Analysis of bleeding risk factors of low molecular weight heparin in prevention and treatment of tumor-associated venous thromboembolism
OBJECTIVE To explore the risks of bleeding associated with dosing of low molecular weight heparin(LMWH)for managing pulmonary thromboembolism(VTE)and provide assistance for individualized dosing of LMWH in the management of deep venous thrombosis(DVT)in cancer patients.METHODS A single-center,retrospective observational cohort study method was used to select tumor patients hospitalized in the First People's Hospital of Ziyang City from January to December 2021 as the observation objects,and 731 patients aged ≥18 years old and using low molecular weight heparin to prevent and treat VTE were included.According to whetherr bleeding events occurred in clinical outcomes,they were divided into bleeding group and non-bleeding group.The effects of demographic characteristics,basic disease status,coagulation function,platelet count and other factors on the risk of bleeding in tumor patients were observed.RESULTS Univariate analysis revealed that body weight was lower in bleeding group than that in non-bleeding group(P=0.009).The proportion of takers of non-steroidal anti-inflammatory drugs(NSAIDs)was higher in bleeding group than that in non-bleeding group(P＜0.01).Daily use of LMWH was higher in bleeding group than that in non-bleeding group(P＜0.01).Creatinine clearance rate(Ccr)was lower in bleeding group than that in non-bleeding group(P＜0.01).Platelet count(PLT)was lower in bleeding group than that in non-bleeding group(P=0.011).Prothrombin time(PT)was lower in bleeding group than that in non-bleeding group(P=0.006).Significant inter-group differences existed in Padua score and bleeding risk score of HAS-BLED(all P＜0.01).No significant inter-group differences existed in gender,age,tumor classification,duration of LMWH,activated partial thromboplastin time(APTT),fibrinogen(FIB)or basic disease status(all P＞0.05).Binary Logistic regression analysis indicated that NSAIDs(P=0.019),HAS-BLED(P＜0.01),LMWH dosing(P=0.021)and PT(P=0.029)were included for modeling.The overall evaluation of the model was Omnibus test(x2=48.124,P＜0.01).A non-linear relationship existed between PLT and bleeding events.Thus PLT was not included for multivariate regression analysis.Receiver operating characteristic(ROC)curve was not ideal for evalu-ating the capability of four variables in predicting related bleeding events.ROC-AUC was＜0.850.CONCLUSION Body weight,NSAIDs,LMWH dosing,PT,Ccr,PLT,Padua score and HAS-BLED may be the risk factors for bleeding in cancer patients on a therapy of LMWH for managing VTE.NSAIDs,HAS-BLED,LMWH dosing and PT may be independent risk factors for predicting bleeding risk in related patients.However,their predictive capabilities are not ideal.
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