1 Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Denmark.
2 The Danish Heart Foundation, Denmark.
Eur J Prev Cardiol. 2018 Apr;25(6):651-658. doi: 10.1177/2047487318759858. Epub 2018 Feb 27.
Background Cancer may influence the risk of thromboembolism and bleeding associated with the CHADS-VASc score. We examined the risk of thromboembolism and bleeding associated with the CHADS-VASc score in atrial fibrillation patients with and without recent cancer. Methods and results Using nationwide registers all patients diagnosed with atrial fibrillation from 2000 to 2015 and not on oral anticoagulation or heparin therapy were included and followed for 2 years. Recent cancer was defined by a cancer diagnosis 5 years or fewer earlier. Risks of thromboembolism and bleeding were estimated in cumulative incidence curves and Cox regression models. We included 122,053 patients with incident atrial fibrillation, 12,014 (10%) had recent cancer. The 2-year cumulative incidence of thromboembolism and bleeding in patients with versus without recent cancer was 1.7% (95% confidence interval (CI) 0.5-2.8) and 4.3% (95% CI 2.4-6.2) versus 1.2% (95% CI 0.9-1.5) and 1.7% (95% CI 1.4-2.0) for CHADS-VASc score 0; 3.2% (95%CI 2.2-4.3) and 4.4% (95%CI 3.2-5.6) versus 1.8% (95%CI 1.6-2.1) and 3.0% (95% CI 2.7-3.3) for CHADS-VASc score 1; and 7.1% (95% CI 6.6-7.7) and 6.8% (95% CI 6.3-7.2) versus 10.9% (95% CI 10.7-11.1) and 6.2% (95% CI 6.1-6.4) for CHADS-VASc score 2 or greater. Although the CHADS-VASc score was associated with thromboembolism and bleeding in both patients with and without cancer, the association differed between the groups for thromboembolism (test for interaction, p < 0.001) and bleeding (test for interaction, p < 0.001). Conclusion The association of the CHADS-VASc score and risk of thromboembolism and bleeding differed between atrial fibrillation patients with and without recent cancer. Therefore, the CHADS-VASc score should be used with caution in patients with recent cancer.
癌症可能会影响 CHADS-VASc 评分相关的血栓栓塞和出血风险。我们研究了伴有和不伴有近期癌症的心房颤动患者中 CHADS-VASc 评分相关的血栓栓塞和出血风险。
使用全国性登记处，纳入了 2000 年至 2015 年期间所有诊断为心房颤动且未接受口服抗凝或肝素治疗的患者，并随访 2 年。近期癌症定义为 5 年内确诊的癌症。血栓栓塞和出血风险采用累积发生率曲线和 Cox 回归模型进行估计。我们纳入了 122053 例新发心房颤动患者，其中 12014 例（10%）有近期癌症。有和无近期癌症的患者，在 2 年的时间内，血栓栓塞和出血的累积发生率分别为 1.7%（95%置信区间（CI）0.5-2.8）和 4.3%（95% CI 2.4-6.2），而 CHADS-VASc 评分为 0 的患者分别为 1.2%（95% CI 0.9-1.5）和 1.7%（95% CI 1.4-2.0）；分别为 3.2%（95%CI 2.2-4.3）和 4.4%（95%CI 3.2-5.6），而 CHADS-VASc 评分为 1 的患者分别为 1.8%（95%CI 1.6-2.1）和 3.0%（95% CI 2.7-3.3）；分别为 7.1%（95% CI 6.6-7.7）和 6.8%（95% CI 6.3-7.2），而 CHADS-VASc 评分为 2 或更高的患者分别为 10.9%（95% CI 10.7-11.1）和 6.2%（95% CI 6.1-6.4）。尽管 CHADS-VASc 评分与伴有和不伴有癌症的患者的血栓栓塞和出血均相关，但两组之间的相关性存在差异（交互检验，p<0.001）。
伴有和不伴有近期癌症的心房颤动患者中，CHADS-VASc 评分与血栓栓塞和出血风险的相关性存在差异。因此，在伴有近期癌症的患者中应谨慎使用 CHADS-VASc 评分。
