title: Cancer effect on periprocedural thromboembolism and bleeding in anticoagulated patients.
abstract: BACKGROUND
  Patients with active cancer are often on chronic anticoagulation and frequently require interruption of this treatment for invasive procedures. The impact of cancer on periprocedural thromboembolism (TE) and major bleeding is not known.
  
  
  METHODS
  Two thousand one hundred and eighty-two consecutive patients referred for periprocedural anticoagulation (2484 procedures) using a standardized protocol were followed forward in time to estimate the 3-month incidence of TE, major bleeding and survival stratified by anticoagulation indication. For each indication, we tested active cancer and bridging heparin therapy as potential predictors of TE and major bleeding.
  
  
  RESULTS
  Compared with patients without cancer, active cancer patients (n=493) had more venous thromboembolism (VTE) complications (1.2% versus 0.2%; P=0.001), major bleeding (3.4% versus 1.7%; P=0.02) and reduced survival (95% versus 99%; P<0.001). Among active cancer patients, only those chronically anticoagulated for VTE had higher rates of periprocedural VTE (2% versus 0.16%; P=0.002) and major bleeding (3.7% versus 0.6%; P<0.001). Bridging with heparin increased the rate of major bleeding in cancer patients (5% versus 1%; P=0.03) without impacting the VTE rate (0.7% versus 1.4%, P=0.50).
  
  
  CONCLUSIONS
  Cancer patients anticoagulated for VTE experience higher rates of periprocedural VTE and major bleeding. Periprocedural anticoagulation for these patients requires particular attention to reduce these complications.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester.
authors.forename: A J
authors.initials: AJ
authors.lastname: Tafur
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester. Electronic address: wysokinski.waldemar@mayo.edu.
authors.forename: W E
authors.initials: WE
authors.lastname: Wysokinski
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester.
authors.forename: R D
authors.initials: RD
authors.lastname: McBane
authors.affiliation: Department of Radiotherapy, Memorial Regional Hospital, Zielona Gora.
authors.forename: E
authors.initials: E
authors.lastname: Wolny
authors.affiliation: Division of Rehabilitation, Department of Orthopedic Surgery, University Medical School of Wroclaw, Wroclaw, Poland.
authors.forename: E
authors.initials: E
authors.lastname: Sutkowska
authors.affiliation: General Internal Medicine, Department of Internal Medicine.
authors.forename: S C
authors.initials: SC
authors.lastname: Litin
authors.affiliation: General Internal Medicine, Department of Internal Medicine.
authors.forename: P R
authors.initials: PR
authors.lastname: Daniels
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Slusser
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, USA.
authors.forename: D O
authors.initials: DO
authors.lastname: Hodge
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester.
authors.forename: J A
authors.initials: JA
authors.lastname: Heit
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000209:etiology*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood*; D011446:Prospective Studies; D054556:Venous Thromboembolism / Q000097:blood / Q000139:chemically induced / Q000209:etiology*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin