Methods. Data from a single-center registry of 3,644 ACS patients discharged with dual antiplatelet therapy (DAPT) were used to investigate the association between post-discharge bleeding and diagnosis of cancer. The adjusted effect of bleeding as time-varying covariate on subsequent cancer diagnosis was assessed using Cox regression models. Positive predictive values (PPVs) of bleeding for cancer diagnosis were calculated.
Results. During a median follow-up of 56.2 months, bleeding events were documented in 1,215 patients and new cancers in 227 patients. After multivariable adjustment, post-discharge bleeding was associated with cancer diagnosis (adjusted HR 3.43, 95% CI 2.62-4.50), but only spontaneous bleeding (adjusted HR=4.38, 95% CI 3.31-5.79). This association was stronger as the severity of the bleeding increased (HR= 1.52, 4.88, 7.30, and 12.29, for BARC type 1, 2, 3a, and 3b bleeding, respectively). With respect to the specific location of bleeding for diagnosis of cancer, only gastrointestinal, genitourinary and bronchopulmonary bleeding result strongly associated with site-specific cancers [Table]. No differences in the adjusted risk of cancer were found for those post-discharge bleedings that happened on-DAPT versus off-DAPT (HR for on-DAPT bleeding vs off-DAPT bleeding: 1.05, 95% CI 0.69-1.62; p=0.832). PPV for cancer diagnosis of post-discharge bleeding was 7.7%. (21.9% for genitourinary bleeding, 18.6% for bronchopulmonary bleeding, 5.8% for gastrointestinal bleeding, and 2.3% for other bleedings). Median time from bleeding to cancer was 4.6 months.
Conclusions. Spontaneous post-discharge bleeding in ACS patients is strongly associated with subsequent cancer diagnosis within the first 6 months. A prompt evaluation of bleeding could be useful for enabling an early detection of cancer in these patients.