Cancer and atrial fibrillation: Epidemiology, mechanisms, and anticoagulation treatment.

Published on Apr 26, 2021in Progress in Cardiovascular Diseases6.763
· DOI :10.1016/J.PCAD.2021.04.004
Danilo Menichelli11
Estimated H-index: 11
(Sapienza University of Rome),
Tommasa Vicario13
Estimated H-index: 13
(Sapienza University of Rome)
+ 4 AuthorsDaniele Pastori31
Estimated H-index: 31
(Sapienza University of Rome)
Sources
Abstract
Cancer patients are at an increased risk of developing atrial fibrillation (AF) and thrombosis. However, the management of anticoagulation in patients with both diseases may be challenging, and data on these patients are lacking. We summarize the current evidence on the incidence and prevalence of cancer in AF and vice versa and provide some practical considerations on the management of oral anticoagulation in specific clinical situations. Low-molecular weight heparins are not approved for thromboprophylaxis in AF, and management of warfarin can be difficult. The use of direct oral anticoagulants may be particularly attractive for their rapid onset/offset action and lower bleeding risk.
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BACKGROUND The number of patients with atrial fibrillation (AF) and cancer is rapidly increasing in clinical practice. The impact of cancer on clinical outcomes in this patient population is unclear, as is the performance of the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol) and CHA2 DS2 -VASc (Congestive Heart Failure, Hypertension, Age ≥ 75 years, Diabetes Mellitus, Stroke or Transient Ischemic Attack, Vasc...
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A B S T R A C T Antithrombotic therapy (anticoagulation or antiplatelet therapy) is frequently prescribed in cancer patients for prior or new indications such as venous thromboembolism, secondary prevention of arterial thrombosis or atrial fibrillation. Therefore, it is not uncommon for thrombocytopenic cancer patients to have an indication for antithrombotic therapy. Thrombocytopenia does not reduce the risk of recurrent thrombosis. The bleeding risk with anticoagulation appears to increase whe...
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Cancer may complicate the clinical course of non-valvular atrial fibrillation (AF) but its association with cardiovascular events (CVEs) is still unclear. We performed a prospective cohort study including 2092 consecutive AF patients on vitamin K antagonists. Principal endpoint was the occurrence of CVEs including fatal/non-fatal myocardial infarction (MI) and ischemic stroke/TIA and cardiovascular death. Secondary endpoints were major adverse cardiac events (MACE) and thromboembolism (TE). Mean...
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Cited By1
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