Evidence map›Paper›PMID 30240508›Full record

ArticleJournal of thrombosis and haemostasis : JTH2018

Impact of anticoagulant choice on hospitalized bleeding risk when treating cancer-associated venous thromboembolism.

N A Zakai, R F Walker, R F MacLehose, T J Adam, A Alonso, P L Lutsey

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of thrombosis and haemostasis : JTH, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

N A ZakaiDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
R F WalkerSchool of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
R F MacLehoseSchool of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
T J AdamDepartment of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.
A AlonsoDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
P L LutseySchool of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.ORCID 0000-0002-1572-1340

Funding

Contemporary Venous Thromboembolism TreatmentR01HL131579 · NHLBI · UNIVERSITY OF MINNESOTA · PI LUTSEY, PAMELA L. · 2017 to 2020
$1.9M
Comparative Effectiveness of Oral Anticoagulants in Atrial FibrillationR01HL122200 · NHLBI · UNIVERSITY OF MINNESOTA · PI ALONSO, ALVARO · 2015 to 2017
$1.2M
NHLBI NIH HHS R01 HL122200NHLBI NIH HHS R01 HL131579
6 · The paper itself

Abstract

Essentials Bleeding risk by anticoagulant choice for cancer-associated venous thrombosis (CA-VTE) is unknown. 26 894 people with CA-VTE were followed for bleeding in a claims database in the United States. Hospitalized bleeding risk was similar with direct acting oral anticoagulants vs. warfarin. Relative hospitalized bleeding risk varied by cancer type and anticoagulant choice. SUMMARY: Background Direct acting oral anticoagulants (DOACs) are associated with less bleeding than traditional venous thromboembolism (VTE) treatments in the general population but are little studied in cancer-associated VTE (CA-VTE). Objective To determine whether different anticoagulation strategies for CA-VTE have different hospitalized bleeding rates. Patients/Methods We conducted a retrospective study of patients with CA-VTE, diagnosed between 2011 and 2015, in a large administrative database. Using validated algorithms, we identified 26 894 CA-VTE patients treated with anticoagulants and followed them for hospitalized severe bleeding. Cox models were used to assess bleeding risk, adjusted for age, sex, high dimensional propensity score and frailty. Results Over 27 281 person-years of follow-up (median 0.6 years), 1204 bleeding events occurred, for a bleeding rate of 4.4% per patient-year. Bleeding rates varied by cancer type, with the highest rate for upper gastrointestinal cancers (8.6%) and the lowest for breast cancer (2.9%). In Cox models (hazard ratio [HR]; 95% confidence interval [CI]), compared with warfarin, DOACS and low-molecular-weight heparin (LMWH) had similar hazards of bleeding (HR, 0.88; 95% CI, 0.69-1.11 and 0.98; 0.85-1.13). Compared with LMWH, there was no difference in hazard of bleeding with DOACs (0.86; 0.66-1.12). There was heterogeneity in bleeding risk with DOACs by cancer type, with a higher risk of bleeding in upper gastrointestinal cancers and lower risk of bleeding in prostate cancer and hematologic cancers. Conclusions In this practice-based sample of CA-VTE patients, DOACs were associated with similar bleeding risks to warfarin and LMWH. These findings suggest a complex association of bleeding risk with anticoagulant choice in cancer patients.

Indexed as

HospitalizationAdministration, OralAdministrative Claims, HealthcareAgedAnticoagulantsBlood CoagulationClinical Decision-MakingDatabases, FactualDrug UtilizationFemaleHemorrhageHumansInpatientsMaleMiddle AgedNeoplasmsAnticoagulantsWarfarinanticoagulantsdrug utilizationhemorrhageneoplasmsvenous thrombosis

Identifiers

PMID30240508
PMCPMC6289651

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.