癌症相关静脉血栓栓塞（VTE）患者复发和治疗相关出血的风险很高，但与这些风险相关的因素仍然未确定。本分析的目的是在卡拉维乔研究中包括癌症相关VTE的患者中确定复发VTE和大出血的风险因素。可能预测复发VTE或大出血的变量在Cox比例危险多变量分析中进行了评估，采用向后变量选择。78名患者（6.8％）出现复发性VTE，45名患者（3.9％）出现重大出血。复发性VTE的独立风险因素是静脉深静脉血栓作为指标事件（风险比（HR）1.84，95％CI 1.17-2.88），ECOG状态为1或更高（HR 1.95，95％CI 1.11 -3.43），胰腺或肝胆癌部位（HR 2.20，95％CI 1.19-4.06），同时进行的抗癌治疗（HR 1.98，95％CI 1.03-3.81）和肌酸酐清除率（HR1.10，95％CI 1.00-1.20，每10毫升/分钟绝对增加）。重大出血的独立风险因素是ECOG状态2（HR2.31，95％CI 1.24-4.29），泌尿生殖癌部位（HR2.72，95％CI 1.28-5.77），上消化道癌部位（HR3.17，95％CI 1.22-8.23）和未切除的肠道内腔肿瘤（HR2.77，95％CI 1.38-5.56）。这项针对癌症相关VTE病人的标准抗凝治疗的Caravaggio研究表明，有五个独立的预测因子导致复发VTE和四个独立的预测因子导致治疗相关的主要出血。考虑到这些风险因素可以帮助临床医生优化癌症相关VTE患者的抗凝治疗。版权所有©2023年欧洲内科医师联合会。由Elsevier B.V.出版。保留所有权利。

Risks of recurrence and treatment-emergent bleeding are high in patients with cancer-associated venous thromboembolism (VTE) but factors associated with these risks remain substantially undefined. The aim of this analysis in patients with cancer-associated VTE included in the Caravaggio study was to identify risk factors for recurrent VTE and major bleeding. Variables potentially predictive for recurrent VTE or major bleeding were evaluated in a Cox proportional hazard multivariable analysis with backward variable selection. Recurrent VTE occurred in 78 patients (6.8%) and major bleeding in 45 (3.9%). Independent risk factors for recurrent VTE were deep vein thrombosis (DVT) as index event (Hazard ratio (HR) 1.84, 95% CI 1.17-2.88), ECOG status of 1 or more (HR 1.95, 95% CI 1.11-3.43), pancreatic or hepatobiliary cancer site (HR 2.20, 95% CI 1.19-4.06), concomitant anti-cancer treatment (HR 1.98, 95% CI 1.03-3.81) and creatinine clearance (HR 1.10, 95% CI 1.00-1.20 for every 10 ml/min absolute increase). Independent risk factors for major bleeding were ECOG status of 2 (HR 2.31, 95% CI 1.24-4.29), genitourinary cancer site (HR 2.72, 95% CI 1.28-5.77), upper gastrointestinal cancer site (HR 3.17, 95% CI 1.22-8.23), and non-resected luminal gastrointestinal cancer (HR 2.77, 95% CI 1.38-5.56). This analysis of the Caravaggio study in patients with cancer-associated VTE who were on standardized anticoagulant treatment identified five independent predictors for recurrent VTE and four independent predictors of treatment-emergent major bleeding. Considering these risks could help clinicians to optimize the anticoagulant treatment in patients with cancer-associated VTE.Copyright © 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.