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Jennifer R. Brown, MD, PhD


Study Finds Risk of VTE May Be Higher Than Previously Thought in Patients With CLL

By: Celeste L. Dixon
Posted: Thursday, March 2, 2023

A recent data analysis has shown that the 5-year and 10-year cumulative risks of venous thromboembolism (VTE) for patients newly diagnosed with monoclonal B-cell lymphocytosis or chronic lymphocytic leukemia (MBL/CLL) were 4.9% and 11.5%, respectively—which is about six times higher than those of an age- and sex-matched general population. As such, clinicians should be vigilant about assessing this population for VTE risk and increase patient education on the subject, according to Sameer A. Parikh, MBBS, of the Mayo Clinic, Rochester, Minnesota, and colleagues. These findings were presented during the Journal of the Advanced Practitioner in Oncology conference JADPRO Live (Abstract JL1018C).

The team focused on data from 904 individuals newly diagnosed with either CLL (n = 611) or MBL (n = 293) between 1998 and 2021 who had no history of VTE. Their median age was 69 years, and 587 (65%) were male. After a median follow-up of 6 years, 8% of patients developed VTE (deep vein thrombosis [n = 43]; pulmonary embolism [n = 24]; or both [n = 4]), with rates similar in both cohorts.

Of the 8% of patients who developed VTE, 47 (68%) had “provoking factors,” described the investigators. These factors included second active malignancy, surgery, hospitalization, travel, trauma, and immobility. In addition, 90% of the patients who developed VTE had received anticoagulation. None of those prescribed indefinite anticoagulation experienced recurrence within the study period, but of those who received time-limited anticoagulation (median duration, 3 months), 10 patients experienced recurrent VTE.

Many patients with CLL or MBL are treated with Bruton’s tyrosine kinase (BTK) inhibitors, with which “warfarin is contraindicated…. Direct oral anticoagulants are preferred,” noted Dr. Parikh and coauthors. Even then, “dose modifications of BTK inhibitors and/or direct oral anticoagulants may be necessary due to [the] concomitant risk of bleeding.”

Disclosure: No disclosure information was provided.

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