Background: Growth-differentiation factor-15 (GDF-15) is a strong predictor for bleeding in patients with atrial fibrillation, but there are no data on this biomarker in cancer patients. Bleeding risk assessment is important in cancer patients when considering primary thromboprophylaxis since it is associated with an increased bleeding risk.

Aims: We aimed to evaluate GDF-15 as predictor for bleeding events in cancer patients previously enrolled in the AVERT trial

Methods: In the AVERT trial, 574 participants were randomized to prophylactic apixaban or placebo and followed for 180 days for venous thromboembolism, major bleeding, clinically relevant non-major bleeding, and any bleeding. GDF-15 levels were measured in citrate plasma collected 1 month after enrollment in AVERT.

Results: In apixaban recipients, the area under the receiver-operator-curve of GDF-15 for major bleeding was 0.73 (95% CI, 0.44-1.00). Compared to the lowest GDF-15 tertile (<1470 ng/L), major bleeding risk was significantly higher in the highest tertile (≥2607 ng/L; HR 3.19; 95% CI, 2.41-4.22), also when adjusting for sex, age, antiplatelet use, and gastrointestinal cancer (_adjHR 2.80; 95% CI, 1.91-4.11). GDF-15 was also significantly associated with clinically relevant non-major bleeding (adjusted HR 1.67, 95% CI 1.08-2.58) and any bleeding (adjusted HR 2.12, 95% CI 1.38-3.25).

Conclusions: Although hypothesis generating, this is the first study to show that GDF-15 predicts bleeding in cancer patients receiving thromboprophylaxis.  

« Back to ISTH 2021 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/growth-differentiation-factor-15-for-prediction-of-bleeding-in-cancer-patients/