How Blood Clotting and Bleeding Complications Impact Survival of Patients with MDS

Blood clotting disorders can present further challenges for people with myelodysplastic syndromes (MDS). At the 2024 ASH annual conference, an oral presentation by Dr. Mansour Gergi from The University of Vermont Medical Center shared insights into research that suspects that blood clotting events during the first year after MDS diagnosis may impact survival outcomes as they shape early therapy in MDS. 

What Were the Study’s Objectives?

For this study, researchers aimed to determine the impact on survival of venous thromboembolism (a blood clot in a vein) or severe bleeding events during the first year following an MDS diagnosis. They also want to understand which risk factors for blood clotting disorders are present in MDS patients. 

How Was This Study Performed? 

Data from 15,277 MDS patients diagnosed between 2007 and 2017 was analyzed using the SEER-Medicare database. These patients were followed for up to two years to monitor venous thromboembolism, bleeding events, and survival. To better analyze this, they took into account multiple variables such as age, sex, race, socioeconomic status, other health issues, and MDS risk of progression into acute leukemia.

What Were the Study Results? 

• 4% of patients experienced venous thromboembolism (VTE), and 6% of patients had a severe bleeding event within the first year of diagnosis.

 Impact of VTE and Severe Bleeding on Survival

• 59% of patients with VTE passed away after 2 years; however, there was no clear association that VTE had an impact on survival 

• 70% with severe bleeding passed away after 2 years, and this was associated with an increased risk of 2-year mortality by 68%

What Are the Risk Factors? 

Venous Thromboembolism Risk Factors 

• Black patients had a 76% increased risk compared to White patients 

• Patients with higher comorbidity burden had an 80% increased risk for VTE 

• High-risk MDS doubled the risk of experiencing VTE. 

Severe Bleeding Risk Factors 

• Patients with higher comorbidity burden had an 89% increased risk of severe bleeding

• Hypertension, diabetes, and liver disease were associated with higher risk.

• High-risk MDS patients had a 4.27-fold increased risk of bleeding 

• Anticoagulant use increased the bleeding risk by 65%. 

What’s the Medication Impact on Blood Clotting Disorders? 

• Hypomethylating agents (HMA) and erythropoietin-stimulating agents (ESA) did not affect VTE or bleeding risk.

• Lenalidomide (Revlimid): Increased VTE risk by 56%  and reduced bleeding risk by 36%. 

What Does This Mean for MDS Patients?

• Patients who have a significant bleeding complication within the first year after being diagnosed with MDS may have a higher risk of serious outcomes, including the possibility of death, within the next two years
• Identifying and managing risk factors, ( such as comorbidities and high-risk MDS) is critical to improving outcomes.
• Some preventive measures for blood clotting are the use of anticoagulants, however they need special attention and monitoring by medical professionals since they vary depending on previous health issues, and the risk of bleeding after taking them. So that’s why it is important to discuss anticoagulant use and potential bleeding risks with your healthcare team.
• When there’s easy bruising or bleeding, it could indicate that the platelet levels in blood are low, however, to determine that it’s important to take a blood test and have a medical professional evaluate blood cell counts and coagulation times known as PT and PTT. You can read more about how low platelet levels are treated in this comprehensive article. 

This study highlights the significant role that thrombosis and bleeding complications play in the early treatment of MDS. Understanding these risks can help refine management strategies and improve survival outcomes. You can actively participate in your care by discussing potential risks and preventative strategies with your healthcare team.

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Source: 

•  Impact of Thrombosis and Bleeding on Survival of Older People with Myelodysplastic Syndromes (MDS): A Population Analysis