Key result
Anticoagulation for VTE yields ~15% 1-year clinically relevant bleeding, strongly predicted by antiplatelet therapy.
Why the study?
Data on anticoagulant-associated bleeding among patients with venous thromboembolism in Southeast Asia are limited.
Cohort (n=395)
No
In a Southeast Asian cohort, anticoagulant-associated bleeding occurred in approximately 15% of patients with VTE over a median of 0.88 years and independently predicted all-cause mortality, underscoring the need for careful monitoring in older patients and those with poor performance status, low BMI, or concomitant antiplatelet therapy.
Bleeding risk in Thai VTE patients on anticoagulation, especially with antiplatelets, warrants caution; hypothesis-generating for tailored regimens in Asian cohorts.
Background: Data on anticoagulant-associated bleeding among patients with venous thromboembolism (VTE) in Southeast Asia are limited. We aimed to determine the incidence and predictors of anticoagulant-associated bleeding and evaluate its association with mortality. Methods: We conducted a retrospective cohort study of patients with VTE treated with anticoagulants between January 2014 and June 2024. Clinically relevant bleeding (CRB) was defined according to the International Society on Thrombosis and Haemostasis criteria. Cumulative incidence was estimated using the Aalen–Johansen method with death as a competing event, and predictors were identified using Fine–Gray sub-distribution hazard models. The association between bleeding and all-cause mortality was evaluated using time-dependent Cox proportional hazards models. Results: Among 395 patients (mean age, 60.7 ± 16.2 years; 65.3% female), 43.5% had cancer-associated thrombosis. Low-molecular-weight heparin was the most commonly prescribed initial anticoagulant (39.0%), followed by warfarin (32.7%) and direct oral anticoagulants (25.1%), of which apixaban was the most frequently used (12.7%). During a median follow-up of 0.88 years, 60 patients (15.2%) developed CRB. The 1-year cumulative incidence of CRB was 14.89% (95% confidence interval (CI), 11.09–19.23). Independent predictors of CRB included concomitant antiplatelet therapy (adjusted sub-distribution hazard ratio (aSHR), 3.48; 95% CI, 1.76–6.90), Eastern Cooperative Oncology Group performance status ≥ 2 (aSHR, 3.05; 95% CI, 1.34–6.94), body mass index (BMI) < 20 kg/m2 (aSHR, 2.50; 95% CI, 1.36–4.61), and age ≥ 65 years (aSHR, 1.97; 95% CI, 1.12–3.45). Both clinically relevant non-major bleeding (adjusted hazard ratio (aHR), 3.72; 95% CI, 1.55–8.92) and major bleeding (aHR, 5.62; 95% CI, 2.91–10.85) were independently associated with increased all-cause mortality. Conclusions: Anticoagulant-associated bleeding is common among Thai patients with VTE and is associated with an increased risk of all-cause mortality. Patients with advanced age, poor performance status, low BMI, or concomitant antiplatelet therapy may benefit from closer monitoring during anticoagulant treatment.
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Thamgrang et al. (2026) conducted a cohort in Venous Thromboembolism (VTE) (n=395). Anticoagulant therapy was evaluated on 1-year cumulative incidence of clinically relevant bleeding (CRB) (95% CI 11.09-19.23). In Thai patients with venous thromboembolism, the 1-year cumulative incidence of anticoagulant-associated clinically relevant bleeding was 14.89%, with antiplatelet therapy as a strong predictor.
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