Incidence of and risk factors for hospital-acquired bleeding in people with cancer: a systematic review

Abstract

Background

Hospital-acquired (HA) bleeding (bleeding occurring during hospitalization) in cancer patients is poorly characterized, potentially increasing morbidity and mortality due to under- or overprescription of low-dose anticoagulation for venous thromboembolism prevention.

Objectives

To perform a systematic review and meta-analysis (as appropriate) to identify the incidence of and risk factors for HA bleeding in people with cancer.

Methods

A systematic English-language search was conducted using Ovid MEDLINE, Ovid EMBASE, Google Scholar, and Cochrane Library. Keywords and controlled vocabulary related to bleeding risk in hospitalized cancer patients were iteratively refined. Studies assessing HA bleeding as a primary or coprimary endpoint were included, excluding those focused solely on bleeding associated with venous thromboembolism prophylaxis or full-dose anticoagulation. Results were reviewed independently by 3 team members.

Results

Six studies met the inclusion criteria. Three studies were conference abstracts, and 3 were peer-reviewed articles. The incidence of HA major bleeding ranged from 1% in all cancer patients admitted to the general medical floor to 14% in hematologic malignancy patients in the intensive care unit.

Conclusion

Limited data suggest unique cancer- and patient-related characteristics are associated with risk of HA bleeding. The paucity of objective data on the incidence of and risk factors for HA bleeding in people with cancer underscores the need for further research to define the epidemiology of, improve risk stratification for, and assess clinical outcomes for HA bleeding in people with cancer.