{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:57:32Z","timestamp":1785585452069,"version":"3.56.0"},"reference-count":43,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 HL180402"],"award-info":[{"award-number":["R01 HL180402"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23 HL159271"],"award-info":[{"award-number":["K23 HL159271"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K08 HL159290"],"award-info":[{"award-number":["K08 HL159290"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004917","name":"Cancer Prevention and Research Institute of Texas","doi-asserted-by":"publisher","award":["RR190104"],"award-info":[{"award-number":["RR190104"]}],"id":[{"id":"10.13039\/100004917","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001422","name":"American Society of Hematology","doi-asserted-by":"publisher","award":["ASH Scholar Award"],"award-info":[{"award-number":["ASH Scholar Award"]}],"id":[{"id":"10.13039\/100001422","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000982","name":"Conquer Cancer Foundation","doi-asserted-by":"publisher","award":["Career Development Award"],"award-info":[{"award-number":["Career Development Award"]}],"id":[{"id":"10.13039\/100000982","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Cancer care is often complicated by coagulopathy leading to thrombosis and bleeding. While venous thromboembolism (VTE) has been extensively studied, bleeding remains an underestimated threat. To address this knowledge gap, we leveraged the Epic Cosmos database to determine the impact of cancer\u2010associated clinically relevant bleeding (CRB) in 2\u2009455\u2009332 individuals with incident cancer encounters from 215 US health systems between 2018 and 2024. In the 12\u2009months leading up to the cancer diagnosis, the period prevalence of CRB was 5.3% in the overall cohort, highlighting CRB as a common early presentation preceding cancer diagnosis. In the 12\u2010month window after cancer diagnosis, the cumulative incidence of CRB was 6.3% in the overall cohort, 7.0% in those receiving systemic antineoplastic therapy, and up to 15.0% among individuals on certain baseline anticoagulants. In addition to age, sex, and race, factors appreciably associated with CRB on multivariable analysis included cancer types, metastatic disease, systemic therapy, anticoagulant or antiplatelet use, higher comorbidity index, recent hospitalization, recent history of bleeding or VTE, and selective laboratory features (hemoglobin, platelets, albumin, eGFR). Furthermore, the onset of CRB as a time varying covariate was independently associated with mortality in multivariable adjusted analysis: intracranial hemorrhage (HR 4.17, 95% CI 4.11\u20134.24); gastrointestinal bleeding (HR 2.52, 95% CI 2.50\u20132.55); other bleeding (HR 2.46, 95% CI 2.44\u20132.49). Together, these findings reveal a substantial and overlooked risk of bleeding in cancer care and underscore a need for validated bleeding risk models that can be integrated alongside VTE prediction tools to guide personalized thromboprophylaxis decisions.<\/jats:p>","DOI":"10.1002\/ajh.70394","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T04:11:37Z","timestamp":1780546297000},"page":"2123-2136","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinically Relevant Bleeding in Individuals With Cancer: Insights From a Nationwide Cohort Study"],"prefix":"10.1002","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5208-3387","authenticated-orcid":false,"given":"Ming Y.","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology and Hematologic Malignancies University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radhika","family":"Gangaraju","sequence":"additional","affiliation":[{"name":"Division of Hematology\u2010Oncology, Department of Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Jafari","sequence":"additional","affiliation":[{"name":"Section of Hematology\u2010Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, the University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5184-1753","authenticated-orcid":false,"given":"Joyce W. T.","family":"Tiong","sequence":"additional","affiliation":[{"name":"Section of Hematology\u2010Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3756-0154","authenticated-orcid":false,"given":"Elizabeth C. L.","family":"Chiang","sequence":"additional","affiliation":[{"name":"Section of Hematology\u2010Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengling","family":"Ma","sequence":"additional","affiliation":[{"name":"Section of Hematology\u2010Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Y.","family":"Jiang","sequence":"additional","affiliation":[{"name":"Division of Hematology University of Southern California  |Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Medicine Section of Hematology, Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5585-3823","authenticated-orcid":false,"given":"Barbara D.","family":"Lam","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology Fred Hutch Cancer Center, University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrinal","family":"Ranjan","sequence":"additional","affiliation":[{"name":"Section of Hematology\u2010Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8455-2309","authenticated-orcid":false,"given":"Ang","family":"Li","sequence":"additional","affiliation":[{"name":"Section of Hematology\u2010Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12075"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572\u2010022\u201000336\u2010y"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20103\u2010030\u201020315\u20103_13"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16112082"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/oncolo\/oyad116"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.4081\/btvb.2024.108"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.17945"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020007338"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102007\u201010\u2010116327"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.01542"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.00255"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103026(18)30063\u20102"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.01461"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2024.0046"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2022.09.026"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/rth2.12431"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2022009577"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538\u20107836.2007.02374.x"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.27588"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1055\/a\u20102145\u20107238"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14007"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102002\u201001\u20100108"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0049\u20103848(10)70015\u20103"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf453"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bvth.2025.100116"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.70090"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2021.09.012"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814468"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814630"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2024025362"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14613"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008500.pub5"},{"key":"e_1_2_10_34_1","unstructured":"J.Tiong E.Chiang O.Jafari et\u00a0al. \u201cComparison of Traditional vs Novel Approach to Define Cancer\u2010Associated Bleeding \u201dpresented at 67th ASH Annual Meeting and Exposition Orlando FL December 8 2025 Session Oral Abstract Session https:\/\/submit.hematology.org\/program\/presentation\/674065."},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtha.2022.11.023"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2019.07.021"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S170304"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010019\u20100841\u20106"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4783"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S400834"},{"key":"e_1_2_10_41_1","article-title":"NCI Comorbidity Index 2021 Version","author":"National Cancer Institute (NCI)","year":"2021","journal-title":"Division of Cancer Control and Population Sciences"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.70271"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021005590"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2023.100739"}],"container-title":["American Journal of Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajh.70394","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ajh.70394","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajh.70394","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:19:00Z","timestamp":1785583140000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajh.70394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":43,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/ajh.70394"],"URL":"https:\/\/doi.org\/10.1002\/ajh.70394","archive":["Portico"],"relation":{},"ISSN":["0361-8609","1096-8652"],"issn-type":[{"value":"0361-8609","type":"print"},{"value":"1096-8652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]},"assertion":[{"value":"2026-05-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}