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Neoplasms · Journal article
Annals of Medicine · August 13, 2026
Well-designed and adequately powered for the question it asks.
This nationwide case-crossover study of 710,910 cancer patients demonstrates that red blood cell transfusion is independently associated with a 44% increased risk of venous thrombosis after adjustment for confounders, whereas erythropoiesis-stimulating agents showed no independent association after adjustment. The finding is robust across multiple sensitivity analyses and suggests transfusion, rather than ESA therapy alone, drives thrombotic risk in cancer-associated anemia management.
Nationwide population-based case-crossover study. Adult patients with newly diagnosed cancer between 2011 and 2020 who developed incident venous thrombosis; enrolled from Korean National Health Insurance Database. Intervention: Exposure to erythropoiesis-stimulating agents (ESAs) and red blood cell (RBC) transfusion. Compared with: Matched 12-week control period (no exposure) separated by 24-week washout interval. n = 710,910. South Korea (Korean National Health Insurance Database, nationwide population-based).
RBC transfusion occurred in 6.85% during hazard period vs 1.79% during control period (p <0.001) Unadjusted RBC transfusion OR 3.83 (95% CI 3.58–4.11); adjusted OR 1.44 (95% CI 1.32–1.58) Unadjusted ESA use OR 3.14 (95% CI 2.63–7.75); adjusted OR 1.12 (95% CI 0.93–1.36), not significant
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Clinicians managing cancer-associated anemia should recognize that RBC transfusion carries an independent 44% increased thrombotic risk after adjustment for confounders, whereas ESA therapy alone does not show independent thrombotic association. This finding supports careful consideration of transfusion thresholds and alternatives when managing anemia in cancer patients.
Large, well-designed population-based case-crossover study with clear effect sizes and confidence intervals showing independent association between RBC transfusion and venous thrombosis in cancer patients after adjustment for confounders.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians managing cancer-associated anemia should recognize that RBC transfusion carries an independent 44% increased thrombotic risk after adjustment for confounders, whereas ESA therapy alone does not show independent thrombotic association. This finding supports careful consideration of transfusion thresholds and alternatives when managing anemia in cancer patients.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Cancer-associated anemia is commonly managed with erythropoiesis-stimulating agents (ESAs) and red blood cell (RBC) transfusions; however, their relative thrombotic risks remain uncertain. We conducted a nationwide population-based case-crossover study using the Korean National Health Insurance Database. Adult patients with newly diagnosed cancer between 2011 and 2020 who developed incident venous thrombosis were included. Exposure to ESAs and other time-varying risk factors was assessed during a 12-week hazard period preceding thrombosis and compared with a matched 12-week control period, separated by a 24-week washout interval. Conditional logistic regression was used to estimate odds ratios (ORs). Among 710,910 patients with cancer, several clinical exposures occurred more frequently during the hazard period than during the control period, including RBC transfusion (6.85% vs 1.79%), hospitalization (11.79% vs 2.77%), surgery (5.70% vs 2.00%), and central venous catheter insertion (3.34% vs 0.74%) (all p <.001). In unadjusted analyses, both ESA use (OR, 3.14; 95% CI, 2.63-7.75) and RBC transfusion (OR, 3.83; 95% CI, 3.58-4.11) were associated with an increased risk of venous thrombosis. After adjustment for time-varying confounders, ESA use was not significantly associated with thrombosis (adjusted OR, 1.12; 95% CI, 0.93-1.36), whereas RBC transfusion remained independently associated with an increased risk (adjusted OR, 1.44; 95% CI, 1.32-1.58). Sensitivity analyses using 8-week and 4-week exposure windows showed consistent results. RBC transfusion was associated with an increased risk of venous thrombosis in patients with cancer, whereas ESA therapy was not independently associated with thrombotic complications after adjustment. These findings suggest that RBC transfusion may contribute to thrombotic risk in patients with cancer and highlight the need for careful consideration when managing cancer-associated anaemia.
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