Atrial fibrillation in cancer: thromboembolism and bleeding in daily practice.

Autor: Chu G; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands., Seelig J; Department of Cardiology, Rijnstate, Arnhem, The Netherlands.; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.; Department of Internal Medicine, Maastricht University Medical Center and Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands., Cannegieter SC; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands., Gelderblom H; Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands., Hovens MMC; Department of Internal Medicine, Rijnstate, Arnhem, The Netherlands., Huisman MV; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands., van der Hulle T; Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands., Trines SA; Department of Cardiology, Heart-Lung Center, Leiden University Medical Center, The Netherlands., Vlot AJ; Department of Internal Medicine, Rijnstate, Arnhem, The Netherlands., Versteeg HH; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands., Hemels MEW; Department of Cardiology, Rijnstate, Arnhem, The Netherlands.; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands., Klok FA; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Jazyk: angličtina
Zdroj: Research and practice in thrombosis and haemostasis [Res Pract Thromb Haemost] 2023 Feb 27; Vol. 7 (2), pp. 100096. Date of Electronic Publication: 2023 Feb 27 (Print Publication: 2023).
DOI: 10.1016/j.rpth.2023.100096
Abstrakt: Background: Cancer is suggested to confer thromboembolic and bleeding risk in patients with atrial fibrillation (AF).
Objectives: We aimed to describe current anticoagulant practice in patients with AF and active cancer, present incidences of thromboembolic and bleeding complications, and evaluate the association between cancer type or anticoagulant management strategy with AF-related complications.
Methods: This retrospective study identified patients with AF and active cancer in 2 hospitals between January 1, 2012, and December 31, 2017. Follow-up lasted for 2 years. Data on cancer and anticoagulant treatment were collected. The outcomes of interest included ischemic stroke or transient ischemic attack (TIA) and clinically relevant nonmajor bleeding (CRNMB/MB). Incidence rates (IRs) per 100 patient-years and subdistribution hazard ratios (SHRs) with corresponding 95% Cis were estimated.
Results: We identified 878 patients with AF who developed cancer (cohort 1) and 335 patients with cancer who developed AF (cohort 2). IRs for ischemic stroke/TIA and MB/CRNMB were 3.9 (2.8-5.3) and 15.7 (13.3-18.5) for cohort 1 and 4.0 (2.2-6.7) and 16.7 (12.6-21.7) for cohort 2. 14.2% (cohort 1) and 19.1% (cohort 2) of patients with a CHA 2 DS 2 -VASc score of ≥2 did not receive anticoagulant treatment. Withholding anticoagulants was associated with thromboembolic complications (SHR: 5.1 [3.20-8.0]). In nonanticoagulated patients with a CHA 2 DS 2 -VASc score of <2, IRs for stroke/TIA were 4.5 (0.75-15.0; cohort 1) and 16.0 (5.1-38.7; cohort 2).
Conclusion: Patients with AF and active cancer experience high rates of thromboembolic and bleeding complications, underlying the complexity of anticoagulant management in these patients. Our data suggest that the presence of cancer is an important factor in determining the indication for anticoagulants in patients with a low CHA 2 DS 2 -VASc score.
(© 2023 The Authors.)
Databáze: MEDLINE
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