P2554Bleedings during antithrombotic therapy: a blessing in disguise

Abstract Background and purpose Antithrombotic therapy in patients with heart diseases is associated with minor and major, sometimes fatal bleedings. On the other hand, bleeding can favor the diagnosis of diseases that have a significant impact on patient's prognosis. In our research, we evaluated the incidence of occult malignancies associated with bleeding during antithrombotic therapy. Methods In the last 5 years, we evaluated 20,154 outpatients. We found that antithrombotic therapy was performed in 9.356 (46%) of subjects. Of these, 6,560 took an antiplatelet monotherapy. 658 were on dual antiplatelet therapy, 465 were anticoagulated with warfarin, 1,154 received new anticoagulants, 145 were on triple antithrombotic therapy, and 354 patients took one anticoagulant plus an antiplatelet. Twenty patients who already had a diagnosis of malignancy were excluded from the analysis. In a one year follow-up, we evaluated the incidence of minor, major and fatal bleedings. All patients with bleedings and suspicion for occult malignancies underwent further diagnostic investigations. Results Table 1 shows the incidence of bleeding (classified according to the ISTH bleeding score). Overall, there were 1,045 bleeds, of which 289 (3.1%) were major, and 756 (8.1%) minor. In 2 cases the bleeding was fatal (0.2%). Malignancies were identified in 88 patients (8.4%); in 72 cases (82%) the treatment was resolutive. Table 1. Rates of major and minor bleedings and occult malignancies Bleedings Major Occult malignancies Minor Occult malignancies Gastrointestinal 130 (1.4%) 15 (5.1%) 289 (3.1%) 45 (6.0%) Urinary 46 (0.5%) 6 (2.1%) 207 (2.2%) 14 (1.8%) Musculo-cutaneous 30 (0.3%) – 47 (0.5%) Epistaxis and airways 36 (0.4%) – 198 (2.1%) 8 (1.0%) Intracranial 28 (0.3%) – – – Ocular 9 (0.1%) – 15 (0.2%) – Intraarticular 10 (0.1%) – – – Others – – – Total 289 (3.1%) 21 (7.2%) 756 (8.1%) 67 (8.8%) Conclusions Our research underlines the importance of prosecuting diagnostic investigations even in patients with minor bleedings, especially in case of gastrointestinal or urinary bleedings, to exclude cancer, since there were no significant differences in the incidence of malignancies between the two groups.