TOPLINE:

Patients diagnosed with cancer had a 53% increased risk of presenting to the hospital with major bleeding in the first year after a myocardial infarction (MI), and the risk persisted into the second year. Among all cancers, bladder cancer was associated with the highest risk.

METHODOLOGY:

• Researchers conducted a retrospective observational cohort study to assess whether a recent diagnosis of cancer raised the risk for major bleeding in the first 2 years after MI.
• They used data from linked national registries in England and identified 587,279 patients with a first MI between 2006 and 2019. Patients with atrial fibrillation, venous thromboembolism, or those using warfarin were not included.
• Among them, 9820 (1.7%) were diagnosed with cancer in the preceding year. Patients with cancer were older than those without cancer (mean age, 73.13 vs 67.05 years), and about two thirds were men in both groups.
• Researchers used propensity scores to balance both the groups for age, sex, and other baseline factors.
• They used diagnostic codes to track the first hospital presentation for major bleeding for up to 24 months. All patients were followed up for 0-12 months, and those who survived year 1 were followed up for 12-24 months.

TAKEAWAY:

• Patients with a recent diagnosis of cancer had a 53% higher risk of presenting with bleeding in year 1 after MI (adjusted hazard ratio [aHR], 1.53; P < .001) and a 42% higher risk in year 2 after MI (aHR, 1.42; P < .001) than those without cancer.
• In year 1, patients with ST-elevation MI who underwent coronary stenting and had cancer had the highest rate of bleeding (aHR, 1.99; P < .001). In year 2, those with ST-elevation MI and cancer had the highest rate of bleeding (aHR, 1.64; P < .001).
• All cancers (except breast) were associated with an increased risk for bleeding in year 1 after MI. Patients with bladder cancer had the highest risk (aHR, 2.38; P < .001), which persisted in year 2 (aHR, 1.92; P < .001).
• Fewer patients with cancer underwent coronary stenting than those without cancer.

IN PRACTICE:

“Balancing ischemic and bleeding risk is challenging in patients with cancer, as contemporary risk scores used are not validated in patients with cancer,” the researchers wrote.

“Characterizing bleeding risks based on different malignancies may allow for a more personalized assessment of risk, potentially enabling future optimization of antiplatelet strategies in patients with cancer, including a shorter duration of antiplatelet use,” they added.

SOURCE:

The study was led by Kok Weng Ow of University of Leicester in Leicester, England. It was published online on December 30, 2025, in Heart.

LIMITATIONS:

The linked database lacked prescription data; thus, the study could not assess the effects of antiplatelet treatment effects. Data on the use of cancer therapies or follow-up tests around MI were not captured. Researchers may have included some patients with cancer outside the 1-year window in the comparison group.

DISCLOSURES:

The study received support from the British Heart Foundation, Cancer Research UK, the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands, and Leicester NIHR Biomedical Research Centre. One author disclosed receiving funding as a NIHR Academic Clinical Fellow in cardiology. Several authors reported research support, consulting honoraria, royalties, patents, leadership roles, or other financial ties with public funders and industry including cardiovascular and pharmaceutical organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.