In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.
COVID-19 and Cardiology Read more

Bleeding in patients treated with anticoagulants should stimulate search for cancer

Cardio-Oncology


Munich, Germany – 26 Aug 2018: Bleeding in patients treated with anticoagulants should stimulate a search for cancer, according to late breaking results from the COMPASS trial (1) presented today at ESC Congress 2018 (2).

Professor John Eikelboom, principal investigator, of the Population Health Research Institute, McMaster University, Hamilton, Canada, said: “In patients with stable coronary artery disease or peripheral artery disease, the occurrence of major gastrointestinal bleeding predicts a substantial increase in new gastrointestinal cancer diagnoses, while major genitourinary bleeding predicts a substantial increase in new genitourinary tract cancer diagnoses.”

Up to one in ten patients with cardiovascular disease have recurrent events each year. As previously reported, the COMPASS trial found that in patients with coronary artery disease or peripheral artery disease, the combination of rivaroxaban (2.5 mg twice daily) and aspirin reduced cardiovascular events compared to aspirin alone, but there were more major bleeding events in the combined drug group. (3)

For the first time today, the investigators report details on the effect of bleeding on subsequent cancer diagnoses.

Briefly, the trial enrolled 27,395 patients with chronic stable coronary or peripheral artery disease from 602 centres in 33 countries. Patients were randomly allocated to one of three groups: 1) rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily 2) rivaroxaban 5 mg twice daily, or 3) aspirin 100 mg once daily. Results in each of the rivaroxaban groups were compared with the aspirin alone group. The mean duration of follow up was 23 months.

The combination increased major bleeding, as defined by the International Society on Thrombosis and Haemostasis (ISTH), compared with aspirin (3.1% versus 1.9%, hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.40–2.05, p<0.0001), but did not significantly increase intracranial (0.3% versus 0.3%, HR 1.16, 95% CI 0.67–2.00, p=0.60) or fatal bleeding (0.2% versus 0.1%, HR 1.49, 95% CI 0.67–3.33, p=0.32).

Major gastrointestinal bleeding was associated with a 20-fold increase in new diagnoses of gastrointestinal cancer (9.3% versus 0.7%, HR 22.6, 95% CI 14.9–34.3, p<0.0001) and a two-fold increase in non-gastrointestinal cancer (4.6% versus 3.1%, HR 2.55, 95% CI 1.47–4.42, p<0.0001).

Major non-gastrointestinal bleeding was associated with a five-fold increase in new non-gastrointestinal cancers (9.4% versus 3.0%, HR 5.49, 95% CI 3.95–7.62, p<0.0001), but not with new gastrointestinal cancer (0.5% versus 0.8%, HR 0.85, 95% CI 0.21–3.45, p=0.82).

Professor Eikelboom said: “More than one in ten patients with major bleeding were subsequently diagnosed with cancer, and more than 20% of new cancer diagnoses were in patients who experienced bleeding. By reducing major cardiovascular events and mortality, the combination of rivaroxaban and aspirin already produces a clear net benefit, and if bleeding unmasks cancer it could potentially lead to the added benefit of improved cancer outcomes.”

ENDS

Notes to editor

SOURCES OF FUNDING: Bayer AG.

DISCLOSURES: John Eikelboom has received honoraria and/or research support from Astra-Zeneca, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Janssen, and Pfizer.

References 

(1) Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial.

(2) "COMPASS Trial - Bleeding and cancer risk in patients with vascular disease treated with Rivaroxaban” will be presented during the session Clinical Trial Updates on Sunday 26 August from 11:00 to 12:30 CEST in Brahms – The Hub.

(3) Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017;377:1319–1330. doi: 10.1056/NEJMoa1709118. 

ESC Press Office
For press enquiries, independent comment, please contact the ESC Press Office at press@escardio.org

To access congress scientific resources visit ESC Congress 365.


About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2018

ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2018 takes place 25 to 29 August at the Messe München in Munich, Germany. Explore the scientific programme.

 

This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2018. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.