Predictors of Recurrent Venous Thromboembolism and Major Bleeding in patients with cancer: a secondary analysis of the CANVAS trial
Abstract
Introduction: Patients with cancer have an increased risk of developing venous thromboembolism (VTE) but also have an increased risk of both recurrent VTE and bleeding with anticoagulation compared to anticoagulated patients without cancer. CANVAS, a randomized pragmatic effectiveness trial, compared the direct oral anticoagulants a class to low molecular weight heparin for treatment of a new VTE in patients with cancer. The aim of this prespecified secondary analysis of the CANVAS trial is to identify predictors of both recurrent VTE and major bleeding in patients with cancer and new VTE. Methods: Data from the 671 participants in the analysis population were used to identify predictors of recurrent VTE and bleeding during the 6-month treatment period. Significant predictors identified in the univariable models were carried forward in the multivariable models to identify independent predictors of both risks. Results: Independent predictors of recurrent VTE include ECOG performance status ≥ 2 (HR, 3.19 [95% CI, 1.45–7.02]; P < .005), presence of metastatic disease (HR, 2.57 [95% CI, 1.14–5.80]; P = .023), treatment with bevacizumab (HR, 2.50 [95% CI, 1.04–5.99]; P = .041), and deep vein thrombosis without pulmonary embolus as index VTE (HR, 1.86 [95% CI, 1.04–3.33]; P = .037). Independent predictors of major bleeding include serum albumin < 3.5 g/dL (HR 1.97 (95% CI, 1.02–3.79; P = .044) and metastatic disease (HR 2.80 (95% CI, 1.08–7.22; P = .034). Conclusion: Findings from…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 671 participants or records.
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