Predicting recurrences or major bleeding in women with cancer and venous thromboembolism. Findings from the RIETE Registry

Background: Cancer patients with venous thromboembolism (VTE) have an increased incidence of recurrences and bleeding complications Reliable information on the factors determining the risk for such complications may facilitate better use of therapy. Methods: RIETE Registry is an ongoing, international registry of consecutive patients presenting with symptomatic acute VTE confirmed by objective tests. We assessed the 3-month outcome in all women with active cancer, trying to identify if differences exist according to the tumor site. Results: Up to May 2007, 18,883 patients had been enrolled. Of them, 3805 (20%) had active cancer, 1719 (45%) were women. During the 3-month study period, 40 (2.3%) had recurrent deep vein thrombosis, 39 (2.3%) recurrent pulmonary embolism (PE), 67 (3.9%) major bleeding, 394 (23%) died. Of these, 13 (33%) women with recurrent PE died of the PE, 17 (42%) with major bleeding had fatal bleeding. In women with gastrointestinal (5.7% vs. 4.3%) or genitourinary (6.4% vs. 4.7%) cancers the incidence of bleeding complications exceeded that of VTE recurrences, while in those with brain (3.4% vs. 13%) or lung cancer (2.6% vs. 11%) the rate of recurrences outweighed that of major bleeding. Conclusions: We identified significant differences in outcome according to the site of cancer that may help to identify those women with cancer and VTE at a higher risk for recurrences or major bleeding. (C) 2009 Elsevier Ltd. All rights reserved.