Abstract 19936: Venous Thromboembolism Recurrence and Bleeding Risk Among Cancer Patients Using a Large Commercial Database
Objectives: To describe the role of anticoagulant use, active cancer and venous thromboembolism (VTE) type on bleeding risk and VTE recurrence among cancer patients diagnosed with VTE.
Methods: A retrospective observational analysis of the Humedica database between 01JAN2008 and 31MARCH2014 was conducted including adult patients (aged >18 years) with ≥2 VTE diagnosis claims (ICD-9-CM codes) in an outpatient setting or with one VTE diagnosis in an inpatient setting who had continuous health plan enrollment 6 months pre-index date. Active cancer patients were differentiated from cancer patients based on diagnosis codes during the baseline period. The incidence rate (in person-years) was calculated for major bleeding and VTE recurrence. Time-to-major bleeding and time-to-VTE recurrence were estimated using Kaplan-Meier curves; a Cox regression was applied to adjust for baseline demographic and clinical characteristics.
Results: A total of 72,224 cancer patients were identified, which included 8,222 active cancer patients. More than 70% of cancer patients were prescribed anticoagulants. The incidence rate of VTE recurrence (24.7 vs. 14.3 per 100 person-years) and major bleeding events (31.2 vs. 15.9 per 100 person-years) was higher among active cancer patients than all VTE cancer patients. The use of combination parenteral and oral anticoagulant treatment (hazard ratio [HR]=1.30, p<0.0001), active cancer (HR=1.10, p=0.0007) and having both pulmonary embolism (PE) and deep vein thrombosis (DVT) as prior diagnoses (HR=1.17, P<0.0001) were significantly associated with an increased risk of major bleeding. Clinical predictors of VTE recurrence included active cancer (HR=1.35, p<0.0001) and having both PE and DVT as prior diagnoses (HR=1.32, p<0.0001). Patients treated with anticoagulants (HR=0.71, p<0.0001) were at a lower risk of VTE recurrence.
Discussion: Active cancer and having both PE and DVT as prior diagnoses were associated with increased VTE recurrence and bleeding risk. The bleeding risk was also highest among patients undergoing parenteral and oral anticoagulant therapy. However, anticoagulant treatment was shown to be associated with a lower risk of VTE recurrence.
Author Disclosures: C. Masseria: Employment; Significant; C.M. is an employee of Pfizer Inc. F. Kariburyo: Consultant/Advisory Board; Significant; F.K. is an employee of STATinMED Research, which is a paid consultant to Bristol-Myers Squibb and Pfizer Inc. J. Mardekian: Employment; Significant; J.M. is an employee of Pfizer Inc. T.C. Lee: Employment; Significant; T.C.L. is an employee of Pfizer Inc. Y. Ravee: Employment; Significant; Y.R. is an employee of Pfizer Inc. H. Phatak: Employment; Significant; H.P. is an employee of Bristol-Myers Squibb. O. Baser: Consultant/Advisory Board; Significant; O.B. is an employee of STATinMED Research, which is a paid consultant to Pfizer Inc. and Bristol-Myers Squibb. M. Hamilton: Employment; Significant; M.H. is an employee of Bristol-Myers Squibb. L. Xie: Consultant/Advisory Board; Significant; L.X. is an employee of STATinMED Research, a paid consultant to Bristol-Myers Squibb and Pfizer Inc...
- © 2015 by American Heart Association, Inc.