Patients with ACS who had a bleeding event after hospital discharge had an increased risk for a subsequent cancer diagnosis within the first 6 months, according to a study published in The American Journal of Cardiology.
“We transmit the message that when spontaneous bleeding of gastrointestinal, genitourinary or bronchopulmonary localization, even minor, tumor etiology should always be ruled out,” Sergio Raposeiras-Roubin, MD, PhD, clinical cardiologist at University Hospital Alvaro Cunqueiro in Vigo, Spain, told Healio. “Of every five major bleeding from those sites, one is caused by cancer, and most of these cancers are diagnosed in the first 3 months after bleeding. Therefore, these bleeding [events] can help us to an early detection of silent cancers.”
Researchers analyzed data from 3,644 patients (mean age, 64 years; 22% women) with ACS who were discharged with dual antiplatelet therapy after PCI between 2010 and 2016.
The primary endpoint was a new diagnosis of cancer, defined as a malignancy other than nonmelanoma skin cancer that was diagnosed after discharge for ACS. Follow-up was conducted for a median of 56.2 months.
Bleeding severity and increased risk for a subsequent cancer diagnosis.
During follow-up, 1,216 patients had a bleeding event after hospital discharge, which equated to a crude rate of 9.4 per 100 patient-years. Cancer was newly diagnosed in 227 patients for a cumulative incidence of 1.4 per 100 patient-years (95% CI, 1.2-1.6).
Bleeding after hospital discharge was linked to a higher rate of newly diagnosed cancer (HR = 3.43; 95% CI, 2.62-4.5), although this was only observed with spontaneous bleeding compared with traumatic bleeding (HR = 4.38; 95% CI, 3.31-5.79). The association between bleeding and cancer was stronger as bleeding severity increased: (Bleeding Academic Research Consortium (BARC) type 1 (HR = 1.52; 95% CI, 0.96-2.43), BARC type 2 (HR = 4.88; 95% CI, 3.48-6.85), BARC type 3a (HR = 7.3; 95% CI, 3.68-14.46), BARC type 3b (HR = 12.29; 95% CI, 5.59-26.98).
The positive predictive value for any bleeding after hospital discharge was 7.7%. The median time from bleeding after hospital discharge to the diagnosis of cancer was 4.6 months.
“Our study teaches the need for a proactive search for cancers in patients who experience bleeding after initiating dual antiplatelet therapy,” Raposeiras-Roubin said in an interview. – by Darlene Dobkowski
For more information:
Sergio Raposeiras-Roubin, MD, PhD, can be reached at firstname.lastname@example.org.
Disclosures: The authors report no relevant financial disclosures.