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Bleeding‐related symptoms in colorectal cancer: a 4‐year nationwide population‐based study
Author(s) -
Hreinsson J. P.,
Jonasson J. G.,
Bjornsson E. S.
Publication year - 2014
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12519
Subject(s) - medicine , aspirin , occult , colorectal cancer , colonoscopy , population , warfarin , gastroenterology , cancer , gastrointestinal bleeding , surgery , pathology , atrial fibrillation , alternative medicine , environmental health
Summary Background Little is known about the major presenting features of patients with colorectal cancer ( CRC ) in a population‐based setting, especially regarding bleeding‐related symptoms. Aim To determine the proportion of CRC patients presenting with bleeding‐related symptoms, to compare bleeders and nonbleeders and to explore the role of anticoagulants in bleeders. Methods This was a nationwide, population‐based, retrospective study, investigating all patients diagnosed with CRC in Iceland from 2008 to 2011. Bleeding‐related symptoms were defined as overt bleeding, iron deficiency anaemia or a positive faecal occult blood test. Obstructive symptoms were defined as a confirmed diagnosis of ileus or dilated intestines on imaging. Results Data were available for 472/496 (95%) patients, males 51%, mean age 69 (±13) years. In all, 348 (74%) patients had bleeding‐related symptoms; of these 348 patients, 61% had overt bleeding. Bleeders were less likely than nonbleeders to have metastases at diagnosis, 19% vs. 34% ( P < 0.001). Overt bleeders were less likely than nonbleeders to have obstructive symptoms, 2% vs. 16% respectively ( P < 0.0001). Occult bleeders were more likely to have proximal cancer (69%) than both overt (17%) and nonbleeders (44%) ( P < 0.0001); however, they were less likely than nonbleeders to have metastases (22% vs. 35%, P < 0.05). Bleeders were more likely to use warfarin than nonbleeders (9% vs. 3%, P < 0.05); the use of low‐dose aspirin was the same (24%). Conclusions The majority of patients with CRC present with bleeding‐related symptoms. Bleeders with CRC present earlier than nonbleeders. Warfarin use may induce bleeding in some patients, resulting in an earlier diagnosis.