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Identifying Risks: Who's at Greater Risk of Bleeding?
Recent research has unveiled that certain patients undergoing extended anticoagulation therapy with apixaban (Eliquis) for cancer-related blood clots need to be particularly cautious about bleeding. Conducted at the American Society of Hematology (ASH) annual meeting, the study revealed four key risk factors that can significantly increase the likelihood of clinically relevant bleeding among cancer patients.
Age, Gender, and Initial Treatment: Key Predictors
According to Dr. Isabelle Mahé from Université Paris Cité, one major finding from the research is that anemia or thrombocytopenia (low platelet count) correlates with a staggering 93% increase in bleeding risk. Additionally, older age, male sex, and a history of pulmonary embolism as the cause for anticoagulation also elevated the risk of bleeding—from 38% to 51%—over a follow-up period averaging nearly 13 months.
Understanding the Importance of Extended Anticoagulation
A proper understanding of these vulnerabilities can empower healthcare professionals to make more informed decisions about anticoagulation therapy. Earlier studies on the first six months of anticoagulation highlighted factors such as previous bleeding episodes, cancer stage, and the type of tumors involved. However, these new findings explore risks over a longer duration, providing essential insights into managing extended therapy.
Balancing Benefits and Risks in Cancer Treatment
This research aims to assist clinicians in weighing the benefits against the risks of extended anticoagulation therapy. As cancer patients often experience both recurrent blood clots and potential bleeding, identifying those who are more prone to complication can help tailor safer, more effective treatment strategies.
Statistics Break Down the Risk
During the trial, which involved 1,766 patients across 121 hospitals in 11 different countries, clinically relevant bleeding events were recorded in 238 patients (approximately 14%). Notably, breast cancer patients experienced the lowest bleeding rates, while other cancer types (like gastrointestinal or lung cancers) reported higher risks.
Insights from Historically Relevant Studies
Complementary studies have shown that higher age, low body mass index (BMI), and lower hemoglobin levels corresponding to specific cancer types lead to increased bleeding risks. These factors remain consistent with findings on the bleeding profiles of drugs like apixaban versus rivaroxaban, where apixaban emerged as a safer choice for patients with gastrointestinal cancers, contributing to lesser bleeding incidents along with a similar recurrence rate of blood clots.
Conclusion and Next Steps for Healthcare Providers
This study serves as a reminder for healthcare providers to proactively identify and monitor patients at risk for complications during extended anticoagulation. As research continues to evolve, it remains essential to integrate these findings into clinical practice, ensuring that patients receive optimal care while minimizing the risk of bleeding.
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