Abstract
BACKGROUND: Thrombotic and bleeding complications in myelodysplastic syndromes (MDS) can affect therapy, but how they impact overall survival remains unclear. OBJECTIVES: Evaluating the impact of venous thromboembolism (VTE) and bleeding on survival in older MDS patients. METHODS: Incident MDS cases were collected from the Surveillance, Epidemiology, and End Results Medicare database (2007-2017) and followed from diagnosis until death. Baseline demographics, comorbidities, and the Surveillance, Epidemiology, and End Results Medicare MDS Risk Score were assessed. VTE and bleeding events were identified using validated algorithms and modeled as time-varying covariates. Cox regression, adjusted for age, sex (male vs female), race, National Cancer Institute Comorbidity Index, and Surveillance, Epidemiology, and End Results Medicare MDS Risk Score, estimated the hazard ratio (HR) for death. RESULTS: Among 13 995 MDS patients (median age, 82 years; 46% female), 1114 VTE and 1905 bleeding events occurred. VTE was associated with increased mortality within <3 months (HR, 3.21; 95% CI, 2.84-3.62) and 3 to 6 months (HR, 1.51; 95% CI, 1.23-1.85), but not for 6 to 12 months (HR, 1.18; 95% CI, 0.98, 1.42) or >12 months (HR, 1.00; 95% CI, 1.91, 1.11). Bleeding was associated with mortality for all postevent time periods assessed: <3 months (HR, 4.25; 95% CI, 3.89, 4.65), 3 to 6 months (HR, 2.11; 95% CI, 1.82, 2.45), 6 to 12 months (HR, 1.60; 95% CI, 1.39, 1.85), and >12 months (HR, 1.43; 95% CI, 1.31, 1.57). Case-crossover analysis confirmed these associations for bleeding but revealed potential unmeasured confounders for VTE. CONCLUSION: Bleeding was associated with subsequent mortality in MDS patients. For VTE, this risk seems to be affected by potential unmeasured confounders. These findings underscore the need for strategies to mitigate bleeding risk in this population.