Maurea Nicola, Riva Letizia
S.C. Cardiologia, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli.
U.O.C. Cardiologia, Ospedale Maggiore, Bologna.
G Ital Cardiol (Rome). 2018 Sep;19(9 Suppl 1):13S-19S. doi: 10.1714/2989.29923.
Advances in cancer therapy have led to a significant improvement of survival in most types of malignancies over the past few decades. As a result, there is a growing population of cancer survivors, expected to reach 18 million people in 2030 in the US and a similar number in Europe. Interestingly, cancer survivor studies have shown that although about half of these patients eventually die of cancer, one third of them actually die of cardiovascular disease. Arrhythmias represent a significant part of cardiovascular complications and atrial fibrillation is the main arrhythmia occurring in cancer patients.Antithrombotic therapy is a challenge: the optimal international normalized ratio (INR) level in patients on therapy with vitamin K antagonists is achieved in only 12% of them; in these patients, direct oral anticoagulants seem to be effective and safe for the prevention of stroke and systemic embolic events compared to warfarin and have similar risk of major bleeding. Among the trials, ENGAGE AF-TIMI 48 provides more data on the efficacy and safety of edoxaban in cancer patients.
在过去几十年里,癌症治疗的进展使大多数类型恶性肿瘤患者的生存率得到显著提高。因此,癌症幸存者的数量不断增加,预计到2030年美国将达到1800万人,欧洲也将有类似数量。有趣的是,癌症幸存者研究表明,虽然这些患者中约有一半最终死于癌症,但其中三分之一实际上死于心血管疾病。心律失常是心血管并发症的重要组成部分,房颤是癌症患者中主要发生的心律失常。抗栓治疗是一项挑战:使用维生素K拮抗剂治疗的患者中,只有12%能达到最佳国际标准化比值(INR)水平;在这些患者中,与华法林相比,直接口服抗凝剂似乎对预防中风和全身性栓塞事件有效且安全,且大出血风险相似。在各项试验中,ENGAGE AF-TIMI 48提供了更多关于依度沙班在癌症患者中疗效和安全性的数据。