Recurrent Thrombosis and Bleeding in Patients with Cancer-Associated Venous Thromboembolism Receiving Anticoagulation: Are These Modifiable Risk Factors for Mortality?

Patients with cancer-associated venous thromboembolism (VTE) have a higher risk of recurrent VTE than those without cancer and require long-term anticoagulation,[1] but these patients are also at a higher risk of anticoagulant-related bleeding because of the frequent presence of disease- or treatment-related predispositions for bleeding ([Fig. 1]).[2] [3] Arterial thromboembolic events are also common in cancer, partly associated with some anticancer therapies and types of cancer, as well as ethnicity.[4] [5] There is a widely held perception that recurrent thrombosis is more serious than bleeding in patients with cancer-associated VTE receiving anticoagulation. In a recent meta-analysis, recurrent VTE had a higher case fatality rate than major bleeding (14.8 vs. 8.9%),[6] supporting guideline recommendation for indefinite anticoagulant therapy for cancer-associated VTE in the absence of contraindication.[7] [8]