Thromboembolic and bleeding complications in patients with oesophageal cancer

Background In patients who undergo curative treatment for oesophageal cancer, risk estimates of venous thromboembolism (VTE), arterial thromboembolism and bleeding are needed to guide decisions about thromboprophylaxis. Methods This was a single-centre, retrospective cohort study of patients with stage I-III oesophageal cancer who received neoadjuvant chemoradiation followed by oesophagectomy. The outcomes VTE, arterial thromboembolism, major bleeding, clinically relevant non-major bleeding and mortality were analysed for four consecutive cancer treatment stages (from diagnosis to neoadjuvant chemoradiotherapy, during neoadjuvant treatment, 30-day postoperative period, and up to 6 months after postoperative period). Results Some 511 patients were included. The 2-year survival rate was 67 center dot 3 (95 per cent c.i. 63 center dot 2 to 71 center dot 7) per cent. During the 2-year follow-up, 50 patients (9 center dot 8 per cent) developed VTE, 20 (3 center dot 9 per cent) arterial thromboembolism, 21 (4 center dot 1 per cent) major bleeding and 30 (5 center dot 9 per cent) clinically relevant non-major bleeding. The risk of these events was substantial at all treatment stages. Despite 30-day postoperative thromboprophylaxis, 17 patients (3 center dot 3 per cent) developed VTE after surgery. Patients with VTE had worse survival (time-varying hazard ratio 1 center dot 81, 95 per cent c.i. 1 center dot 25 to 2 center dot 64). Most bleeding events occurred around the time of medical intervention, and approximately one-half during concomitant use of prophylactic or therapeutic anticoagulation. Conclusion Patients with oesophageal cancer undergoing neoadjuvant chemoradiotherapy and surgery are at substantial risk of thromboembolic and bleeding events throughout all stages of treatment. Survival is worse in patients with thromboembolic events during follow-up.