Cisplatin-Based Chemotherapy Increases Risk of Venous Thromboembolism

The risk of venous thromboembolism (VTE)—formation of a blood clot in the vein—in patients with cancer is known to be significantly higher compared with the general population. Now, a new study has found that in addition to tumor type, stage, and the presence of comorbidities, patients receiving cisplatin-based treatments might be at an increased risk of VTE.

For their retrospective study, authors divided 200 patients who had been treated at the Aga Khan University Hospital in Karachi, Pakistan, into 2 cohorts: those who received cisplatin-based chemotherapy and those who received other forms of chemotherapy. Patients who were treated between November 1, 2010, and October 31, 2012, and followed for a month after completion of treatment, were included in the study. Exclusion criteria were patients on antiplatelet agents or anticoagulants, with a previous history of deep vein thrombosis (DVT) or pulmonary embolism (self-reported), known pro-thrombotic disorders or hyper-coagulable states, patients who were on erythropoiesis-stimulating agent during chemotherapy or up to 6 weeks prior to the first cycle of chemotherapy, and female patients on oral contraceptive pills.

The primary outcome of the study was any VTE event at least 3 days after initiation of chemotherapy or within 4 weeks after completion of chemotherapy.

Of the 200 patients, most of whom had metastatic disease, 31 VTE events were observed at a mean cumulative dose of 471 mg/m². The mean cumulative cisplatin dose was 322 mg/m² in the group that did not have any VTE events. Eighteen events in the cisplatin group were DVT, as opposed to 7 in the non-cisplatin group; of those patients who reported VTE, 4 died in the cisplatin group and 1 in the non-cisplatin group. Based on the analysis of these data, the author found a 2.8-times higher risk of VTE in the cisplatin group (95% CI, 1.4-4.22) compared with the non-cisplatin group. After adjusting for the patient’s Eastern Cooperative Oncology Group status, presence of a central venous catheter, and Khorana risk score, the adjusted risk rose to 3.32 (95% CI, 1.6-6.8).

The authors recommend conducting additional investigation to confirm the association between use of cisplatin and the risk of VTE and the need to use safer chemotherapeutic agents in patients undergoing chemotherapy treatment.

Reference

Zahir MN, Shaikh Q, Shabbir-Moosajee M, Jabbar AA. Incidence of Venous Thromboembolism in cancer patients treated with Cisplatin based chemotherapy — a cohort study. BMC Cancer. 2017;17:57. doi: 10.1186/s12885-016-3032-4.