Risk factors predictive of occult cancer detection in patients with unprovoked venous thromboembolism

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Introduction

Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal condition.^1⇓-3 Unprovoked events, which occur in the absence of a major thrombogenic risk factor, represent approximately 40% of all VTEs.⁴ Unprovoked VTEs may be the earliest indication of cancer.^5,6 It was previously demonstrated that between 3.2% and 10.0% of patients presenting with unprovoked VTEs will be subsequently diagnosed with cancer, with the highest risk in the first year after the diagnosis of VTE.^7⇓-9 This has led to a debate on whether an extensive screening for occult cancer in these patients is warranted. Two recently published studies have reported that using an extensive screening strategy is unlikely to provide benefit to all patients with unprovoked episodes of VTE.^9,10 However it remains unclear whether a subgroup of high-risk patients could potentially benefit from a more extensive occult cancer screening strategy. Identification of risk factors associated with early detection of occult cancers to stratify patients with higher risk of cancer detection after an unprovoked VTE might be of potential clinical importance and provide a basis for effective screening and preventive strategies. We sought to assess the risk factors predictive of occult cancer detection in patients with a first objectively proven unprovoked symptomatic VTE.