Key result
Worse performance status is linked to ~76% higher VTE or bleeding risk during chemotherapy.
Why the study?
Whether ECOG-PS carries prognostic value during primary thromboprophylaxis for cancer-associated VTE was unknown.
Does ECOG performance status predict VTE or clinically relevant bleeding in ambulatory patients with cancer initiating chemotherapy?
Observational (n=428)
Double-blind
Yes
Does ECOG performance status predict VTE or clinically relevant bleeding in ambulatory patients with cancer initiating chemotherapy?
In ambulatory cancer patients receiving thromboprophylaxis, poor ECOG performance status independently predicts higher risks of bleeding, thromboembolic complications, and mortality, highlighting the need for individualized risk assessment.
Answers are grounded in this paper and cite their sources.
ECOG-PS 2–3 may warrant closer monitoring for VTE or bleeding on thromboprophylaxis; supports its prognostic value but leaves tailored strategies open.
The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is central to cancer care planning and prognostication. Whether ECOG-PS also carries prognostic value in the setting of primary thromboprophylaxis for cancer-associated venous thromboembolism (VTE) remains unknown. To evaluate the impact of ECOG-PS on clinical outcomes in ambulatory patients with cancer initiating chemotherapy. This was a post-hoc analysis of the AVERT randomized controlled trial that evaluated apixaban (2.5 mg twice daily) for thromboprophylaxis in patients at intermediate-to-high VTE risk. Multivariable survival models assessed the association between ECOG-PS (0–1 versus 2–3) and the composite primary outcome of VTE or clinically relevant bleeding (CRB), as well as its individual components and all-cause mortality, over 180 days. Of 428 patients included, 368 (86.0%) and 60 (14.0%) had an ECOG-PS of 0–1 and 2–3, respectively. The primary composite outcome occurred in 12.8% (n = 47) in those with ECOG 0–1 and 18.3% (n = 11) with ECOG-PS 2–3 (6-month cumulative incidence: 13.0% [95% CI: 9.8%–16.7%] versus 19.9% [95% CI: 10.5%–31.4%], respectively). Worse performance status was associated with higher risks for the composite outcome (aHR: 1.76; 95% CI: 1.14–2.72; p = 0.011), CRB (aHR: 1.58; 95%CI: 1.53–1.63; p < 0.0001), and all-cause mortality (aHR: 5.77; 95% CI: 4.98–6.67; p < 0.0001). In exploratory treatment-effect analyses, apixaban reduced VTE risk across ECOG-PS strata, including among participants with ECOG-PS 2–3, without clear evidence of excess CRB in this subgroup. ECOG-PS predicts VTE-related outcomes in ambulatory patients with cancer and may inform individualized, value-based shared decision-making regarding anticoagulant thromboprophylaxis. • Poor ECOG performance status predicts higher bleeding, thromboembolic complications, and mortality in ambulatory cancer patients. • In exploratory treatment-interaction analyses, apixaban appeared to reduce VTE across ECOG-PS strata, without evidence of excess bleeding among patients with worse performance status.
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Potere et al. (2026) conducted an observational in Active cancer at intermediate-to-high risk for VTE (n=428). ECOG-PS 2-3 vs. ECOG-PS 0-1 was evaluated on Composite of venous thromboembolism (VTE) or clinically relevant bleeding (CRB) over 180 days (aHR 1.76, 95% CI 1.14-2.72, p=0.011). In ambulatory patients with cancer initiating chemotherapy, worse performance status (ECOG-PS 2-3) was associated with a 76% higher risk of venous thromboembolism or clinically relevant bleeding compared to ECOG-PS 0-1 (aHR 1.76).
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