Incidence of Venous Thromboembolism in the Year Before the Diagnosis of Cancer in 528 693 Adults

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Abstract
When a patient develops acute venous thromboembolism (VTE), physicians commonly try to determine whether there is an underlying condition or risk factor associated with the thrombotic event. Patients with a provoking risk factor, such as recent trauma, major surgery, or immobility, have a better long-term prognosis with a lower incidence of recurrent VTE than patients who present with unprovoked VTE.1 In the absence of an obvious provoking risk factor, the presence of an underlying malignancy is often considered.2,3 This is because some types of cancer appear to be able to initiate or trigger a thrombotic diathesis through a number of mechanisms, which have been recently reviewed.4,5 Several cohort studies have suggested that the incidence of cancer among patients who present with unprovoked VTE is more than 3 times higher than among patients with a provoked VTE,6-12 and there is evidence that more than 40% of these cancers are metastatic at the time of diagnosis.13