Addressing modifiable risk factors for anticoagulant-related bleeding in patients with cancer is an effective way to reduce bleeding and enable these patients to continue anticoagulant therapy, according to the results of a recently presented study at the 66th ASH Annual Meeting & Exposition held in San Diego, CA.1
Kristen M. Sanfilippo, MD, of the Washington University School of Medicine St. Louis, Chesterfield, MO, and St. Louis Veterans Affairs Medical Center in St. Louis, MO, and colleagues presented data from the US Veterans Administration healthcare system at the meeting. The researchers identified 11,731 patients with newly diagnosed cancer associated venous thromboembolism and who had been given a new prescription for anticoagulant therapy between 2012 and 2020.
Approximately half of the patients, 47.7%, received low-molecular-weight heparin, followed by direct oral anticoagulants (26.8%), vitamin K antagonists (24.5%), and fondaparinux (1%).
Bleeding probability before death at 1 year was 8.5%, and the most frequent sites of clinically significant bleeding included the gastrointestinal tract (57.2%), genitourinary tract (20.2%), and intracranial hemorrhage (10.4%).
Key modifiable risk factors associated with increased anticoagulant-related bleeding at 1 year included:
- Alcohol abuse (subdistribution hazard ratio [sHR], 1.30; 95% CI, 1.02-1.65)
- Anemia (hemoglobin <10 g/dL) (sHR, 1.27; 95% CI, 1.11-1.46)
- Antiplatelet therapy (sHR, 1.16; 95% CI, 0.98-1.37)
- Uncontrolled hypertension (sHR, 1.19; 95% CI, 1.04-1.37)
The researchers noted that eliminating anemia and uncontrolled hypertension together could reduce the bleeding probability by 19%, and that if all 4 of the listed modifiable risk factors were eliminated, the bleeding probability could be reduced by 23%.
“Identifying and potentially eliminating modifiable risk factors could reduce bleeding events without eliminating anticoagulant therapy,” the researchers concluded.
Reference
- Sanfilippo KM, Yan Y, Luo S, et al. Elimination of modifiable risk factors for anticoagulant-related bleeding in patients with cancer reduces the probability of bleeding. Presented at: 66th ASH Annual Meeting & Exposition. December 7-10, 2024; San Diego, CA. Abstract 814.
