Three-Month Outcomes in Cancer Patients with Superficial or Deep Vein Thrombosis in the Lower Limbs : Results from the RIETE Registry

The natural history of isolated lower-limb superficial vein thrombosis (SVT) in cancer patients is not well understood. To address this gap, we analyzed data from the RIETE registry, which included 110 cancer patients with isolated SVT, 1695 cancer patients with isolated deep vein thrombosis (DVT), and 1030 non-cancer patients with SVT. Compared to cancer patients with DVT, cancer patients with lower-limb SVT received lower doses of anticoagulants, had similar rates of subsequent pulmonary embolism (PE), DVT or SVT, were less likely to have metastases and had a lower mortality rate. However, cancer patients with lower-limb SVT had a higher rate of subsequent PE, DVT or SVT than non-cancer patients with SVT. Additionally, in cancer patients with lower-limb SVT, almost all recurrences and bleeding occurred within the first three months. Background: The clinical characteristics and outcomes of cancer patients with lower-limb isolated superficial vein thrombosis (SVT) have not been consistently evaluated. Methods: We used data in the RIETE registry to compare the clinical characteristics and 90-day outcomes for patients with: (1) active cancer and lower-limb SVT; (2) active cancer and lower-limb deep vein thrombosis (DVT); (3) lower-limb SVT without cancer. The primary outcomes included subsequent symptomatic SVT, DVT or pulmonary embolism (PE). Secondary outcomes were major bleeding and death. Results: From March 2015 to April 2021, there were 110 patients with cancer and SVT, 1695 with cancer and DVT, and 1030 with SVT but no cancer. Most patients in all subgroups (93%, 99% and 96%, respectively) received anticoagulants, while those with SVT received lower daily doses of low-molecular-weight heparin (114 ± 58, 163 ± 44, and 106 ± 50 IU/kg, respectively). During the first 90 days, 101 patients (3.6%) developed subsequent VTE (PE 47, DVT 41, SVT 13), whereas 72 (2.5%) had major bleeding and 282 (9.9%) died. Among the three groups, 90-day events were, respectively: VTE at rates of 7.3%, 4.0% and 2.4%; major bleeding at rates of 2.7%, 3.9% and 0.3%; mortality at rates of 8.2%, 16% and 0.3%. Between D90 and D180, only one SVT recurrence and one death occurred in SVT cancer patients. In multivariable analysis, cancer was associated with subsequent VTE (HR = 2.04; 1.15-3.62), while initial presentation as SVT or DVT were not associated with a different risk. Conclusions: The risk for subsequent VTE (including symptomatic SVT, DVT or PE) was similar in cancer patients with isolated SVT than in those with isolated DVT.