Gastrointestinal (GI) and genitourinary (GU) bleeding are powerful predictors of new cancer diagnosis in patients with vascular disease, based on findings from the COMPASS Trial presented Aug. 26 at ESC Congress 2018. In addition, increased GI bleeding with rivaroxaban appears to unmask cancer even earlier.

The trial randomized 27,395 patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD) to receive either rivaroxaban (2.5 mg bid) plus aspirin, rivaroxaban (5 mg bid) only, or aspirin (100 mg od) only. Researchers then analyzed the proportion of new cancer diagnosis before and after bleeding; the association between bleeding and new cancer diagnosis; and the rates of cancer diagnosis.

Results showed a total of 1,082 new cancers diagnosed during the trial, with 23.8 percent (N=257) diagnosed after bleeding. Of the 307 new cases of GI cancer and 138 new GU cancers, 22.8 percent and 44.9 percent were diagnosed post-bleeding, respectively. The majority of new GI and GU cancers were diagnosed within six months of a bleed (77.1 percent and 88.7 percent, respectively).

"More than one in five new diagnoses of cancer are preceded by bleeding," researchers noted. They added that within the first year, those patients taking rivaroxaban plus aspirin, as well as those taking rivaroxaban alone, had greater frequency of new GI cancer in the first year (0.6 percent) compared with those taking aspirin (0.4 percent).

"The occurrence of GI or GU bleeding in patients receiving antithrombotic drugs should stimulate a search for cancer in the same organ system," researchers said. The also suggested that extended follow-up of COMPASS Trial participants may help show whether earlier identification of cancer after bleeding improves cancer outcomes.

Keywords: ESC18, ESC Congress, Acute Coronary Syndrome, Neoplasms, Hemorrhage, Vascular Diseases, Cardiotoxicity, Cardiotoxins

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