwide retrospective	Diagnosis of cancer	National registries	N/A	CHD: 1.7% at first 6 months of diagnosis Ischemic stroke: 1.6% at first 6 months of diagnosis Hemorrhagic stroke: 2.2% at first 6 months of diagnosis Highest risk of CHD/CVD in first 6 months of diagnosis and metastatic disease
Navi et al. [37] (2002–2011)	279,719	Retrospective matched	Age >65 (older adults) Breast, lung, prostate, gastric, pancreatic colorectal, bladder, NHL	SEER Medicare data	N/A	The 6‐month cumulative incidence of CHD was 2.0% in patients with cancer compared with 0.7% in control patients (HR, 2.9; 95% CI, 2.8–3.1) The 6‐month cumulative incidence of ischemic stroke was 3.0% in patients with cancer compared with 1.6% in control patients (HR, 1.9; 95% CI, 1.8–2.0)
Brenner et al. [40] (2009–2014)	5,717	Multicenter prospective	Active cancer with previous diagnosis of venous thrombosis	RIETE Registry	1.10%	Arterial ischemic events and major bleeding appeared early after VTE in patients with active cancer and were among frequent causes of their deaths 6.1% had major bleeding with 30‐day mortality of 41%
Grilz et al. [38] (2003–2013)	1,880	Single‐center prospective	Age >18 years with active cancer diagnosis No indication for long‐term anticoagulation	CATS database	1.7% at 12 months	The cumulative 3‐, 6‐, 12‐, and 24‐month risks of ATE were 0.9%, 1.1%, 1.7%, and 2.6%, respectively Occurrence of ATE was associated with a 3.2‐fold increased risk of all‐cause mortality (HR, 3.2; 95% CI, 2.2–4.8; p < .001)

Abbreviations: ATE, arterial thromboembolism; CATS, Vienna Cancer and Thrombosis Study; CHD, coronary heart disease; CI, confidence interval; CVD, Cerebrovascular disease; HR, hazard ratio; N/A, not assessed; NHL, non‐Hodgkin lymphoma; OR, odds ratio; RIETE, Registro Informatizado de Enfermedad TromboEmbólica; SEER, Surveillance, Epidemiology, and End Results; VTE, venous thromboembolism.

Source: Adopted from De Stefano V, Arterial thrombosis and cancer: The neglected side of the coin of Trousseau syndrome. Haematologica 2018;103:1419–1421.