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Linda S. Elting, DrPH; Carmelita P. Escalante, MD; Catherine Cooksley, DrPH; Elenir B. C. Avritscher, MD, MBA; Danna Kurtin, PhD; Lois Hamblin, BA; Shikha Gupta Khosla, MD; Edgardo Rivera, MD

Arch Intern Med. 2004;164:1653-1661.

Background  Although deep venous thrombosis (DVT) often complicates the clinical course in patients with cancer, few studies of the outcomes of DVT in this population have been published. Furthermore, the cost of DVT is largely undescribed. We herein report the largest study of DVT in this population to date.

Methods  We reviewed the medical records of 529 consecutive cancer patients in whom DVT developed from January 1, 1994, through December 31, 1997, and followed up these patients through December 31, 2000, for outcomes. The cost of hospitalization was obtained from our hospital's cost-accounting system and inflated to 2002 US dollars using the Consumer Price Index for Medical Care. Logistic regression was used to identify factors that were associated with a high risk of poor outcomes.

Results  The most common complication of DVT was bleeding, which occurred in 13% of patients. Pulmonary embolus occurred in 4%. Five patients (1%) died of complications of DVT and 5 (1%) of complications of anticoagulation. Recurrence of DVT was common (17% overall), particularly among those who had inferior vena cava filters (32%; P<.001) or a previous episode of DVT (P = .03). All but 4 patients were hospitalized for initial anticoagulation therapy, for a mean of 11 days. The mean cost of hospitalization was 2002 US $20 065.

Conclusions  Among patients with cancer, DVT frequently is associated with serious clinical outcomes. Its treatment is resource intensive and costly. More effective agents and less costly management strategies could have a significant impact on the outcomes and cost of DVT in this population.

From the Section of Health Services Research, Department of Biostatistics (Drs Elting, Cooksley, Avritscher, and Khosla), and the Departments of General Internal Medicine (Dr Escalante), Faculty Academic Affairs (Dr Kurtin), Radiation Oncology (Ms Hamblin), and Breast Medical Oncology (Dr Rivera), The University of Texas M. D. Anderson Cancer Center, Houston. The authors have no relevant financial interest in this article.

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