In the Journals

Bleeding risk increased in patients with cancer-associated VTE, chronic kidney disease

Show Citation

January 10, 2014

Patients with cancer-associated venous thromboembolism and chronic kidney disease were at increased risk for major bleeding during anticoagulant treatment, according to study results.

The risk was highest among patients treated with low–molecular-weight heparin and in those with an estimated glomerular filtration rate (eGFR) less than 30 mL min-1.

Data on recurrent VTE and major bleeding during anticoagulant treatment of patients with cancer-associated VTE and chronic kidney disease are limited, but better management strategies are needed for this patient population, according to background information in the study.

Researchers assessed the risks for recurrent VTE and major bleeding events in 1,684 patients with cancer-associated VTE.

Patients were followed for 180 days after VTE diagnosis, and they were primarily treated with low–molecular-weight heparin or vitamin K antagonists.

The researchers observed 15.9 recurrent VTEs per 100 patient-years in those without chronic kidney disease (eGFR > 60 mL min-1); 19.5 events per 100 patient-years in those with stage IIIA chronic kidney disease (eGFR between 45 mL min-1 and 60 mL min−1); 14.9 events per 100 patient-years in those with stage IIIB disease (eGFR between 30 mL min-1 and 45 mL min-1); and 6.8 events per100 patient-years in those with stage IV/stage V disease (eGFR < 30 mL min-1).

Researchers reported major bleeding rates of 11.4 per 100 patient-years in those without chronic kidney disease; 18.5 per 100 patient-years in those with stage IIIA disease; 16 per 100 patient-years in those with stage IIIB disease; and 40.8 per 100 patient-years in those with stage IV/stage V disease.

Rates of fatal bleeding events were 1.1 per 100 patient-years in those without chronic kidney disease; 3.4 per 100 patient-years in those with stage IIIA disease; 6.3 per 100 patient-years in those with stage IIIB disease; and 15.7 per 100 patient-years in those with stage IV/stage V disease.

“These increased bleeding risks in chronic kidney disease patients were mainly observed in those on low–molecular-weight heparin treatment, not vitamin-K antagonists,” the researchers wrote.