Arterial Thromboembolism Risk in Cancer Patients

Study Questions:

What are the risks of myocardial infarction (MI) and ischemic stroke in patients with cancer?


Using the Surveillance Epidemiology and End Results–Medicare linked dataset, the authors identified patients with a new primary solid-tumor cancer diagnosis between 2002 and 2011. These patients were matched to Medicare enrollees without cancer and the pairs were followed through 2012. Using validated diagnosis codes, episodes of ischemic stroke or MI (stroke/MI) were identified.


The authors identified 279,719 pairs of patients. The 6-month cumulative incidence of stroke/MI was 4.7% (95% confidence interval [CI], 4.6-4.8%) in cancer patients and 2.2% (95% CI, 2.1-2.2%) in noncancer patients (hazard ratio [HR], 2.2; 95% CI, 2.1-2.3). Excess risk varied by cancer type (greatest for lung cancer), correlated with cancer stage, and generally resolved by 1 year. Among cancer patients, the development of stroke/MI was associated with an increased hazard for mortality (30-day cumulative incidence of 17.6% vs. 11.6%; adjusted HR, 3.1; 95% CI, 3.0-3.1) as compared to noncancer patients.


The authors concluded that patients with incident cancer are at increased short-term risk of ischemic stroke and MI.


While cancer is well known to increase the risk of venous thromboembolism, the risk of arterial thromboembolism (stroke and MI) is less well understood. The authors demonstrate the increased risk of stroke/MI among cancer patients and its associated mortality risk. However, clinicians should give pause before routinely prescribing statin and antithrombotic therapy (e.g., aspirin or oral anticoagulation) to new cancer patients without a firm indication. Ongoing studies will help to identify the potential benefit and risks associated with such therapies.

Keywords: Aspirin, Cardiotoxicity, Fibrinolytic Agents, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lung Neoplasms, Myocardial Infarction, Neoplasms, Primary Prevention, Risk, Stroke, Thrombosis, Vascular Diseases, Venous Thromboembolism

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