Cancer-related thrombosis: impact of biological sex on the risk of rethrombosis and bleeding

Abstract

Patients with cancer have a higher risk of re-thrombosis and bleeding secondary to anticoagulant treatment than have individuals without cancer. Given the lack of specific clinical trials, the decision regarding the optimal duration of treatment must consider multiple factors, including sex. The current study used data from the international, prospective TESEO Registry that includes consecutive patients diagnosed with cancer-associated thrombosis. Between July 2018 and December 2022, 2,823 patients were included in the TESEO Registry, 1,351 (48%) of whom were female. The most common venous thromboembolic event (VTE) in both sexes was pulmonary embolism, with an incidence of 58.0% among men and 54.3% in women (P=0.045). After a median follow-up of 6.9 months (interquartile range, 1.9-14.4), the re-thrombosis rate at the end of follow-up was 10.0% in males and 15.0% in females (P=0.14). The location of the primary tumor in the gastrointestinal tract was associated with a greater risk of re-thrombosis, whereas sex had no significant impact. Men had twice as many major bleeds. Additional risk factors for major bleeding included situations of risk due to tumor site or thrombocytopenia, as well as the presence of active tumor bleeding at the time of VTE diagnosis. Overall survival was longer among women. Given the higher incidence of major bleeding among men, sex should be deemed a relevant factor when deciding the duration of anticoagulant treatment in cancer patients.

Figure 1.

Survival by sex. 95% CI: 95% confidence interval.

Figure 2.

Survival by type of venous thromboembolic event. (A) Kaplan-Meier curve comparing survival from time of cancer diagnosis to demise according to type of venous thromboembolic event (VTE) (all patients, excluding patients with simultaneous VTE). (B) Kaplan-Meier curve comparing survival from time of cancer diagnosis to demise according to type of VTE (male, excluding patients with simultaneous VTE). (C) Kaplan-Meier curve comparing survival from time of cancer diagnosis to demise according to type of VTE (female, excluding patients with simultaneous VTE). 95% CI: 95% confidence interval; NA: not available; PE: pulmonary embolism; DVT: deep vein thrombosis.