In patients with cancer receiving anticoagulation therapy, circulating tissue factor may represent a potential biomarker of recurrent venous thromboembolism (VTE), according to a study published in the Journal of Clinical Oncology.1

Although circulating tissue factor has been evaluated as a biomarker for predicting initial VTE in cancer, it has not been studied as a predictor for recurrent VTE. Therefore, researchers sought to evaluate the association of tissue factor, clinical risk factors, and other biomarkers measured at the time of initial VTE with recurrent VTE.

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In this prespecified analysis of the multicenter, randomized CATCH (Comparison of Acute Treatments in Cancer Hemostasis; Identifier: NCT01130025) trial, researchers assayed circulating tissue factor ELISA, soluble P-selectin, D-dimer, FVIII, and C-reactive protein of patients with cancer acute, symptomatic VTE receiving tinzaparin once daily or dose-adjusted warfarin for 6 months.

Among the 900 patients included in this analysis, 8.4% experienced a recurrent VTE. Mean and median circulating tissue factor levels were 72.5 pg/mL and 50.3 pg/mL, respectively.

Results showed that patients in the highest quartile of tissue factor levels (greater than 64.6 pg/mL) had more than a 3 times higher risk for developing VTE recurrence compared with all other patients (relative risk [RR], 3.3; 95% CI, 2.1-5.1; P <.001).

In a competing risk regression analysis of time to recurrent VTE, researchers found that tissue factor continued to be strongly associated with recurrent VTE (subdistribution hazard ratio [SHR], 3.3; 95% CI, 1.7-6.4).

The analysis further revealed that venous compression from mass (SHR, 3.1; 95% CI, 1.4-6.5) and hepatobiliary cancer (SHR, 5.5; 95% CI, 2.3-13.6) were significantly associated with VTE recurrence.

These findings suggest that researchers may be able to incorporate circulating tissue factor levels into a risk-adapted strategy to better identify high-risk patients who may derive more benefit from intensive anticoagulation approaches.


1. Khorana AA, Kamphuisen PW, Meyer G, et al. Tissue factor as a predictor of recurrent venous thromboembolism in malignancy: Biomarker analyses of the CATCH trial. J Clin Oncol. 2016 Dec 28. doi: 10.1200/JCO.2016.67.4564. [Epub ahead of print]