Predictors of recurrent venous thromboembolism and bleeding in patients with cancer: a meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported in abstract

• Effect Size: Highest risk factors: pancreatic cancer (aHR 3.20), hepatobiliary cancer (aHR 2.37), ECOG >1 (aHR 2.44) for VTE recurrence

• Primary Outcome: Recurrent VTE and anticoagulant-related bleeding in cancer patients

• Nnt Or Sensitivity: History of bleeding increases bleeding risk 2.4-fold (aHR 2.41, 95% CI 1.50-3.88)

• Confidence Interval: 95% confidence intervals provided for all estimates, ranging from 1.08-4.96 across different factors

Clinical Application

Highly feasible - prognostic factors are readily available clinical variables (performance status, cancer type, surgical history) Directly applicable to Australian oncology and haematology practice; aligns with NHMRC cancer care guidelines and supports PBS anticoagulant prescribing decisions Adult cancer patients with established VTE requiring anticoagulation therapy

Abstract

BACKGROUND AND AIMS: Patients with cancer and venous thromboembolism (VTE) have a high risk of recurrent VTE and anticoagulant-related bleeding. This study aimed to identify prognostic factors for these complications. METHODS: A systematic review was performed for randomized trials and cohort studies evaluating prognostic factors for recurrent VTE or anticoagulant-related bleeding in adult patients with cancer and VTE. Adjusted hazard ratios (aHRs) for factors were pooled using random-effects meta-analysis. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: Thirty-three studies (n = 96 753) were included in the meta-analyses. Factors with high certainty of association with increased risk of recurrent VTE included a previous history of VTE [aHR 1.50 (95% CI 1.08-2.09)], Eastern Cooperative Oncology Group (ECOG) performance status >0 [1.81 (1.34-2.46)] or >1 [2.44 (1.55-3.84)], advanced cancer [1.38 (1.15-1.65)], and specific cancer sites including lung [1.78 (1.29-2.46)], hepatobiliary [2.37 (1.70-3.30)], pancreas [3.20 (2.06-4.96)], and genitourinary [1.38 (1.14-1.67)]. Conversely, recent surgery [aHR 0.56 (95% CI 0.40-0.76)] and breast cancer [0.43 (0.23-0.81)] had a high certainty of association with a decreased risk. Factors with a high certainty of association with an increased risk of anticoagulant-related bleeding included a history of bleeding [aHR 2.41 (95% CI 1.50-3.88)], ECOG performance status ≥2 [2.10 (1.48-2.99)], advanced cancer [1.60 (1.29-1.97)], and cancers of the brain [2.25 (1.64-3.09)], gastrointestinal system [1.74 (1.44-2.11)], genitourinary system [1.90 (1.48-2.45)], and prostate [1.72 (1.26-2.34)]. CONCLUSIONS: The prognostic factors identified in this meta-analysis should be considered as part of risk stratification frameworks for anticoagulation management in patients with cancer and VTE.

References

1. 1.Khan, F., Tritschler, T., Marx, C. E., Lanting, V., Rochwerg, B., Tran, A., Fernando, S. M., Lorenzetti, D. L., Wunsch, H., Holodinsky, J., Fiest, K., Stelfox, H. T., Delluc, A., Fergusson, D. A., Le Gal, G., Wells, P. S., Wang, T. F., Sanfilippo, K., van Es, N., Schrag, D., Connors, J. M., & Carrier, M. (2026). Predictors of recurrent venous thromboembolism and bleeding in patients with cancer: a meta-analysis. European Heart Journal. https://doi.org/10.1056/NEJMoa2416112