Elsevier

Annals of Oncology

Volume 23, Issue 8, August 2012, Pages 1998-2005
Annals of Oncology

original articles
Quality of life and supportive care
Cancer effect on periprocedural thromboembolism and bleeding in anticoagulated patients

https://doi.org/10.1093/annonc/mds058Get rights and content
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ABSTRACT

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 % ; P = 0.001), major bleeding (3.4 % versus 1.7 % ; P = 0.02) and reduced survival (95 % versus 99 % ; P < 0.001). Among active cancer patients, only those chronically anticoagulated for VTE had higher rates of periprocedural VTE (2 % versus 0.16 % ; P = 0.002) and major bleeding (3.7 % versus 0.6 % ; P < 0.001). Bridging with heparin increased the rate of major bleeding in cancer patients (5 % versus 1 % ; P = 0.03) without impacting the VTE rate (0.7 % versus 1.4 % , P = 0.50).

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.

bleeding
malignancy
periprocedural management of anticoagulation
thromboembolism

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