Fatal Events in Cancer Patients Receiving Anticoagulant Therapy for Venous Thromboembolism

Abstract

In cancer patients treated for venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and pulmonary embolism (PE), analyzing mortality associated with recurrent VTE or major bleeding is needed to determine the optimal duration of anticoagulation.This was a cohort study using the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) Registry database to compare rates of fatal recurrent PE and fatal bleeding in cancer patients receiving anticoagulation for VTE.As of January 2013, 44,794 patients were enrolled in RIETE, of whom 7911 (18%) had active cancer. During the course of anticoagulant therapy (mean, 181 ± 210 days), 178 cancer patients (4.3%) developed recurrent PE (5.5 per 100 patient-years; 95% CI: 4.8-6.4), 194 (4.7%) had recurrent DVT (6.2 per 100 patient-years; 95% confidence interval [CI]: 5.3-7.1), and 367 (8.9%) bled (11.3 per 100 patient-years; 95% CI: 10.2-12.5). Of 4125 patients initially presenting with PE, 43 (1.0%) died of recurrent PE and 45 (1.1%) of bleeding; of 3786 patients with DVT, 19 (0.5%) died of PE, and 55 (1.3%) of bleeding. During the first 3 months of anticoagulation, there were 59 (1.4%) fatal PE recurrences and 77 (1.9%) fatal bleeds. Beyond the third month, there were 3 fatal PE recurrences and 23 fatal bleeds.In RIETE cancer patients, the rate of fatal recurrent PE or fatal bleeding was much higher within the first 3 months of anticoagulation therapy.

FIGURE 1

Cumulative rate of recurrent pulmonary embolism (PE), recurrent deep-vein thrombosis (DVT) and major bleeding within the first 12 months of anticoagulation, according to initial venous thromboembolism (VTE) presentation (PE, with or without DVT, or DVT alone) in 7911 cancer patients enrolled in RIETE and treated for VTE.

FIGURE 2

Cumulative incidence of major bleeding (and sites of bleeding) within the first 12 months of anticoagulation in 7911 cancer patients enrolled in RIETE and treated for venous thromboembolism (VTE) (pulmonary embolism (PE), with or without deep-vein thrombosis (DVT), or DVT alone).

FIGURE 3

Cumulative rate of fatal pulmonary embolism (PE) and fatal bleeding within the first 12 months of anticoagulation, according to initial venous thromboembolism (VTE) presentation, PE with or without deep-vein thrombosis (DVT), or DVT alone in 7911 cancer patients enrolled in RIETE and treated by anticoagulation.