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Elevated white blood cell count and outcome in cancer patients with venous thromboembolism - Findings from the RIETE Registry*

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Issue: 2008: 100/5 (Nov) pp. 727-954
Pages: 905-911

Elevated white blood cell count and outcome in cancer patients with venous thromboembolism - Findings from the RIETE Registry*

Javier Trujillo-Santos 1, Pierpaolo Di Micco 2, Mariateresa Iannuzzo 3, Ramón Lecumberri 4, Ricardo Guijarro 5, Olga Madridano 6, Manuel Monreal 7; for the RIETE Investigators
1 Department of Internal Medicine, Hospital Universitario Santa María de Rosell, Cartagena, Murcia, Spain; 2 Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy; 3 Department of Epidemiology, Fatebenefratelli Hospital, Naples, Italy; 4 Department of Haematology, Clinica Universitaria de Navarra, Pamplona, Spain; 5 Departament of Internal Medicine, Hospital Universitario Carlos Haya, Málaga, Spain; 6 Departament of Internal Medicine, Hospital La Paz, Madrid, Spain; 7 Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain


cancer, venous thromboembolism, outcome, leukocytosis


A significant association between elevated white blood cell (WBC) count and mortality in patients with cancer has been reported, but the predictive value of elevatedWBC on mortality in cancer patients with acute venous thromboembolism (VTE) has not been explored. RIETE is an ongoing registry of consecutive patients with acute VTE. We compared the three-month outcome of cancer patients with acuteVTE according to theirWBC count at baseline. As of May 2007, 3805 patients with active cancer and acuteVTE had been enrolled in RIETE. Of them, 215 (5.7%) had low- (<4,000 cells/μl), 2,403 (63%) normal- (4,000–11,000 cells/μl), 1,187 (31%) elevated (>11,000 cells/μl) WBC count. During the study period 190 patients (5.0%) had recurrent VTE, 156 (4.1%) major bleeding, 889 (23%) died (399 of disseminated cancer, 113 of PE, 46 of bleeding. Patients with elevated WBC count at baseline had an increased incidence of recurrent VTE (odds ratio [OR]: 1.6; 95% confidence interval [CI]: 1.2–2.2), major bleeding (OR: 1.5; 95% CI: 1.1–2.1) or death (OR: 2.7; 95% CI: 2.3–3.2). Most of the reported causes of death were significantly more frequent in patients with elevated WBC count. Multivariate analysis confirmed that elevatedWBC count was independently associated with an increased incidence of all three complications. In conclusion, cancer patients with acute VTE and elevatedWBC count had an increased incidence ofVTE recurrences, major bleeding or death.This worse outcome was consistent among all subgroups and persisted after multivariate adjustment.

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