Bleeding and New Cancer Diagnosis in Patients With Atherosclerosis

John W Eikelboom; Stuart J Connolly; Jacqueline Bosch; Olga Shestakovska; Victor Aboyans; Marco Alings; Sonia S Anand; Alvaro Avezum; Scott D Berkowitz; Deepak L Bhatt; Nancy Cook-Bruns; Camilo Felix; Keith A A Fox; Robert G Hart; Aldo P Maggioni; Paul Moayyedi; Martin O'Donnell; Lars Rydén; Peter Verhamme; Petr Widimsky; Jun Zhu; Salim Yusuf

doi:10.1161/CIRCULATIONAHA.119.041949

Bleeding and New Cancer Diagnosis in Patients With Atherosclerosis

John W Eikelboom, Stuart J Connolly, Jacqueline Bosch, Olga Shestakovska, Victor Aboyans, Marco Alings, Sonia S Anand, Alvaro Avezum, Scott D Berkowitz, Deepak L Bhatt, Nancy Cook-Bruns, Camilo Felix, Keith A A Fox, Robert G Hart, Aldo P Maggioni, Paul Moayyedi, Martin O'Donnell, Lars Rydén, Peter Verhamme, Petr WidimskyJun Zhu, Salim Yusuf

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	1451-1459
Number of pages	9
Journal	Circulation
Volume	140
Issue number	18
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.119.041949
Publication status	Published - 29 Oct 2019
Externally published	Yes

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10.1161/CIRCULATIONAHA.119.041949

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Eikelboom, J. W., Connolly, S. J., Bosch, J., Shestakovska, O., Aboyans, V., Alings, M., Anand, S. S., Avezum, A., Berkowitz, S. D., Bhatt, D. L., Cook-Bruns, N., Felix, C., Fox, K. A. A., Hart, R. G., Maggioni, A. P., Moayyedi, P., O'Donnell, M., Rydén, L., Verhamme, P., ... Yusuf, S. (2019). Bleeding and New Cancer Diagnosis in Patients With Atherosclerosis. Circulation, 140(18), 1451-1459. https://doi.org/10.1161/CIRCULATIONAHA.119.041949

@article{07d6b4aa43854f2cab268ab481810e12,

title = "Bleeding and New Cancer Diagnosis in Patients With Atherosclerosis",

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.",

author = "Eikelboom, {John W} and Connolly, {Stuart J} and Jacqueline Bosch and Olga Shestakovska and Victor Aboyans and Marco Alings and Anand, {Sonia S} and Alvaro Avezum and Berkowitz, {Scott D} and Bhatt, {Deepak L} and Nancy Cook-Bruns and Camilo Felix and Fox, {Keith A A} and Hart, {Robert G} and Maggioni, {Aldo P} and Paul Moayyedi and Martin O'Donnell and Lars Ryd{\'e}n and Peter Verhamme and Petr Widimsky and Jun Zhu and Salim Yusuf",

note = "Copyright: This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine",

year = "2019",

month = oct,

day = "29",

doi = "10.1161/CIRCULATIONAHA.119.041949",

language = "English",

volume = "140",

pages = "1451--1459",

journal = "Circulation",

issn = "0009-7322",

publisher = "Lippincott Williams & Wilkins",

number = "18",

}

Eikelboom, JW, Connolly, SJ, Bosch, J, Shestakovska, O, Aboyans, V, Alings, M, Anand, SS, Avezum, A, Berkowitz, SD, Bhatt, DL, Cook-Bruns, N, Felix, C, Fox, KAA, Hart, RG, Maggioni, AP, Moayyedi, P, O'Donnell, M, Rydén, L, Verhamme, P, Widimsky, P, Zhu, J & Yusuf, S 2019, 'Bleeding and New Cancer Diagnosis in Patients With Atherosclerosis', Circulation, vol. 140, no. 18, pp. 1451-1459. https://doi.org/10.1161/CIRCULATIONAHA.119.041949

TY - JOUR

T1 - Bleeding and New Cancer Diagnosis in Patients With Atherosclerosis

AU - Eikelboom, John W

AU - Connolly, Stuart J

AU - Bosch, Jacqueline

AU - Shestakovska, Olga

AU - Aboyans, Victor

AU - Alings, Marco

AU - Anand, Sonia S

AU - Avezum, Alvaro

AU - Berkowitz, Scott D

AU - Bhatt, Deepak L

AU - Cook-Bruns, Nancy

AU - Felix, Camilo

AU - Fox, Keith A A

AU - Hart, Robert G

AU - Maggioni, Aldo P

AU - Moayyedi, Paul

AU - O'Donnell, Martin

AU - Rydén, Lars

AU - Verhamme, Peter

AU - Widimsky, Petr

AU - Zhu, Jun

AU - Yusuf, Salim

N1 - Copyright: This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine

PY - 2019/10/29

Y1 - 2019/10/29

N2 - 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.

AB - 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.

U2 - 10.1161/CIRCULATIONAHA.119.041949

DO - 10.1161/CIRCULATIONAHA.119.041949

M3 - Article

C2 - 31510769

SN - 0009-7322

VL - 140

SP - 1451

EP - 1459

JO - Circulation

JF - Circulation

IS - 18

ER -

Bleeding and New Cancer Diagnosis in Patients With Atherosclerosis

Abstract

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