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Clinically Relevant Bleeding in Individuals With Cancer: Insights From a Nationwide Cohort Study
Ming Y Lim1, Radhika Gangaraju2, Omid Jafari3
1Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, Utah, USA.
American Journal of Hematology
|June 4, 2026
Summary
Clinically relevant bleeding (CRB) is a common, underestimated threat in cancer care, often preceding diagnosis. This study highlights CRB
Area of Science:
- Oncology
- Hematology
- Clinical Informatics
Background:
- Cancer patients face coagulopathy, with bleeding being an underestimated risk compared to thrombosis.
- Venous thromboembolism (VTE) is well-studied, but clinically relevant bleeding (CRB) in cancer patients requires further investigation.
Purpose of the Study:
- To determine the impact and incidence of cancer-associated clinically relevant bleeding (CRB).
- To identify risk factors associated with CRB in cancer patients.
- To assess the association between CRB and mortality in cancer patients.
Main Methods:
- Utilized the Epic Cosmos database, analyzing data from 2,455,332 individuals with incident cancer encounters across 215 US health systems (2018-2024).
- Conducted multivariable analysis to identify factors associated with CRB, including demographics, cancer characteristics, treatments, and laboratory features.
- Assessed the independent association of CRB onset with mortality using time-varying covariate analysis.
Main Results:
- CRB presented in 5.3% of patients in the 12 months before cancer diagnosis and had a cumulative incidence of 6.3% in the 12 months after diagnosis.
- Higher CRB incidence was observed in patients receiving systemic antineoplastic therapy (7.0%) and those on certain baseline anticoagulants (up to 15.0%).
- Intracranial hemorrhage (HR 4.17), gastrointestinal bleeding (HR 2.52), and other bleeding (HR 2.46) were independently associated with increased mortality.
Conclusions:
- Cancer-associated CRB is a substantial and frequently overlooked risk, often appearing early in the disease course.
- Factors including cancer type, metastatic disease, systemic therapy, anticoagulation, comorbidities, and specific lab values are associated with CRB.
- There is a critical need for validated bleeding risk models to complement VTE prediction tools for personalized thromboprophylaxis in cancer care.
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