{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:46:26Z","timestamp":1792071986880,"version":"4.4.0"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,4,14]],"date-time":"2019-04-14T00:00:00Z","timestamp":1555200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["1R01CA102713\u201001"],"award-info":[{"award-number":["1R01CA102713\u201001"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013191","name":"South Carolina Center of Economic Excellence","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013191","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Chronic lymphocytic leukemia (CLL) patients are at increased risk for major hemorrhage (MH). We examined incidence of and risk factors for MH in CLL patients before introduction of newer CLL therapies such as ibrutinib, which includes bleeding risk. This study included 24\u00a0198 CLL patients treated in the VA system before FDA approval of ibrutinib as CLL therapy. Data came from VA databases from 1999 to 2013. MH incidence was 1.9\/100 person\u2010years (95% CI: 1.8\u20101.9), with cumulative incidences of 2.3%, 5.2%, and 7.3% by year 1, 3, and 5, respectively. Median time from CLL diagnosis to MH was 2.8\u00a0years (range: 0\u201015.7\u00a0years). In multivariate analyses, concurrent anticoagulant and antiplatelet use (HR: 4.2; 95% CI: 3.2\u20105.6), anticoagulant use only (HR: 2.6; 95% CI: 2.3\u20103.1), and antiplatelet use only (HR: 1.5; 95% CI: 1.3\u20101.7) increased MH risk vs not receiving those medications; being nonwhite, male, having MH history, renal impairment, anemia, thrombocytopenia, and alcohol abuse were associated with increased MH risk. These pre\u2010ibrutinib data are important for providing context for interpreting MH risk in ibrutinib\u2010treated patients. As ibrutinib clinical use is increasing, updated analyses of MH risk among ibrutinib\u2010treated VA patients with CLL may provide additional useful insight.<\/jats:p>","DOI":"10.1002\/cam4.2134","type":"journal-article","created":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T02:29:25Z","timestamp":1555295365000},"page":"2233-2240","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Major hemorrhage in chronic lymphocytic leukemia patients in the US Veterans Health Administration system in the pre\u2010ibrutinib era: Incidence and risk factors"],"prefix":"10.1002","volume":"8","author":[{"given":"Peter","family":"Georgantopoulos","sequence":"first","affiliation":[{"name":"William Jennings Bryan Dorn Veterans Affairs Medical Center Columbia South Carolina"},{"name":"Southern Network on Adverse Reactions (SONAR), South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy University of South Carolina Columbia South Carolina"},{"name":"Department of Epidemiology and Biostatistics, Arnold School of Public Health University of South Carolina Columbia South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiying","family":"Yang","sequence":"additional","affiliation":[{"name":"Pharmacyclics LLC, an AbbVie Company Sunnyvale California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LeAnn B.","family":"Norris","sequence":"additional","affiliation":[{"name":"Southern Network on Adverse Reactions (SONAR), South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy University of South Carolina Columbia South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8645-5705","authenticated-orcid":false,"given":"Charles L.","family":"Bennett","sequence":"additional","affiliation":[{"name":"William Jennings Bryan Dorn Veterans Affairs Medical Center Columbia South Carolina"},{"name":"Southern Network on Adverse Reactions (SONAR), South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy University of South Carolina Columbia South Carolina"},{"name":"Department of Epidemiology and Biostatistics, Arnold School of Public Health University of South Carolina Columbia South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,14]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V126.23.3268.3268"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V126.23.3301.3301"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14660"},{"key":"e_1_2_8_5_1","volume-title":"Cancer Stat Facts: Chronic Lymphocytic Leukemia (CLL)","author":"National Cancer Institute","year":"2017"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428190701724785"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14785"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-8-32"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2007.06791.x"},{"key":"e_1_2_8_10_1","volume-title":"IMBRUVICA\u00ae (ibrutinib) Capsules and Tablets, for Oral Use [Prescribing Information]","year":"2018"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1509388"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1400376"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215637"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1509981"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1501548"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-08-664086"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1306220"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hon.2438_97"},{"key":"e_1_2_8_19_1","volume-title":"Department of Veterans Affairs statistics at a glance","author":"United States Department of Veterans Affairs","year":"2016"},{"key":"e_1_2_8_20_1","unstructured":"BagalmanE.The Number of Veterans that Use VA Health Care Services: A Fact Sheet.2014.https:\/\/fas.org\/sgp\/crs\/misc\/R43579.pdf. 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