Prophylaxis of atrial fibrillation (AF)-related cardioembolism in oncology is often
challenging [
[1]
]. The CHA2DS2-VASc score performs differently according to the presence or absence of cancer, with
more thromboembolic and bleeding events occurring in subjects with than without malignancy
and a CHA2DS2-VASc score <2 [
[2]
]. INR values are often out of the therapeutic range in oncological patients receiving
vitamin K antagonist (VKA), and the pharmacokinetics and pharmacodynamics of direct
oral anticoagulants (DOAC) may be significantly affected by antineoplastic therapies
[
[1]
]. Because of these treatment difficulties and tumor-related factors, risk of bleeding
is enhanced when anticoagulation for AF is provided to cancer patients [
[3]
]. Moreover, low molecular weight heparin (LMWH) has historically been prescribed for
cancer-associated AF without supporting evidence, possibly on the grounds that this
treatment is effective in preventing venous thromboembolism in the oncological population
[
[4]
]. All these issues are reflected by the lack of guideline recommendations specifically
on thromboprophylaxis of AF with concomitant cancer [
[5]
], which further complicates therapeutic decisions.Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Insights into onco-cardiology: atrial fibrillation in cancer.J Am Coll Cardiol. 2014; 63: 945-953
- CHA2DS2-VASc score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer.Eur J Prev Cardiol. 2018; 25: 651-658
- Efficacy and safety of edoxaban in patients with active malignancy and atrial fibrillation: analysis of the engage AF - TIMI 48 Trial.J Am Heart Assoc. 2018; 7e008987
- Atrial fibrillation in patients with active malignancy and use of anticoagulants: under-prescription but no adverse impact on all-cause mortality.Eur J Intern Med. 2019; 59: 27-33
- ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS.Eur Heart J. 2016; 37: 2893-2962
- Cardiovascular risk profile and events before and after treatment with anti-VEGF drugs in the setting of a structured cardio-oncologic program.Eur J Prev Cardiol. 2020; 6 (2047487320923056)
- The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation.Eur Heart J. 2018; 39: 1330-1393
- Anticoagulation prescribing patterns in patients with cancer.J Thromb Thrombolysis. 2018; 45: 89-98
- Use of oral anticoagulants after ischaemic stroke in patients with atrial fibrillation and cancer.J Intern Med. 2020; 9
- Provider specialty, anticoagulation, and stroke risk in patients with atrial fibrillation and cancer.J Am Coll Cardiol. 2018; 72: 1913-1922
Article info
Publication history
Published online: August 05, 2020
Accepted:
August 1,
2020
Received:
July 14,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
