ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Colorectal Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1648003
This article is part of the Research TopicCancer and Cardiovascular Diseases: Common Mechanisms and Strategies of PreventionView all articles
Risk factors for recurrence and bleeding in colorectal cancer patients with cancer-associated venous thrombembolism
Provisionally accepted
- The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Colorectal cancer (CRC) patients with cancer-associated venous thromboembolism (VTE) face high risks of recurrence and anticoagulant-related bleeding. Objectives: Our aim was to assess risk factors associated with recurrence and bleeding and analyze the impact of these outcomes on survival during one-year follow up. Design: Retrospective study. Methods: This analysis included consecutive VTE patients treated with anticoagulants from January 2019 to January 2023. The incidence of recurrent VTE, major bleeding (MB), and clinically relevant non-major bleeding (CRNMB) was evaluated and their associated risk factors were identified using univariate and multivariate models. Furthermore, the impact of anticoagulant treatment outcomes on all-cause mortality was analyzed by Cox proportional hazards model and Kaplan-Meier method. Results: This study included 1,792 CRC patients with cancer-associated VTE. In competing-risk multivariate analysis, independent predictors of recurrent VTE included age (HR with 95%CI: 1.005 [1.002-1.008] per year), history of VTE (4.288 [2.902-6.334]), index pulmonary embolism (PE) (1.698 [1.252-2.303]), ECOG ≥ 2 (1.561 [1.036-2.350]), hemoglobin < 100 g/L (1.363 [1.045-1.778]), and aPTT > 36.5 s (2.034 [1.223-3.383]); whereas recent major surgery or trauma within 1 month (0.451 [0.259-0.786]) and tumor stage II (0.607 [0.377-0.978]) or III (0.562 [0.333-0.949]) were associated with lower recurrence risk. Independent predictors of MB included age ≥ 75 (1.637 [1.011-2.652]), history of MB (5.320 [1.880-15.050]), ECOG ≥ 2 (9.979 [4.292-23.203]), antiplatelet therapy (2.592 [1.539-4.367]), and platelet count < 100×109/L (2.685 [1.336-5.397]); whereas tumor stage III (0.122 [0.053-0.278]) and metastatic cancer (0.190 [0.086-0.421]) predicted lower bleeding risk. Similarly, independent predictors of CRNMB included age ≥ 75 (1.465 [1.005-2.137]), ECOG ≥ 2 (1.750 [1.184-2.586]), hemoglobin < 100 g/L (1.870 [1.316-2.657]), and platelet count < 100×109/L (2.057 [1.076-3.932]). Recurrent VTE, MB, and CRNMB each adversely impacted one-year survival. Conclusions: The independent risk factors identified in this study may serve as a reference for improving risk stratification in CRC patients receiving anticoagulant treatment. Additionally, adverse outcomes such as VTE recurrence, MB, and CRNMB significantly increase the one-year all-cause mortality risk in CRC patients.
Keywords: colorectal cancer, Cancer-associated venous thromboembolism, Recurrent thrombosis, Bleeding events, Patient survival
Received: 04 Jul 2025; Accepted: 07 Aug 2025.
Copyright: © 2025 Liang, Mao, Xie, Li and Qin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zhikun Liang, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Li Qin, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.