Format

Send to

Choose Destination
Circulation. 2019 Oct 29;140(18):1451-1459. doi: 10.1161/CIRCULATIONAHA.119.041949. Epub 2019 Sep 12.

Bleeding and New Cancer Diagnosis in Patients With Atherosclerosis.

Author information

1
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (J.W.E., S.J.C., J.B., O.S., S.S.A., R.G.H., P.M., S.Y.).
2
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada (J.B.).
3
Department of Cardiology, Dupuytren University Hospital, Limoges, France (V.A.).
4
Amphia Ziekenhuis and WCN, Utrecht, the Netherlands (M.A.).
5
Hospital Alemão Oswaldo Cruz, São Paulo, Brazil (A.A.).
6
Bayer AG, Whippany, NJ (S.D.B.).
7
Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.).
8
Bayer AG, Leverkusen, Germany (N.C.-B.).
9
Facultad de Ciencias de la Salud Eugenio Espejo-Universidad UTE, Quito, Ecuador (C.F.).
10
Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.).
11
ANMCO Research Center, Florence, Italy (A.P.M.).
12
NUI, Galway, Ireland (M.O.).
13
Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (L.R.).
14
University Leuven, Belgium (P.V.).
15
Cardiocenter, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic (P.W.).
16
FuWai Hospital, CAMS & PUMC, Beijing, China (J.Z.).

Abstract

BACKGROUND:

Patients treated with antithrombotic drugs are at risk of bleeding. Bleeding may be the first manifestation of underlying cancer.

METHODS:

We examined new cancers diagnosed in relation to gastrointestinal or genitourinary bleeding among patients enrolled in the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies) and determined the hazard of new cancer diagnosis after bleeding at these sites.

RESULTS:

Of 27 395 patients enrolled (mean age, 68 years; women, 21%), 2678 (9.8%) experienced any (major or minor) bleeding, 713 (2.6%) experienced major bleeding, and 1084 (4.0%) were diagnosed with cancer during a mean follow-up of 23 months. Among 2678 who experienced bleeding, 257 (9.9%) were subsequently diagnosed with cancer. Gastrointestinal bleeding was associated with a 20-fold higher hazard of new gastrointestinal cancer diagnosis (7.4% versus 0.5%; hazard ratio [HR], 20.6 [95% CI, 15.2-27.8]) and 1.7-fold higher hazard of new nongastrointestinal cancer diagnosis (3.8% versus 3.1%; HR, 1.70 [95% CI, 1.20-2.40]). Genitourinary bleeding was associated with a 32-fold higher hazard of new genitourinary cancer diagnosis (15.8% versus 0.8%; HR, 32.5 [95% CI, 24.7-42.9]), and urinary bleeding was associated with a 98-fold higher hazard of new urinary cancer diagnosis (14.2% versus 0.2%; HR, 98.5; 95% CI, 68.0-142.7). Nongastrointestinal, nongenitourinary bleeding was associated with a 3-fold higher hazard of nongastrointestinal, nongenitourinary cancers (4.4% versus 1.9%; HR, 3.02 [95% CI, 2.32-3.91]).

CONCLUSIONS:

In patients with atherosclerosis treated with antithrombotic drugs, any gastrointestinal or genitourinary bleeding was associated with higher rates of new cancer diagnosis. Any gastrointestinal or genitourinary bleeding should prompt investigation for cancers at these sites.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT01776424.

KEYWORDS:

aspirin; hemorrhage; neoplasms; rivaroxaban

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center