Treatment and Bleeding Complications of Cancer-Associated Venous Thromboembolism: A Korean Population-Based Study

Abstract

Objectives: Recent studies have shown that direct oral anticoagulants (DOACs) are effective for cancer-associated venous thromboembolism (CAT). This study investigated the treatment pattern and the rate of bleeding complications in real-world practice in CAT patients. Patients/Methods: We used the Korean Health Insurance Review and Assessment service database (2014-2018). Among patients with venous thromboembolism, patients with concomitant malignancy diagnostic codes were categorized as CAT, while all others were categorized as non-CAT. Treatments were categorized as DOAC, parenteral anticoagulant (PAC), warfarin, and mixed anticoagulant. Results: We identified 27,205 CAT and 57,711 non-CAT patients. DOACs were the most frequently used anticoagulants. The proportion of patients treated with PAC was significantly higher in CAT than non-CAT patients. (35.7% vs. 19.5%) (P<0.01). In CAT, the cumulative incidence of any/major bleeding was significantly higher with DOAC (8.1%/3.9%) than PAC (7.5%/3.2%; P=0.04 and 0.01, respectively). However, there was no difference in major bleeding when compared with warfarin (P=0.11) or mixed anticoagulant (P=0.94). Overall, gastrointestinal (GI) cancer patients showed higher risks of bleeding. The cumulative incidence of major GI bleeding was higher with DOAC than PAC (4.9% vs. 3.0%; P<0.01), while there was no difference compared with warfarin (P=0.59) or mixed anticoagulant (P=0.80). Major bleeding with each DOAC showed no difference among entire CAT (P=0.94), GI cancer (P=0.27), and GU cancer (P=0.88) patients. Conclusions: DOACs have become the most prescribed anticoagulant in CAT. Bleeding was more prevalent with DOAC than PAC. The bleeding complications should be carefully monitored to ensure optimal treatment, especially with DOAC.

Dynamic Patterns and Persistence of Anticoagulation Therapy in Patients with Venous Thromboembolism in South Korea: A Nationwide Cohort Study

“…Sizeable proportions of non-cancer patients who initiated PAC were observed in our study. Based on a previous study in Korea, 19.5% of non-cancer patients initiated PACs, supporting our findings and representing routine clinical practice of PAC utilization [26]. Interestingly, initial PAC therapy in patients with VTE with active cancer was substantial, which may be a good reflection of the clinical guidelines for optimizing anticoagulation therapy [27,28].…”

A Happy New Year 2023 from Thrombosis and Haemostasis

“…Another nice example of a visual summary from TH Open is the paper by Spyropoulos et al 18 These also facilitate our social media activities, which include interviews with authors of featured papers, for example, this one by Kim et al 19 https://twitter.com/TH_Journal/status/15572940705061 80608.…”

“…These also facilitate our social media activities, which include interviews with authors of featured papers, for example, this one by Kim et al 19…”

Immune Checkpoint Inhibitors and Venous Thromboembolism: The More Things Change…

“…5,6 Although initial toxicity reports did not include vascular effects, emerging data from various groups focused on hematologic toxicities have pointed to a high rate of an old complication associated with these new agents: venous thromboembolism (VTE). 7 In this issue of the journal, le Sève et al buttress the existing data with interesting new information. 8 The investigators conducted a cohort study of 374 cancer patients (mostly with lung cancer or melanoma) receiving ICI therapy (mostly single-agent nivolumab) at their institution.…”