Risk factors for recurrence and bleeding in colorectal cancer patients with cancer-associated venous thrombembolism.

BACKGROUND

Colorectal cancer (CRC) patients with cancer-associated venous thromboembolism (VTE) face high risks of recurrence and anticoagulant-related bleeding.

OBJECTIVES

Our aim was to assess risk factors associated with recurrence and bleeding and analyze the impact of these outcomes on survival during one-year follow up.

DESIGN

Retrospective study.

METHODS

This analysis included consecutive VTE patients treated with anticoagulants from January 2019 to January 2023. The incidence of recurrent VTE, major bleeding (MB), and clinically relevant non-major bleeding (CRNMB) was evaluated and their associated risk factors were identified using univariate and multivariate models. Furthermore, the impact of anticoagulant treatment outcomes on all-cause mortality was analyzed by Cox proportional hazards model and Kaplan-Meier method.

RESULTS

This study included 1,792 CRC patients with cancer-associated VTE. In competing-risk multivariate analysis, independent predictors of recurrent VTE included age (HR with 95%CI: 1.005 [1.002-1.008] per year), history of VTE (4.288 [2.902-6.334]), index pulmonary embolism (PE) (1.698 [1.252-2.303]), ECOG ≥ 2 (1.561 [1.036-2.350]), hemoglobin < 100 g/L (1.363 [1.045-1.778]), and aPTT > 36.5 s (2.034 [1.223-3.383]); whereas recent major surgery or trauma within 1 month (0.451 [0.259-0.786]) and tumor stage II (0.607 [0.377-0.978]) or III (0.562 [0.333-0.949]) were associated with lower recurrence risk. Independent predictors of MB included age ≥ 75 (1.637 [1.011-2.652]), history of MB (5.320 [1.880-15.050]), ECOG ≥ 2 (9.979 [4.292-23.203]), antiplatelet therapy (2.592 [1.539-4.367]), and platelet count < 100×10/L (2.685 [1.336-5.397]); whereas tumor stage III (0.122 [0.053-0.278]) and metastatic cancer (0.190 [0.086-0.421]) predicted lower bleeding risk. Similarly, independent predictors of CRNMB included age ≥ 75 (1.465 [1.005-2.137]), ECOG ≥ 2 (1.750 [1.184-2.586]), hemoglobin < 100 g/L (1.870 [1.316-2.657]), and platelet count < 100×10/L (2.057 [1.076-3.932]). Recurrent VTE, MB, and CRNMB each adversely impacted one-year survival.

CONCLUSIONS

The independent risk factors identified in this study may serve as a reference for improving risk stratification in CRC patients receiving anticoagulant treatment. Additionally, adverse outcomes such as VTE recurrence, MB, and CRNMB significantly increase the one-year all-cause mortality risk in CRC patients.