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"Latar Belakang: Pasien kanker memiliki risiko tromboemboli vena (Venous Thromboembolism/VTE) dan perdarahan yang tinggi. Terapi antikoagulan untuk VTE meningkatkan risiko perdarahan. Data mengenai kejadian perdarahan pada pasien kanker yang mendapatkan terapi antikoagulan dan faktor-faktor yang memengaruhinya di Indonesia masih sangat terbatas.Tujuan: Mengetahui kejadian perdarahan dan rerata waktu terjadinya perdarahan selama tiga bulan terapi antikoagulan serta faktor-faktor yang memengaruhi.Metode: Studi kohort retrospektif menggunakan data rekam medik pasien kanker dengan VTE yang mendapatkan antikoagulan pada Januari 2018-Desember 2024. Analisis kejadian perdarahan menggunakan Kurva Kaplan-Meier. Analisis bivariat dan multivariat dilakukan dengan cox proportional hazards regression terhadap faktor usia, kanker saluran cerna, jenis antikoagulan, metastasis, trombositopenia, dan laju filtrasi glomerulusHasil: Dari 227 subjek, angka kejadian perdarahan sebesar 45,8%, dengan perdarahan minor sebesar 85,6% dan perdarahan mayor sebesar 14,4%. Median waktu terjadinya perdarahan adalah tujuh hari (IK 95%; 4.86-9.13). Antikoagulan heparin tidak terfraksi (Unfractionated Heparin/UFH) (HR 4,55; IK 95%; 1,40–14,72; p=0,01) dan trombositopenia (HR 2,24; IK 95%; 1,05–4,75; p=0,03) merupakan faktor risiko independen terhadap perdarahan.Kesimpulan: Kejadian perdarahan pada pasien kanker padat dengan tromboemboli vena yang menerima antikoagulan cukup tinggi dan terjadi pada fase awal terapi. Penggunaan UFH dan adanya trombositopenia merupakan faktor risiko perdarahan yang signifikan.

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Background: Cancer patients are at an increased risk of venous thromboembolism (VTE) and bleeding complications. Anticoagulant therapy, while essential for VTE management, increases bleeding risk. There is limited data in Indonesia regarding bleeding incidence and risk factors in solid cancer patients with VTE receiving anticoagulants.

Objective: To determine bleeding incidence and median time to bleeding within three months of anticoagulant therapy, and to identify associated risk factors.

Methods: A retrospective cohort study from medical records of cancer patients with VTE receiving anticoagulation therapy from January 2018 to December 2024. Bleeding events were analyzed with Kaplan-Meier curve. Bivariate and multivariate Cox proportional hazards regression analyses were performed to evaluate the influence of age, gastrointestinal cancer, type of anticoagulant, metastatic status, thrombocytopenia, and glomerular filtration rate (GFR) on bleeding risk.

Results: Among the 227 subjects, the incidence of bleeding was 45.8%, with minor bleeding accounting for 85.6% and major bleeding for 14.4%. The median time to bleeding onset was seven days (95% CI: 4.86–9.13). Unfractionated heparin (UFH) (HR 4.55; 95% CI: 1.40–14.72; p=0.01) and thrombocytopenia (HR 2.24; 95% CI: 1.05–4.75; p=0.03) were identified as independent risk factors for bleeding.

Conculusion: Bleeding events are common and occur early during anticoagulant therapy. Use of UFH and presence of thrombocytopenia significantly increase bleeding risk."

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