Cancer Screening in Patients with Unprovoked Thromboembolism: How to do it and Who Benefits?

Introduction: Unprovoked venous thromboembolism (uVTE) may be the first manifestation of cancer. The main objectives of this study were to compare limited screening (LS) and extended screening (ES) and to make a protocol to approach these patients. Methods: This is a retrospective, unicentric observational study that included 245 patients with venous thromboembolism (VTE) admitted to an Internal Medicine Service for five years. The incidence of cancer and mortality during hospitalization, and at one and three years after admission were calculated in both LS and ES groups and compared. Results: Of the 245 patients with VTE, 59 (24.1%) had uVTE: 35 (59.3%) were submitted to LS and 24 (40.7%) to ES, with 10 (4.1%) diagnosis of cancer. In the following three years, 10 more patients were diagnosed. There were no statistically significant differences in inpatient diagnosis rates (8.6% vs. 4.2%; p=0.51) or in-hospital mortality (2.9% vs. 4.2%; p=0.79) or mortality at one year (8.6% vs. 8.3%; p=0.97) and three years (20.0% vs. 20.8%; p = 0.94) between LS and ES groups respectively. The Computerized Registry of Patients with Venous Thromboembolism (RIETE) score was equal or superior to 3 in 69.5% (N=41) of the population with uVTE. Discussion: The results of our study are consistent with the literature; there are no differences between screenings, as the difference in the number of diagnoses does not reflect on mortality. Conclusion: There were no statistically significant differences between the two types of screening in this population. We suggest a protocol that includes the RIETE score to better select the patients who might benefit the most from an ES.