Evidence map›Paper›PMID 34662498›Full record

Trial reportJournal of thrombosis and haemostasis : JTH2022

Growth differentiation factor-15 for prediction of bleeding in cancer patients.

Frits I Mulder, Floris T M Bosch, Marc Carrier, Ranjeeta Mallick, Saskia Middeldorp, Nick van Es, Pieter Willem Kamphuisen, Phill S Wells

Open access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of thrombosis and haemostasis : JTH, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
2.0field-weighted citation impact, top 13% of its field
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

9 citing papers in PubMed, 22 citations in OpenAlex.

  1. Trial
  2. Trial
  3. Article
  4. Review
  5. Anticoagulants in hematologic malignancies: what is the data?Hematology. American Society of Hematology. Education Program · 2025
    Review
  6. Article
  7. Article
  8. Article
  9. Article
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

8 authors at 4 institutions in 2 countries.

Frits I MulderDepartment of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University, Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.ORCID 0000-0002-6902-3425
Floris T M BoschDepartment of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University, Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.ORCID 0000-0002-1286-5402
Marc CarrierDepartment of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Ranjeeta MallickDepartment of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Saskia MiddeldorpDepartment of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University, Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.ORCID 0000-0002-1006-6420
Nick van EsDepartment of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University, Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Pieter Willem KamphuisenDepartment of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University, Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Phill S WellsDepartment of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Tergooi · NLUniversity of Ottawa · CAAmsterdam University Medical Centers · NLRadboud University Nijmegen · NL

Funding

CIHR
6 · The paper itself

Abstract

backgroundGrowth differentiation factor-15 (GDF-15) is a strong predictor for bleeding in patients with atrial fibrillation, but there are no data on cardiovascular outcomes for this biomarker in cancer patients. Bleeding risk assessment is important in cancer patients when considering primary thromboprophylaxis because it is associated with an increased bleeding risk.

objectivesTo evaluate GDF-15 as predictor for bleeding events in cancer patients previously enrolled in the AVERT trial. PATIENTS/

methodsIn this trial, 574 participants were randomized to prophylactic apixaban or placebo and followed for 180 days for venous thromboembolism, major bleeding, clinically relevant nonmajor bleeding, and any bleeding. Plasma concentrations of GDF-15 were measured centrally with the Elecsys GDF-15 commercial assay kit (Roche Diagnostics GmbH).

resultsIn apixaban recipients, the area under the receiver operator characteristic curve of GDF-15 for major bleeding was 0.73 (95% confidence interval [CI], 0.44-1.00). Compared with the lowest GDF-15 tertile (<1470 ng/L), major bleeding risk was significantly higher in the highest tertile (≥2607 ng/L; hazard ratio [HR] 3.19; 95% CI, 2.41-4.22), also when adjusting for sex, age, antiplatelet use, and gastrointestinal cancer (adjusted HR 2.80; 95% CI, 1.91-4.11). GDF-15 was also significantly associated with clinically relevant nonmajor bleeding (adjusted HR 1.67; 95% CI, 1.08-2.58) and any bleeding (adjusted HR 2.12; 95% CI, 1.38-3.25).

conclusionsAlthough hypothesis generating, this is the first study to show that GDF-15 predicts bleeding in cancer patients receiving thromboprophylaxis.

Indexed as

NeoplasmsVenous ThromboembolismAnticoagulantsGrowth Differentiation Factor 15HemorrhageHumansAnticoagulantsGrowth Differentiation Factor 15biomarkershemorrhageneoplasmsriskvenous thromboembolism

Identifiers

PMID34662498
PMCPMC9298353
OpenAlexW3205811878

What OpenQuestion holds

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LicenceCC BY-NC-ND
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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.