Variation in Venous Thromboembolism Outcomes Based on Primary Cancer Site

Figures

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  Figure 1. Adjusted Risks for Venous Thromboembolism Outcomes by Cancer Status This figure shows the adjusted HRs for VTE-related outcomes (including the composite of fatal PE or recurrent VTE, major bleeding, and all-cause mortality) in patients with active cancer compared to those without cancer, using multivariable Cox and Fine-Gray models. All outcomes occurred within the first 90 days of anticoagulation therapy. Results demonstrate that patients with cancer experienced significantly higher risks of both thrombotic and bleeding complications, supporting the need for tumor-specific risk assessment in anticoagulant decision-making. aHR = adjusted HR; cHR = crude HR; PE = pulmonary embolism; VTE = venous thromboembolism.

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  Figure 2. Venous Thromboembolism vs Bleeding Risk in Cancer Patients Comparison of adjusted HRs for the composite outcome (fatal PE or recurrent VTE) vs major bleeding in patients with active cancer, stratified by cancer site. Lung, pancreatic, breast, and hematologic cancers were associated with a notably higher thrombotic risk than bleeding risk. In contrast, gastrointestinal and genitourinary cancers showed a more balanced or bleeding-predominant risk profile. These findings underscore the need for personalized anticoagulation strategies tailored to cancer type. Abbreviations as in Figure 1.

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  Central Illustration. Variations in Venous Thromboembolism Outcomes Based on Primary Cancer Sites This visual summarizes the 90-day risks of VTE-related complications (fatal PE or recurrent VTE) and major bleeding by cancer type, based on data from 18,660 patients with active cancer in the RIETE registry. Lung and pancreatic cancers were associated with the highest thrombotic risks, while gastrointestinal and genitourinary cancers had the highest bleeding risks. The comparison highlights the imbalance between thrombosis and bleeding across cancer types, emphasizing the need for personalized anticoagulation strategies in cancer-associated VTE. These findings support a shift away from one-size-fits-all approaches toward individualized treatment decisions that incorporate cancer site, bleeding risk, and patient-level factors such as anemia and renal function. CAT = cancer-associated thrombosis; RIETE = Registro Informatizado de la Enfermedad Tromboembólica; other abbreviations as in Figure 1.

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  Figure 3. Venous Thromboembolism and Bleeding Risks in Genitourinary cancers Adjusted HRs for the composite outcome and major bleeding in patients with GU cancers compared to noncancer patients. Subgroup analyses are shown for bladder, prostate, ovarian, and uterine cancers. Ovarian and uterine cancers were associated with particularly high thrombotic risk, while bleeding risk was elevated in bladder and prostate cancers. These differences within the GU category highlight the heterogeneity of anticoagulation risk and the need for site-specific treatment considerations. GU = genitourinary.

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  Figure 4. Venous Thromboembolism and Bleeding Risks in Gastrointestinal Cancers Adjusted HRs for the composite outcome and major bleeding in patients with GI cancers. Subgroup analyses include colorectal, gastric, hepatic, and biliary cancers. Patients with biliary cancer had the highest risk of the composite outcome, while major bleeding risk was elevated across most GI cancers, especially gastric. The variation in outcomes reinforces the complexity of managing anticoagulation in GI malignancies and supports individualized risk assessments. GI = gastrointestinal.