Cancer effect on periprocedural thromboembolism and bleeding in anticoagulated patients

Cancer effect on periprocedural thromboembolism and bleeding in anticoagulated patients:

Background:
Patients with active cancer are often on chronic anticoagulation and frequently require interruption of this treatment for invasive procedures. The impact of cancer on periprocedural thromboembolism (TE) and major bleeding is not known.

Patients and methods:
Two thousand one hundred and eighty-two consecutive patients referred for periprocedural anticoagulation (2484 procedures) using a standardized protocol were followed forward in time to estimate the 3-month incidence of TE, major bleeding and survival stratified by anticoagulation indication. For each indication, we tested active cancer and bridging heparin therapy as potential predictors of TE and major bleeding.

Results:
Compared with patients without cancer, active cancer patients (n = 493) had more venous thromboembolism (VTE) complications (1.2% versus 0.2%), major bleeding (3.4% versus 1.7%) and reduced survival (95% versus 99%). Among active cancer patients, only those chronically anticoagulated for VTE had higher rates of periprocedural VTE (2% versus 0.16%;) and major bleeding (3.7% versus 0.6%). Bridging with heparin increased the rate of major bleeding in cancer patients (5% versus 1%;) without impacting the VTE rate (0.7% versus 1.4%,).

Conclusions:
Cancer patients anticoagulated for VTE experience higher rates of periprocedural VTE and major bleeding. Periprocedural anticoagulation for these patients requires particular attention to reduce these complications.

Medscape: Bleeding Rates and Medical Costs of New Oral Anticoagulants (warfarin, dabigatran...)

Bleeding Rates and Medical Costs of New Oral Anticoagulants

April 2, 2012 (Chicago, Illinois) — Firsthand experience with the new oral anticoagulants, coupled with excitement over those yet to be widely in use, has inspired a range of studies examining real-world risk/benefits, as well as the potential costs of replacing warfarin with the new agents.

In a poster session at last week's American College of Cardiology 2012 Scientific Sessions, investigators presented two separate experiences with dabigatran from different US centers--showing very different results--while others presented new cost analyses comparing different oral agents with warfarin.

One US report of patients switched to dabigatran showed a much higher rate of major bleeding than in the RE-LY trial, but a lower rate of dyspepsia, while a second report showed a lower rate of both major and minor bleeding compared with RE-LY trial.

Bridging Anticoagulation: Is it Needed When Warfarin Is Interrupted Around the Time of a Surgery or Procedure?

Bridging Anticoagulation
 Cardiology Patient Page

Is it Needed When Warfarin Is Interrupted Around the Time of a Surgery or Procedure?

1. The BRIDGE Study Investigators