Bleeding in cancer patients and its treatment: a review

Abstract

Bleeding is a common problem in cancer patients, related to local tumor invasion, tumor angiogenesis, systemic effects of the cancer, or anti-cancer treatments. Existing bleeds can also be exacerbated by medications such as bevacizumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticoagulants. Patients may develop acute catastrophic bleeding, episodic major bleeding, or low-volume oozing. Bleeding may present as bruising, petechiae, epistaxis, hemoptysis, hematemesis, hematochezia, melena, hematuria, or vaginal bleeding. Therapeutic intervention for bleeding should start by establishing goals of care, and treatment choice should be guided by life expectancy and quality of life. Careful thought should be given to discontinuation of medications and reversal of anticoagulation. Interventions to stop or slow bleeding may include systemic agents or transfusion of blood products. Noninvasive local treatment options include applied pressure, dressings, packing, and radiation therapy. Invasive local treatments include percutaneous embolization, endoscopic procedures, and surgical treatment.

Bleeding incidence and risk factors among cancer patients treated with anticoagulation

“…However, predictors of bleeding in cancer patients are incompletely understood and formal bleeding prediction algorithms have not been developed in this population. Prior studies estimate bleeding complications occur in 6%‐10% of patients with advanced cancer, however, further data are needed to better predict which cancer patients are more prone to bleeding, particularly in the DOAC era. The aims of our study were to describe the incidence of bleeding among cancer and non‐cancer patients, treated with different anticoagulants in a real‐world setting, and to identify risk factors for bleeding in cancer patients.…”

Anticoagulation of cancer patients with non‐valvular atrial fibrillation receiving chemotherapy: Guidance from the SSC of the ISTH

“…Atrial fibrillation becomes more prevalent with age and increases the overall risk of embolic stroke five‐fold . Anticoagulation has long been established as the most effective way to prevent embolic stroke, but this is challenging in the cancer setting since it is associated with a higher rate of clinically relevant non‐major and major bleeding . Cancer patients often have additional risk factors for bleeding, independent of anticoagulation, including thrombocytopenia, use of non‐steroidal antiinflammatory drugs or antiplatelet agents, or renal dysfunction …”

Bevacizumab Eligibility in Patients with Metastatic and Recurrent Cervical Cancer: A Retrospective Review

“…It is important to note that in clinical practice, eligibility for any particular therapy is a dynamic process. Patients presenting with vaginal bleeding, especially if such bleeding is low-grade, could potentially be managed with palliative radiation to control or stop bleeding 15 in order to allow more women to receive bevacizumab as part of their therapy. This is left to the discretion of the practitioner, anticipating control of tumor-associated bleeding.…”