Clinical Impact and Course of Anticoagulant-Related Major Bleeding in Cancer Patients.

Autor:	Kraaijpoel N; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands., van Es N; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands., Bleker SM; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands., Brekelmans MPA; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands., Eerenberg ES; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands., Middeldorp S; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands., Cohen AT; Department of Haematological Medicine, Guy's and St Thomas' Hospitals, King's College London, London, United Kingdom., Raskob GE; College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States., Büller HR; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	Thrombosis and haemostasis [Thromb Haemost] 2018 Jan; Vol. 118 (1), pp. 174-181. Date of Electronic Publication: 2018 Jan 05.
DOI:	10.1160/TH17-04-0274
Abstrakt:	Cancer patients with venous thromboembolism (VTE) have a two- to six-fold increased risk of anticoagulant-related major bleeding events compared with VTE patients without cancer. It is unknown whether major bleeding events are more severe in cancer patients than in those without cancer. Individual patient data from four randomized phase III trials that compared factor Xa inhibitors and vitamin K antagonists for the treatment of VTE were used to compare the severity of major bleeding events in patients with and without cancer. Using predefined criteria, the severity of the clinical presentation and course of major bleeding events were classified into four categories of increasing severity. A one-stage meta-analysis was used to evaluate the effect of cancer on the severity of the clinical presentation and course by estimating crude odds ratios (ORs) and ORs adjusted for age, sex and anticoagulant type with 95% confidence intervals (CIs). The study group comprised 290 patients with major bleeding, of whom 50 (17%) had cancer. The clinical presentation was judged to be severe (category 3 or 4) in 38% of patients with cancer and 44% of patients without cancer (adjusted OR, 0.90; 95% CI, 0.47-1.72). The clinical course was found to be severe in 20 and 25% of patients with and without cancer, respectively (adjusted OR, 0.75; 95% CI, 0.35-1.61). The present study suggests that the clinical presentation and course of anticoagulant-related major bleeding events are not more severe in cancer patients than in patients without cancer. This may be reassuring for physicians who treat cancer patients with anticoagulant-related bleeding. Competing Interests: Conflicts of Interest: N. K. has nothing to disclose. N. v. E. reports a personal fee from Pfizer. S. M. B. has nothing to disclose. M. P. A. B. has nothing to disclose. E. S. E. reports personal fees from CSL Behring, grants from Sanquin and grants from Baxter, outside the submitted work. A. T. C. reports grants and personal fees from Bristol-Myers Squibb and Pfizer Limited, and personal fees from Boehringer Ingelheim, Johnson & Johnson, Portola, Sanofi Aventis, XO1, Janssen and Bayer HealthCare, and grants from Daiichi Sankyo, outside the submitted work. S. M. reports grants and personal fees from GSK, BMS/Pfizer, Aspen and Daiichi Sankyo, personal fees from Bayer and Boehringer Ingelheim, and grants from Sanquin, outside the submitted work. G. E. R. reports personal fees from Daiichi Sankyo, Itreas, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Isis Pharmaceuticals, Janssen, Pfizer and Portola, outside the submitted work. H. R. B. reports grants and personal fees from Daiichi Sankyo, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Isis Pharmaceuticals, GSK, Roche, Sanofi and Thrombogenics, outside the submitted work. (Schattauer GmbH Stuttgart.)
Databáze:	MEDLINE
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