The oncology treatment of patients who use oral anticoagulants is connected with high risk of bleeding complications

Abstract

The data about risk for bleeding complications during anticoagulation in cancer patients with different oncology treatment are conflicting. To investigate the rate of bleeding in the course of oral anticoagulants, during treatment of malignant diseases, we conducted a retrospective study including 75 patients on stable anticoagulation prior to commencing their different oncology treatment. All patients were treated according to the consiliar decision, made based on the localization and pathohistological findings of the malignant disease. During their treatment the regular laboratory monitoring of INR was done. Every dose of oral anticoagulants, INR changes, as well as the size and localization of bleeding were recorded. During all the malignancy treatment 22 (30%) of patients were overanticoagulated. In 15 (20%) patients it was associated with bleeding, while 3 (4%) of them had to be transfused with fresh frozen plasma to stop the major bleeding. Most bleeding complications occurred in the group of patients treated with chemotherapy or with analgesics in the group with advanced disease. None of the bleeding complications were observed in patients treated with irradiation and surgery alone, where the bridging of oral anticoagulants with low molecular weight heparin was done before surgery. The oncology treatment of patients who take oral anticoagulants was connected with high risk for bleeding especially if chemotherapy as a therapeutic options was used. Therefore physicians should be aware of this risk and carefully monitor the intensity of anticoagulant therapy, especially during the first treatment weeks when the risk of bleeding is greatest.

Predictors of major bleeding in peri‐procedural anticoagulation management

“…Active cancer has been suggested as a strong predictor of bleeding complications [6,8,14,15]. Cancer‐specific therapy is associated with bleeding complications among patients who are on chronic anticoagulation [14].…”

Vitamin K Antagonists Compared to Low-Molecular-Weight Heparins for Treatment of Cancer-Associated Venous Thromboembolism: An Observational Study in Routine Clinical Practice

“…Treatment of cancer-associated venous thromboembolism (VTE) is challenging as the risks of recurrent VTE and bleeding complications are notably higher compared with the general VTE population. [1][2][3] In the past decade, several clinical trials have demonstrated a reduced risk of symptomatic recurrent VTE in cancer patients treated with longterm low-molecular-weight heparins (LMWH) monotherapy compared with patients receiving conventional treatment with vitamin K antagonists (VKA). [4][5][6][7] As a result, current international guidelines consider LMWH as the agent of choice in this setting.…”