Atrial fibrillation (AF) is the most prevalent sustained arrhythmia. Benefits of anticoagulation
therapy in reducing the risk of ischemic stroke in the majority of patients with AF
are well-established [
[1]
,
[2]
]. AF incidence is suggested to be increased in cancer patients and they are hypothesized
to be at a higher risk of ischemic stroke [
[3]
]. The efficacy of prophylactic anticoagulation in cancer patients has lately been
assessed in several studies, reporting divergent results [
[4]
,
[5]
]. In the last decade, four direct oral anticoagulants (DOACs) designed to reduce
the risk of stroke and systemic embolism have been approved. Some studies, evaluating
the efficacy and safety of DOACs relative to vitamin K antagonists (VKA) in cancer
patients with AF, have shown a lower or similar risk of stroke and bleeding in patients
on DOACs compared to VKA users [
[6]
,
[7]
]. Low-molecular-weight-heparin (LMWH) is considered superior to VKA for the prevention
of venous thromboembolism (VTE) recurrence in cancer patients [
[8]
]. Recently, a number of studies have demonstrated that direct Xa inhibitors are also
safe and efficacious in cancer-related VTE [
[9]
]. According to these findings, DOACs appear to be a reasonable choice in the cancer
setting. Given the complexity of the clinical scenario and the scarcity of data on
superiority or non-inferiority of DOACs versus LMWH in patients with AF and a coexistent
malignancy, the current study has aimed to compare the efficacy and safety of these
two types of anticoagulants in such challenging setting.Keywords
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References
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- Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and cancer a meta-analysis.J Thromb Thrombolysis. 2020;
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- Anticoagulation of cancer patients with non-valvular atrial fibrillation receiving chemotherapy: Guidance from the SSC of the ISTH.J Thromb Haemost. 2019; 17: 1247-1252
Article info
Publication history
Published online: May 10, 2021
Accepted:
April 7,
2021
Received in revised form:
March 31,
2021
Received:
March 8,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
