Bayer Pharma AG

Essence of this Article

Bleeding complications associated with anticoagulation therapy have been shown to be more frequent in patients with cancer than in those without cancer. Striking a balance between the risk of bleeding and the benefits of anticoagulant therapy in patients with cancer is, therefore, particularly important. The 2012 American College of Chest Physicians (ACCP) guidelines identify several factors that, in patients at a high risk of bleeding, indicate a lower risk of recurrence of venous thromboembolism (VTE) in patients with cancer, and may support stopping anticoagulant therapy.

Balancing the risks and benefits of anticoagulation in patients with cancer

Striking a balance between the risk of bleeding and the benefits of anticoagulant therapy in patients with cancer is particularly important because bleeding complications associated with anticoagulation therapy have been shown to be more frequent in patients with cancer than in those without cancer.277, 304, 310

Registry data from approximately 4000 patients with cancer and acute VTE showed that an increased incidence of major bleeding was associated with:

  • Immobility
  • Metastatic cancer
  • Recent bleeding
  • Creatinine clearance <30 ml/min308

The 2012 ACCP guidelines suggest that in patients at a high risk of bleeding, the following factors indicate a lower risk of recurrence in patients with cancer, and, therefore, may support stopping anticoagulant therapy:

  • VTE associated with a superimposed reversible risk factor (e.g. recent surgery, chemotherapy)
  • A response to cancer treatment
  • Cancer that has not metastasized
  • Isolated distal deep vein thrombosis301

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