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

Sang-A Kim1, Ju Hyun Lee1, Ji Yun Lee1

  • 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Thrombosis and Haemostasis
|June 28, 2022
PubMed

Insights

Direct oral anticoagulants (DOACs) are common for cancer-associated venous thromboembolism (CT) but show higher bleeding risks than parenteral anticoagulants (PACs) in real-world Korean practice. Gastrointestinal cancer patients face elevated bleeding risks with DOACs.

Area of Science:

  • Cardiology
  • Oncology
  • Pharmacology

Background:

  • Cancer-associated venous thromboembolism (CT) presents unique challenges in anticoagulation management.
  • Real-world data on treatment patterns and bleeding risks in CT patients are crucial for clinical decision-making.

Purpose of the Study:

  • To investigate the treatment patterns of anticoagulation in cancer-associated venous thromboembolism (CT) patients.
  • To evaluate the rate of bleeding complications associated with different anticoagulant therapies in CT patients.

Main Methods:

  • Utilized the Korean Health Insurance Review and Assessment Service database (2014-2018).
  • Categorized patients into CT and non-CT groups based on diagnostic codes.
  • Classified anticoagulant treatments into direct oral anticoagulant (DOAC), parenteral anticoagulant (PAC), warfarin, and mixed anticoagulants.

Main Results:

  • DOACs were the most frequent anticoagulant used in both CT and non-CT patients.
  • The proportion of patients treated with PAC was significantly higher in CT patients (35.7%) compared to non-CT patients (19.5%).
  • In CT patients, DOACs were associated with a higher incidence of any/major bleeding (8.1%/3.9%) compared to PAC (7.5%/3.2%).
  • Gastrointestinal (GI) cancer patients exhibited higher bleeding risks, with DOACs showing increased major GI bleeding compared to PAC.

Conclusions:

  • Direct oral anticoagulants (DOACs) have become the most prescribed anticoagulant in Korea for venous thromboembolism, including in cancer patients.
  • Bleeding complications are more frequent in cancer-associated venous thromboembolism (CT) patients than in non-CT patients, particularly those treated with DOACs.
  • Specific patient subgroups, such as those with GI cancer, may experience higher bleeding risks with certain anticoagulant therapies.
Abstract

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