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June 6, 2026American Journal of HematologyOpen Access

Clinically Relevant Bleeding in Individuals With Cancer: Insights From a Nationwide Cohort Study

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Key result

Clinically relevant bleeding was independently associated with mortality in cancer patients, including intracranial hemorrhage (HR 4.17; 95% CI 4.11-4.24) and gastrointestinal bleeding (HR 2.52).

Why the study?

What is the incidence of clinically relevant bleeding and its association with mortality in individuals with cancer?

Population

2,455,332 individuals with incident cancer encounters from 215 US health systems between 2018 and 2024

Design

Cohort

Follow-up

12 months after cancer diagnosis

Authors

MLMing Y. LimRGRadhika GangarajuOJOmid Jafari

Discussion

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Overview

Clinically relevant bleeding is a frequent complication in cancer patients, particularly those on anticoagulants, and is strongly associated with increased mortality.

Key Points

  • To evaluate the prevalence and incidence of clinically relevant bleeding (CRB) in individuals with cancer and its association with mortality.
  • Analyzed data from 2,455,332 individuals with incident cancer encounters using the Epic Cosmos database.
  • Examined prevalence of CRB in the 12 months before and cumulative incidence in the 12 months after cancer diagnosis.
  • Performed multivariable analysis to assess factors associated with CRB and its impact on mortality.
  • CRB was prevalent in 5.3% of individuals before diagnosis and 6.3% after, reaching 7.0% in those receiving systemic therapy.
  • Factors linked to higher CRB incidence included certain cancer types, anticoagulant use, and previous VTE history.
  • Intracranial hemorrhage had the highest mortality risk (HR 4.17, 95% CI 4.11-4.24) associated with CRB.

Study Design

Type

Cohort (n=2,455,332)

Multicenter

Yes

Structured PICO

What is the incidence of clinically relevant bleeding and its association with mortality in individuals with cancer?

P
Population
2,455,332 individuals with incident cancer encounters from 215 US health systems between 2018 and 2024, evaluated for clinically relevant bleeding.
O
Outcome
Clinically relevant bleeding (CRB) and its association with mortalityhard clinical

Main Result

Hazard Ratio: 4.17 (95% CI 4.11–4.24)

Clinically relevant bleeding is a frequent complication in cancer patients, particularly those on anticoagulants, and is strongly associated with increased mortality.

Cite This Study

Lim et al. (2026) conducted a cohort in Cancer (n=2,455,332). Clinically relevant bleeding vs. No clinically relevant bleeding was evaluated on Mortality (HR 4.17, 95% CI 4.11-4.24). Clinically relevant bleeding was independently associated with mortality in cancer patients, including intracranial hemorrhage (HR 4.17; 95% CI 4.11-4.24) and gastrointestinal bleeding (HR 2.52).

synapsesocial.com/papers/6a23bb7971a5da9775e76f10https://doi.org/10.1002/ajh.70394
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Risk factors for recurrence and bleeding in colorectal cancer patients with cancer-associated venous thrombembolism2025 · 3 citations
  2. 2Distribution and risk for bleeding in patients with cancer by anticoagulant therapy exposure2025
  3. 3Impact of thrombocytopenia on hemorrhage and recurrent thrombosis in patients with cancer associated thrombosis, a time varying analysis2025
  4. 4Venous thromboembolism and bleeding in cancer patients: role of inflammatory and cardiac biomarkers2025
  5. 5Cancer-Associated Thromboembolic Disease and the Evolution of Management2025