Hemorrhage and recent oncology diagnosis in individuals with atherosclerosis

Abstract

Patients receiving antithrombotic therapy are at increased risk of bleeding. In some cases, bleeding may be the first manifestation of an underlying malignancy. We investigated newly diagnosed cancers associated with gastrointestinal or genitourinary bleeding among patients enrolled in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial and assessed the risk of recent cancer diagnoses following bleeding at these sites. During a 23-month follow-up of 27,395 patients (mean age: 68 years; 21% female), 2,678 patients (9.8%) experienced any bleeding, 713 (2.6%) experienced major bleeding, and 1,084 (4.0%) were diagnosed with cancer. Among the 2,678 patients with bleeding, 257 (9.9%) were subsequently diagnosed with cancer. Gastrointestinal bleeding was 20-fold more common in patients with newly diagnosed gastrointestinal cancers (7.4% vs. 0.5%; HR 20.6, 95% CI: 15.2-27.8) and 1.7-fold more common in those with non-gastrointestinal cancers (3.8% vs. 3.1%; HR 1.70, 95% CI: 1.20-2.40). Genitourinary bleeding was associated with a 32-fold increased risk of newly diagnosed genitourinary malignancy (15.8% vs. 0.8%; HR 32.5, 95% CI: 24.7-42.9), while urinary bleeding was linked to a 98-fold higher risk of newly diagnosed urinary cancer (14.2% vs. 0.2%; HR 98.5, 95% CI: 68.0-142.7). Non-gastrointestinal, non-genitourinary bleeding was associated with a threefold higher risk of non-gastrointestinal, non-genitourinary cancers (4.4% vs. 1.9%; HR 3.02, 95% CI: 2.32-3.91). Among patients with atherosclerosis receiving antithrombotic therapy, gastrointestinal or genitourinary bleeding was associated with an increased incidence of cancer diagnosis. Any gastrointestinal or genitourinary bleeding should prompt evaluation for possible malignancy at these sites.