Predictors of recurrent venous thromboembolism and bleeding in patients with cancer: a meta-analysis Journal Article

  


Authors: Khan, F.; Tritschler, T.; Marx, C. E.; Lanting, V.; Rochwerg, B.; Tran, A.; Fernando, S. M.; Lorenzetti, D. L.; Wunsch, H.; Holodinsky, J.; Fiest, K.; Stelfox, H. T.; Delluc, A.; Fergusson, D. A.; Le Gal, G.; Wells, P. S.; Wang, T. F.; Sanfilippo, K.; van Es, N.; Schrag, D.; Connors, J. M.; Carrier, M.
Article Title: Predictors of recurrent venous thromboembolism and bleeding in patients with cancer: a meta-analysis
Abstract: Background and Aims Patients with cancer and venous thromboembolism (VTE) have a high risk of recurrent VTE and anticoagulant-related bleeding. This study aimed to identify prognostic factors for these complications.Methods A systematic review was performed for randomized trials and cohort studies evaluating prognostic factors for recurrent VTE or anticoagulant-related bleeding in adult patients with cancer and VTE. Adjusted hazard ratios (aHRs) for factors were pooled using random-effects meta-analysis. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.Results Thirty-three studies (n = 96 753) were included in the meta-analyses. Factors with high certainty of association with increased risk of recurrent VTE included a previous history of VTE [aHR 1.50 (95% CI 1.08-2.09)], Eastern Cooperative Oncology Group (ECOG) performance status >0 [1.81 (1.34-2.46)] or >1 [2.44 (1.55-3.84)], advanced cancer [1.38 (1.15-1.65)], and specific cancer sites including lung [1.78 (1.29-2.46)], hepatobiliary [2.37 (1.70-3.30)], pancreas [3.20 (2.06-4.96)], and genitourinary [1.38 (1.14-1.67)]. Conversely, recent surgery [aHR 0.56 (95% CI 0.40-0.76)] and breast cancer [0.43 (0.23-0.81)] had a high certainty of association with a decreased risk. Factors with a high certainty of association with an increased risk of anticoagulant-related bleeding included a history of bleeding [aHR 2.41 (95% CI 1.50-3.88)], ECOG performance status >= 2 [2.10 (1.48-2.99)], advanced cancer [1.60 (1.29-1.97)], and cancers of the brain [2.25 (1.64-3.09)], gastrointestinal system [1.74 (1.44-2.11)], genitourinary system [1.90 (1.48-2.45)], and prostate [1.72 (1.26-2.34)].Conclusions The prognostic factors identified in this meta-analysis should be considered as part of risk stratification frameworks for anticoagulation management in patients with cancer and VTE.
Keywords: bleeding; outcomes; venous thromboembolism; molecular-weight heparin; risk-factors; prevention; definition; pulmonary-embolism; deep-vein thrombosis; clinical-course; cancer; prognosis; active cancer
Journal Title: European Heart Journal
ISSN: 0195-668X
Publisher: Oxford University Press  
Publication status: Online ahead of print
Date Published: 2025-01-01
Online Publication Date: 2025-01-01
Language: English
ACCESSION: WOS:001518847700001
DOI: 10.1093/eurheartj/ehaf453
PROVIDER: wos
Notes: Article; Early Access -- Source: Wos
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