The case fatality rate of recurrent venous thromboembolism (VTE) appears to be higher than that of major bleeding in patients with cancer who receive anticoagulation, according to findings published in Thrombosis and Haemostasis.

Alym Abdulla, MD, of the department of medicine at the University of British Columbia in Canada, and colleagues performed a systematic review and meta-analysis to estimate the incidence and case fatality rates of recurrent VTE and major bleeding in adult patients with cancer-associated VTE.

The study included prospective cohort studies (n = 15) and randomized controlled trials (n = 14) published between 1980 and January 2019. Outcome events data included recurrent VTE, major bleeding events, fatal recurrent VTE, fatal major bleeding events, and death.

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In total, data from 29 publications included 8000 patients with active cancer during 4786 patient-years of follow up. The recurrent VTE and fatal recurrent VTE rates were 23.7 and 1.9 per 100 patient-years of follow-up, respectively, yielding a recurrent VTE case fatality rate of 14.8%.

Major bleeding event and fatal major bleeding event rates were 13.1 and 0.8 per 100 patient-years of follow-up, respectively, yielding a case fatality rate of 8.9%.

Limitations of the study included considerable heterogeneity among the studies and inconsistent definitions of active cancer and outcomes among the studies; additionally, individual patient data was not available for subgroup analyses.

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The authors also noted that estimates of case fatality varied with anticoagulation regimen and study design; however, in their study, the differences between them were not statistically significant.

“As cancer treatments continue to improve and patient survival is extended, it will become increasingly important to have reliable case fatality data to inform clinical decision-making,” concluded the authors.

Disclosures: Some authors have declared affiliations with the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Abdulla A, Davis WM, Ratnaweera N, Szefer E, Ballantyne Scott B, Lee AYY. A meta-analysis of case fatality rates of recurrent venous thromboembolism and major bleeding in patients with cancer.Thromb Haemost. 2020;120(04):702-713.