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Impact of Anticoagulant Choice on Hospitalized Bleeding Risk when Treating Cancer-Associated Venous Thromboembolism.
J Thromb Haemost. 2018 Sep 21;:
Authors: Zakai NA, Walker RF, MacLehose RF, Adam TJ, Alonso A, Lutsey PL
Abstract
BACKGROUND: Direct acting oral anticoagulants (DOAC) are associated with less bleeding than traditional venous thromboembolism (VTE) treatments in the general population but are little studied in cancer-associated VTE (CA-VTE).
OBJECTIVE: To determine whether different anticoagulation strategies for CA-VTE have different hospitalized bleeding rates.
PATIENTS/METHODS: We conducted a retrospective study of patients with CA-VTE diagnosed between 2011-2015 in a large administrative database. Using validated algorithms, we identified 26,894 CA-VTE patients treated with anticoagulants and followed them for hospitalized severe bleeding. Cox models were used to assess bleeding risk adjusted for age, sex, high dimensional propensity score, and frailty.
RESULTS: Over 27,281 person-years of follow-up (median 0.6 years), 1,204 bleeding events occurred for a bleeding rate of 4.4% per patient-year. Bleeding rates varied by cancer type with the highest rate for upper gastrointestinal cancers (8.6%) and the lowest for breast cancer (2.9%). In Cox models (HR; 95% CI), compared with warfarin, DOACS and LMWH had similar hazards of bleeding (HR 0.88; 0.69 - 1.11 and HR 0.98; 0.85 - 1.13). Compared to LMWH, there was no difference in hazard of bleeding with DOACs (0.86; 0.66 - 1.12). There was heterogeneity in bleeding risk with DOACs by cancer type, with a higher risk of bleeding in upper gastrointestinal cancers and lower bleeding risk in prostate cancer and hematologic cancers.
CONCLUSIONS: In this practice-based sample of CA-VTE patients, DOACs were associated with similar bleeding risks to warfarin and LMWH. These findings suggest a complex association of bleeding risk with anticoagulant choice in cancer patients. This article is protected by copyright. All rights reserved.
PMID: 30240508 [PubMed - as supplied by publisher]