Introduction In cancer patients, current guidance suggests similar treatment for incidental and symptomatic venous thromboembolism (VTE), mainly based on retrospective data. We aimed to evaluate anticoagulant therapy in cancer patients with incidental and symptomatic VTE. Methods The Hokusai VTE Cancer Study was a randomised controlled trial comparing edoxaban with dalteparin for cancer-associated VTE. The primary outcome was the composite of first recurrent VTE or major bleeding. Secondary outcomes included major bleeding, recurrent VTE and mortality. Outcomes in patients with incidental and symptomatic VTE were evaluated during the 12-month study period. Results 331 patients with incidental VTE and 679 patients with symptomatic VTE were enrolled, of whom the index event was confirmed by an independent radiologist. Median durations of anticoagulant treatment were 195 and 189 days, respectively. In patients with incidental VTE, the primary outcome occurred in 12.7% of patients, major bleeding in 6.6% of patients and recurrent VTE in 7.9% of patients. Out of the 26 VTE recurrences in patients with incidental VTE, five (31%) were incidental, seven (44%) were symptomatic and four (25%) were deaths for which pulmonary embolism could not be ruled out. In patients with symptomatic VTE, the primary outcome occurred in 13.8% of patients, major bleeding in 4.9% of patients and recurrent VTE in 10.9% of patients. All-cause mortality was similar in both groups. Conclusion Clinical adverse outcomes are substantial in both cancer patients with incidental and symptomatic VTE, supporting current guideline recommendations that suggest treating incidental VTE in the same manner as symptomatic VTE. In cancer patients with incidental venous thromboembolism (VTE), the risk of recurrent VTE is substantial despite initiation of anticoagulant treatment. Incidental VTE is a serious condition, which should be treated similar to symptomatic VTE. http://bit.ly/2qM4XUp

中文翻译：

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癌症患者偶发静脉血栓栓塞的临床意义

简介 在癌症患者中，目前的指南建议对偶发性和症状性静脉血栓栓塞 (VTE) 进行类似的治疗，主要基于回顾性数据。我们的目的是评估癌症患者偶然和症状性静脉血栓栓塞的抗凝治疗。方法 Hokusai VTE 癌症研究是一项比较依度沙班与达肝素治疗癌症相关 VTE 的随机对照试验。主要结局是首次复发性 VTE 或大出血的复合结局。次要结果包括大出血、复发性 VTE 和死亡率。在 12 个月的研究期间，对偶发性和症状性 VTE 患者的结果进行了评估。结果 331 名偶发性 VTE 患者和 679 名症状性 VTE 患者被纳入研究，其中指标事件由独立放射科医师确认。抗凝治疗的中位持续时间分别为 195 天和 189 天。在偶发性 VTE 患者中，主要结局发生率为 12.7%，大出血发生率为 6.6%，VTE 复发率为 7.9%。在偶发性 VTE 患者的 26 例 VTE 复发中，5 例 (31%) 是偶然的，7 例 (44%) 是有症状的，4 例 (25%) 是不能排除肺栓塞的死亡。在有症状的 VTE 患者中，主要结局发生率为 13.8%，大出血发生率为 4.9%，VTE 复发率为 10.9%。两组的全因死亡率相似。结论 伴有偶发性和症状性 VTE 的癌症患者的临床不良结果是显着的，支持当前的指南建议，建议以与有症状的 VTE 相同的方式治疗偶发性 VTE。在偶发性静脉血栓栓塞 (VTE) 的癌症患者中，尽管开始抗凝治疗，VTE 复发的风险仍然很大。偶发性 VTE 是一种严重的疾病，应该像有症状的 VTE 一样对待。http://bit.ly/2qM4XUp