PB0919 - High rates of bleeding in unselected patients with cancer: results from a prospective cohort study

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Cornelia Englisch, MD

PhD Student
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria
Vienna, Wien, Austria

Co-Author(s)

Florian Moik, MD PhD (he/him/his)

Medical University of Vienna, Department of Medicine I, Clinical Division of Haematology and Haemostaseology
Vienna, Austria
Daniel Steiner, MD

PhD Student
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
AB

Anna Berghoff

Head of Translational Research Unit
Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Austria
Vienna, Wien, Austria
MP

Matthias Preusser

Head of Division
Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Austria
Vienna, Wien, Austria
Ingrid Pabinger, MD

Co-Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
Cihan Ay, MD (he/him/his)

Professor, Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria

Background: Hemostatic imbalances are frequent in patients with cancer. While thrombotic complications have been extensively studied, less is known about baseline bleeding risk and risk factors for bleeding. To allow for a personalized risk-assessment balancing the risk of thrombotic complications and bleeding in patients with cancer, more knowledge on bleeding risk is needed.

Aims: We aimed to investigate bleeding events and risk factors for bleeding in a prospective cohort study including patients with cancer initiating systemic anti-cancer therapies.

Methods: Bleeding events were classified according to the ISTH definition of major bleeding (MB) and clinically relevant non-major bleeding (CRNMB). All cause-mortality was considered a competing event and therefore competing risk analyses were performed.

Results: In total, 702 patients (median age [interquartile range, IQR]: 63 [54-71] years) were included, of which 47% were female. During a median follow-up time of 10 months (IQR: 4-18 months), 355 (50.4%) patients died. We observed 146 clinically relevant bleeding events (defined as the composite of MB, n=64 and CRNMB, n=83) in 106 patients (6-months cumulative incidence for clinically relevant bleeding: 8.1%, 95% confidence interval [CI]: 6.1-10.3; and major bleeding: 4.2%, 95% CI: 2.9-6.0, figure 1). Of those, 58 events (38.9%) were considered as tumor bleeds, 42 (28.2%) occurred during active anticoagulation treatment, and 17 (11.4%) during a period of thrombocytopenia (defined as platelets < 100G/L). Low hemoglobin, high leukocyte and platelet counts, and low BMI at baseline were associated with increased bleeding risk, whereas cancer stage and kidney function were not associated with bleeding risk (table 1).

Conclusion(s): Bleeding events are frequent in unselected patients with cancer and a large percentage of bleeding events were tumor-related bleeds. Low hemoglobin, high leukocyte and platelet counts, and lower BMI were associated with a higher risk of bleeding.