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    Poster Networking

    Venous Thromboembolism

    Poster Networking Session

    PB0928 - Competing risks analysis of recurrent venous thromboembolism (VTE) and bleeding on anticoagulation in patients with cancer-associated VTE

    Monday, June 26, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Co-Author(s)

    • DS

      David Simon

      MSc
      U1304-GETBO, Brest University, Data Stat Unit, CHU Brest, Brest, France
      Brest, Bretagne, France

    • BE

      Benjamin Espinasse

      MD
      INSERM U1304-GETBO, Univ Brest, FCRIN INNOVTE, Brest, France
      Brest, Bretagne, France

    • RL

      Raphaël Le Mao

      MD
      INSERM U1304-GETBO, Univ Brest, FCRIN INNOVTE, Brest, France.
      Brest, Bretagne, France

    • Leela Raj (she/her/hers)

      BHSc
      Schulich School of Medicine & Dentistr, London, Canada, Western University, U1304-GETBO, Brest, France
      London, Ontario, Canada

    • Claire de Moreuil, MD,PhD (she/her/hers)

      Hospital Practioner in Internal Medicine
      Internal medicine and Pneumology Department, Brest University Hospital, UMR 1304, GETBO
      BREST, Bretagne, France

    • CT

      Cecile Tromeur

      MD, PhD
      Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
      Brest, Bretagne, France

    • MG

      Marie Guegan

      TEC
      INSERM U1304-GETBO, Univ Brest, FCRIN INNOVTE, Brest, France
      Brest, Bretagne, France

    • EL

      Emmanuelle Le Moigne

      MD
      INSERM U1304-GETBO, Univ Brest, FCRIN INNOVTE, Brest, France
      Brest, Bretagne, France

    • EP

      Elise Poulhazan

      MSc
      U1304-GETBO, Brest University, Data Stat Unit, CHU Brest, Brest, France
      Brest, Bretagne, France

    • KL

      Karine Lacut

      MD, PhD
      U1304-GETBO, Brest University, Department of internal medicine and chest disease, CHU Brest, Brest, France
      Brest, Bretagne, France

    • CL

      Christophe Leroyer

      MD, PhD
      Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
      Brest, Bretagne, France

    • Isabelle MAHE, MD, PhD (she/her/hers)

      MD,PhD
      Paris Cité University, APHP, Hôpital Louis Mourier, Colombes, Internal Medicine Department, INSERM UMR_S1140, and F-CRIN InnoVTE, France
      Colombes, Ile-de-France, France

    • EN

      Emmanuel Nowak

      PhD
      U1304-GETBO, Brest University, Data Stat Unit, CHU Brest, Brest, France
      Brest, Bretagne, France

      • Presenting Author(s)

    • Francis Couturaud, PhD (he/him/his)

      MD, PhD
      Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
      Brest, Bretagne, France

    Background: Patients with cancer-associated thrombosis (CAT) have a high risk of recurrent venous thromboembolism (VTE) and clinically relevant bleeding (CRB). Knowledge on the risk factors for these two outcomes during anticoagulant therapy is sparse.

    Aims: To identify predictors of recurrent VTE and CRB during anticoagulant therapy.

    Methods: Cumulative incidences and risk factors for recurrent VTE and CRB were evaluated in CAT patients from EDITH cohort using cumulative incidence functions (CIF) and competing risks analysis with cause-specific and Fine-Gray models, considering recurrent VTE and CRB as events of interest and death as competing risk.

    Results: Among the 782 included patients, 84 (10.7%) patients developed recurrent VTE, 61 (7.8%) CRB, 145 (18.5%) died and 492 (62.9%) were event-free, during anticoagulation, at 18-month follow-up. The cumulative incidences (95% confidence interval [95%CI]) of recurrent VTE, CRB and death at 18 months were 13.1% (95%CI, 10.5-15.9), 10.0% (95%CI, 7.7-12.7), 24.4% (95%CI, 20.8-28.0), respectively (Figure). Using a competing risk multivariable model, metastasis (cause-specific hazard ratio (CHSR) 2.37 [95%CI, 1.49-3.77]; subdistribution hazard ratio (SHR) 1.90 [95%CI, 1.20-3.00]) and male sex (CHSR 1.75 [95%CI, 1.09-2.83]; SHR 1.67 [95%CI, 1.03-2.69]) were associated with increased risk and incidence of recurrent VTE, whereas cancer surgery (CHSR 0.47 [95%CI, 0.27-0.81]; SHR 0.51 [95%CI, 0.30-0.86]), and BMI ≥25 (CHSR 0.56 [95%CI, 0.35-0.90]; SHR 0.59 [95%CI, 0.37-0.92]) were associated with decreased risk and incidence of recurrent VTE; chemotherapy (SHR 0.55 [95%CI, 0.31-0.96]) was associated with decreased incidence of recurrent VTE (Table). Regarding the risk of CRB, the univariable analysis identified chemotherapy (CHSR 0.55 [95%CI, 0.33-0.94]; SHR 0.58 [95%CI, 0.34-0.97]) as associated with decreased rate and incidence of CRB; no predictors of CRB were found with competing multivariable model.

    Conclusion(s): During anticoagulation for CAT, metastasis, sex, cancer surgery, BMI and chemotherapy were predictive of recurrent VTE whereas chemotherapy was associated with CRB.