{
  "abstract": "Background Determining the most appropriate treatment in patients with cancer with an acute myocardial infarction (MI) can be challenging. Optimal management requires an understanding of bleeding risk which may be different in this population. This study aimed to investigate the bleeding risk among patients with MI with and without cancer, in the first and second year post-MI.Methods Patients with MI, with and without cancer were identified from a national cardio-oncology database from England between 2006 and 2019. The outcome was a presentation to hospital for a major bleeding event, with patients followed for a maximum of 24 months. Inverse probability weighting was used to compare cancer and non-cancer cohorts in time-to-event analyses.Results 587 279 patients with MI were identified, 9820 (1.7%) had cancer and 577 459 (98.3%) did not. Colorectal, prostate, breast, lung and bladder cancer were the most common types of cancer. The rate of hospital presentation for bleeding in the first year post-MI was higher in patients with cancer than the non-cancer reference population (HR: 1.53, 95% CI 1.45 to 1.62, p<0.001). 506 280 patients with MI were followed up in the second year post-MI. 5666 (1.1%) had cancer and 500 614 (98.9%) did not. The bleeding rate in patients with MI with cancer remained elevated in the second year post-MI (HR: 1.42, 95% CI 1.29 to 1.56, p<0.001). There were marked differences in bleeding between cancer types.Conclusion In this real-world observational study, patients with cancer had an increased bleeding risk in the first year post-MI which decreased but persisted in the second year after MI. Bleeding risk in patients with cancer must be carefully assessed post-MI.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK",
        "National Disease Registration Service, NHS England, London, UK"
      ],
      "name": "Kok Weng Ow"
    },
    {
      "affiliations": [
        "National Disease Registration Service, NHS England, London, UK",
        "Department of Population Health Sciences, University of Leicester, Leicester, UK",
        "Observational and Pragmatic Research Institute, England, UK"
      ],
      "name": "Freya Tyrer"
    },
    {
      "affiliations": [
        "Department of Experimental Cardiology, University Medical Centre Groningen, Groningen, The Netherlands"
      ],
      "name": "Freek Van Den Berg"
    },
    {
      "affiliations": [
        "National Disease Registration Service, NHS England, London, UK"
      ],
      "name": "Jennifer Lai"
    },
    {
      "affiliations": [
        "National Disease Registration Service, NHS England, London, UK"
      ],
      "name": "Sally Vernon"
    },
    {
      "affiliations": [
        "National Disease Registration Service, NHS England, London, UK"
      ],
      "name": "Lizz Paley"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK",
        "National Disease Registration Service, NHS England, London, UK",
        "Center for Molecular Cardiology, University of Zurich, Zürich, Switzerland",
        "Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Florian A Wenzl"
    },
    {
      "affiliations": [
        "Glangwili General Hospital, Carmarthen, UK"
      ],
      "name": "Clive Weston"
    },
    {
      "affiliations": [
        "Department of Population Health Sciences, University of Leicester, Leicester, UK"
      ],
      "name": "Mark J Rutherford"
    },
    {
      "affiliations": [
        "Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway",
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Paul C Lambert"
    },
    {
      "affiliations": [
        "National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden and Greater East Midlands Commissioning Support Unit, Leicester, UK",
        "William Harvey Research Institute, Queen Mary University of London, London, UK"
      ],
      "name": "Mark A de Belder"
    },
    {
      "affiliations": [
        "Institute of Cardiovascular Science, University College London, London, UK",
        "National Institute of Cardiovascular Outcomes Research (NICOR), London, UK"
      ],
      "name": "John Deanfield"
    },
    {
      "affiliations": [
        "University of Leicester, Leicester, UK"
      ],
      "name": "Michael D Peake"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK",
        "Leicester British Heart Foundation Centre of Research Excellence, Leicester, UK"
      ],
      "name": "David Adlam"
    }
  ],
  "title": "Impact of a recent cancer diagnosis on bleeding risk after myocardial infarction",
  "uid": "4a843c94-1851-531b-9ad5-b2cc069ff659"
}