Department of Hematology, ICO‑Hospital Germans Trias i Pujol, Josep Carreras Institute, Universitat Autònoma de Barcelona, Badalona, Spain.
Pol Arch Intern Med. 2020 Oct 29;130(10):878-886. doi: 10.20452/pamw.15315. Epub 2020 Apr 24.
Atrial fibrillation and cancer are common comorbidities. Given an increased risk of arterial thrombosis caused by the former and an increased risk of bleeding in patients with the latter, the management of anticoagulation in patients in whom they coexist is complex. On the basis of generally low‑quality evidence, numerous documents have been published in the past 3 years providing practice points for physicians to offer the best treatment plan to their patients. The present review begins with a summary of these recommendations and then proceeds to outline 9 practical challenges that fit into the larger questions of when and in whom anticoagulation is indicated, and what is the best agent in patients with atrial fibrillation and active cancer. For each of these 9 challenges, the evidence available is presented, the author's personal practical advice is given and the most pressing need to move the field forward is stated. I conclude by emphasizing the need for high‑quality evidence and, more practically, by stressing 1) the importance of patient preference and values in the decision on whether and how to anticoagulate, and 2) the need for periodic reassessment of the benefits of anticoagulation with changes in cancer status and treatment plan.
心房颤动和癌症是常见的合并症。鉴于前者会增加动脉血栓形成的风险，而后者会增加出血的风险，因此，同时存在这两种疾病的患者的抗凝管理非常复杂。基于一般质量较低的证据，过去 3 年来发表了许多文件，为医生为患者提供最佳治疗方案提供了实践要点。本综述首先总结了这些建议，然后概述了 9 个实际挑战，这些挑战涵盖了何时以及在哪些情况下抗凝、在患有心房颤动和活动性癌症的患者中使用哪种最佳药物等更大的问题。对于这 9 个挑战中的每一个，都提出了可用的证据，给出了作者的个人实际建议，并指出了推动该领域向前发展的最紧迫需求。最后，我强调了高质量证据的必要性，更实际地强调了 1）在是否以及如何抗凝的决策中患者偏好和价值观的重要性，以及 2）随着癌症状况和治疗计划的变化，定期重新评估抗凝益处的必要性。
