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.

abstract: the Oncologist - Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

 Abstract

Background. Evidence-based treatment guidelines recommend low molecular weight heparin (LMWH) monotherapy for cancer-associated venous thromboembolism (VTE). This analysis assessed the first-line treatment strategies for VTE in patients with advanced solid tumors.


Conclusions. Adoption of LMWH monotherapy as initial treatment for cancer-associated VTE was low but increased steadily over the study period. Future studies should explore reasons underlying the underutilization of this preferred evidence-based treatment as well as the comparative effectiveness of LMWH versus warfarin-based anticoagulation in real-world cancer patients with VTE.

Table 1. Baseline cohort patient characteristics, risk factors and comorbidities,....