Venous thromboembolism in patients with breast, ovarian, and uterine cancer. A comparative analysis from the Registro Informatizado Enfermedad TromboEmbólica registry

BACKGROUND: The risk of recurrent venous thromboembolism (VTE) and bleeding during anticoagulation may vary by the cancer type.

OBJECTIVES: We assessed outcomes during anticoagulation in women with breast, ovarian, or uterine cancer and VTE.

METHODS: We analyzed data from the Registro Informatizado Enfermedad TromboEmbólica registry on 4721 women with active breast (n = 2929), ovarian (n = 886), or uterine (n = 906) cancer and acute VTE. We assessed VTE recurrences, bleeding, and mortality according to cancer type and anticoagulant type. Multivariate Cox models were adjusted for age, metastases, anemia, renal function, and treatment at VTE onset.

RESULTS: Uterine cancer patients had the highest rates of major bleeding (11.1 per 100 patient-years) and fatal bleeding (1.07 per 100 patient-years), while ovarian cancer patients had the highest rate of VTE recurrences (7.29 per 100 patient-years). In contrast, breast cancer patients had the lowest event rates overall. Among low-molecular-weight heparin-treated patients, major bleeding was higher in uterine (6.37 per 100 patient-years) and ovarian (4.62 per 100 patient-years) cancer than breast cancer patients (1.89 per 100 patient-years). Direct oral anticoagulant use was associated with low recurrence rates in breast cancer (0.58 per 100 patient-years), but outcomes in uterine cancer remained less favorable. Multivariable models confirmed cancer-specific risks.

CONCLUSIONS: VTE outcomes vary significantly by cancer type. Patients with uterine cancer face an elevated bleeding risk, potentially impacting anticoagulant continuity and contributing to VTE recurrence. These findings support the need for cancer-specific risk assessment and individualized anticoagulation strategies adapted to the specific cancer type.