I was talking about work first that we are presenting at this conference which is focussed on evaluating the mortality after bleeding events or thrombotic recurrence events in patients with cancer associated venous thromboembolic event in Ontario. We conducted a population-based study in Ontario, Canada among patients who were aged 65 or older and who had been diagnosed with a cancer associated venous thromboembolic event. The objective of our study was to evaluate what was the mortality within seven days of a venous thromboembolic recurrence or bleeding in this population. We know that this population has a high risk of recurrence and also a high risk of bleeding but no studies have ever looked at an absolute difference in mortality associated with these events.

We included about 7,000 patients in this retrospective population-based cohort study that had developed a VTE within the diagnosis of cancer. What we found is that there were about 3% major bleeding events in this cohort compared to about 11% thrombotic recurrences. However, the mortality was much higher within seven days of a major bleeding event compared to a thrombotic event. In the best case scenario the mortality rate ratio was about nine times for bleeding compared to that of VTE. So we do believe that this information is fairly important in actually developing and designing further studies and it needs to be corroborated because it’s observational and based on administrative data but this is a really important piece of information.

And for any patients or geriatric oncologists working with elderly patients who might be, for example, receiving blood thinners for differing conditions, what does that mean for their treatment going forwards?

If you are referring, for instance, to patients with atrial fibrillation, [?? 2:26] coagulation who also happen to have cancer I don’t think that we can have any conclusion in that regard. But certainly the management of anticoagulants in cancer patients, specifically in those who have active chemotherapy treatment who might be at higher risk of developing other complications such as thrombocytopenia, that’s something that needs to be taken into account. But it’s nothing that we can conclude from this study because it was not the population that we included.

Are there any plans to take this forward and be able to answer these questions in other studies?

We are looking into that as well and we would like to expand this with other cohorts that we have available and access to in Canada. There are other countries that also have population based registries that we are going to reach out to try to duplicate these findings. Because I think this is a particularly important point for management.

I’ve just remembered seeing the news not so long back that non-steroidal anti-inflammatory drugs were found to put patients at increased risk of bleed as well. Is that something that patients should be aware of if they are taking just regular aspirin?

Yes, that’s something that has been shown for a long time and we do tend to eliminate the concurrent use of non-steroidal anti-inflammatory drugs, including aspirin, in conjunction with warfarin or any other anticoagulant, including the new direct oral anticoagulants, so that will increase the risk. That’s something that needs to be considered, yes.