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Thromb Haemost 2022; 122(12): 2011-2018
DOI: 10.1055/a-1886-5991
Stroke, Systemic or Venous Thromboembolism

Treatment and Bleeding Complications of Cancer-Associated Venous Thromboembolism: A Korean Population-Based Study

Sang-A Kim 
1   Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
,
Ju Hyun Lee
1   Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
,
Ji Yun Lee
1   Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
,
Hun-Gyu Hwang
2   Division of Respiratory, Department of Internal Medicine, Gumi Hospital, School of Medicine, Soonchunhyang University, Gumi, Korea
,
Yang-Ki Kim
3   Division of Respiratory, Department of Internal Medicine, Seoul Hospital, School of Medicine, Soonchunhyang University, Seoul, Korea
,
Ho-Young Yhim
4   Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea
,
Junshik Hong
5   Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
,
Jeong-Ok Lee
1   Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
,
Soo-Mee Bang
1   Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
› Author Affiliations Funding None.
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Abstract

Objectives This study investigated the treatment pattern and the rate of bleeding complications in real-world practice in cancer-associated venous thromboembolism (CT) patients.

Methods We used the Korean Health Insurance Review and Assessment Service database (2014–2018). Among patients with venous thromboembolism, patients with concomitant malignancy diagnostic codes were categorized as CT, while all others were categorized as non-CT. Treatments were categorized as direct oral anticoagulant (DOAC), parenteral anticoagulant (PAC), warfarin, and mixed anticoagulants.

Results We identified 27,205 CT and 57,711 non-CT patients. DOACs were the most frequently used anticoagulants. The proportion of patients treated with PAC was higher in CT than in non-CT patients (35.7 vs. 19.5%; p < 0.01). In CT, the cumulative incidence of any/major bleeding was higher with DOAC (8.1%/3.9%) than with PAC (7.5%/3.2%; p = 0.04 and 0.01, respectively). However, there was no difference in major bleeding when compared with warfarin (p = 0.11) or mixed anticoagulants (p = 0.94). Overall, gastrointestinal (GI) cancer patients showed higher risks of bleeding. The cumulative incidence of major GI bleeding was higher with DOAC than with PAC (4.9 vs. 3.0%; p < 0.01), while there was no difference compared with warfarin (p = 0.59) or mixed anticoagulants (p = 0.80). Major bleeding with each DOAC showed no difference among entire CT (p = 0.94), GI cancer (p = 0.27), and genitourinary cancer (p = 0.88) patients.

Conclusion Five years after their introduction into clinical practice, DOACs have become the most prescribed anticoagulant in Korea. In our patient population, bleeding complications occurred more frequently in CT than in non-CT, especially in patients treated with DOACs.

Keywords

anticoagulants - hemorrhage - heparin - low-molecular-weight heparin - venous thromboembolism

Author Contributions

S.-A.K. and S.-M.B. drafted the article. S.-A.K., J.H.L., and S.-M.B. contributed to the acquisition, analysis, and interpretation of data. J.Y.L., H.-G.H., Y.-K.K, H.-Y.Y., J.H., J.-O. L., and S.-M.B. revised the manuscript critically for important intellectual content. S.-A.K., J. H.L., J.Y.L., H.-G.H., Y.-K.K., H.-Y.Y., J.H., J.-O.L., and S.-M.B. approved the final version of the manuscript for publication.


Supplementary Material



Publication History

Received: 21 November 2021

Accepted: 25 June 2022

Accepted Manuscript online:
28 June 2022

Article published online:
28 October 2022

© 2022. Thieme. All rights reserved.

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