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Thromb Haemost 2020; 120(04): 702-713
DOI: 10.1055/s-0040-1708481
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

A Meta-Analysis of Case Fatality Rates of Recurrent Venous Thromboembolism and Major Bleeding in Patients with Cancer

Alym Abdulla 
1   Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
,
Wendy M. Davis
1   Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
,
Namali Ratnaweera
2   Faculty of Social Sciences, University of Victoria, Victoria, British Columbia, Canada
,
Elena Szefer
3   Emmes Canada, Burnaby, British Columbia, Canada
,
Brooke Ballantyne Scott
4   Department of Evaluation and Research Services, Royal Columbian Hospital, New Westminster, British Columbia, Canada
,
Agnes Y. Y. Lee
1   Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
5   British Columbia Cancer Agency, Vancouver, British Columbia, Canada
› Author Affiliations Funding None.
Further Information

Publication History

05 November 2019

01 February 2020

Publication Date:
14 April 2020 (online)

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Abstract

Background Knowing the case fatality rates of recurrent venous thromboembolism (VTE) and major bleeding is important for weighing the relative risks and benefits of anticoagulation and deciding on the duration of anticoagulant therapy, but these rates are uncertain in patients with cancer-associated thrombosis.

Methods We performed a systematic review and a meta-analysis to determine the incidence of recurrent VTE and major bleeding and their respective case fatality rates in patients with cancer-associated VTE.

Results Our analysis included 29 studies (15 prospective cohort studies and 14 randomized controlled trials) from 1980 to January 2019. Data from 8,000 cancer patients with 4,786 patient-years of follow-up were summarized. Rates of recurrent VTE and fatal recurrent VTE were 23.7 (95% confidence interval [CI]: 20.1–27.8) and 1.9 (95% CI: 0.8–4.0) per 100 patient-years of follow-up, respectively, with a case fatality rate of 14.8% (95% CI: 6.6–30.1%). The rates of major bleeding and fatal major bleeding events were 13.1 (95% CI: 10.3–16.7) and 0.8 (95% CI: 0.3–2.1) per 100 patient-years of follow-up, respectively, with a case fatality rate of 8.9% (95% CI: 3.5–21.1%). While the estimates of case fatality vary by anticoagulation regimen and study design, the differences between them were not statistically significant.

Conclusion In cancer patients receiving anticoagulation, the case fatality rate of recurrent VTE is higher than the case fatality rate of major bleeding. These findings may help to inform decisions regarding the management of anticoagulation in patients with active cancer and VTE.

Keywords

thrombosis - malignancy - clinical trials: heparins/low-molecular-weight heparin - clinical trials: oral anticoagulants

Authors' Contributions

A.A. and B.B.S. conducted the initial literature search. A.A. and W.M.D. reviewed abstracts for inclusion in the study. A.A., W.M.D., and N.R. extracted data from included studies. E.S. conducted the analysis and synthesized results. A.A., W.M.D., and A.Y.Y.L designed the research, analyzed and interpreted the results, and wrote the manuscript. All authors have read and approved the manuscript for submission for final publication.


Note

N.R. was funded by a summer studentship from the Centre for Blood Research, University of British Columbia.


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