Association Between Anticoagulant‐Related Bleeding and Mortality in Patients With Solid Tumors and Cancer‐Associated Venous Thromboembolism

To the editor:Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in cancer patients.Managing VTE in cancer patients involves balancing elevated risks of VTE recurrence with anticoagulant (AC)-related bleeding.Risk of AC-related bleeding is exacerbated in cancer patients due to older age, thrombocytopenia, frailty, comorbid disease, and tumor invasion [1].Limited data exist on the association between AC-related bleeding and survival in patients with cancer-associated VTE.In one meta-analysis of patients with cancer, the case fatality rate for AC-related major bleeding was nearly 1 in 10 patients [2].In another study, patients with cancer-associated VTE had a 2.7-fold increased rate of bleedingrelated mortality compared to patients with VTE without cancer [3].However, fatality in respect to site of bleed was not reported.This study aims to quantify the relationship between clinically significant bleeding events and death in patients with cancer-associated VTE newly initiated on AC therapy, stratified by site of bleeding.Utilizing data from the nationwide US Veterans Affairs (VA) healthcare system between 2012 and 2020, we retrospectively identified patients with solid tumor using international classification of diseases, 9 th and 10 th Revisions (ICD-9/10) codes.We identified new