Department of Anatomy, Jagiellonian University, Medical College, Kraków, Poland; National Cancer Institute, Maria Skłodowska-Curie Memorial Institute, Kraków Branch, Poland.
Department of Internal Medicine, Jagiellonian University, Medical College, Kraków, Poland.
Int J Cardiol. 2021 Feb 1;324:78-83. doi: 10.1016/j.ijcard.2020.09.037. Epub 2020 Sep 12.
Atrial fibrillation (AF) is a frequent comorbidity in malignant patients. Anticancer therapies complicate anticoagulant strategy. We evaluated the safety and efficacy of long-term use of direct oral anticoagulants (DOACs) in breast cancer women.
In a prospective cohort study we enrolled 48 consecutive radically treated breast cancer women with AF (median age 63 [interquartile range 56-69] years, CHADS-VASc 2 [2,3]) score) and adjuvant hormonal therapy. Thromboembolic complications (stroke, transient ischemic attack [TIA], venous thromboembolism [VTE]) and bleeding events (major and clinically relevant non-major bleeding [CRNMB]) were recorded in follow-up.
During a median follow-up of 40 (interquartile range 28-50.5) months 13 (27%) patients received apixaban, 22 (46%) rivaroxaban, and 13 (27%) dabigatran. One stroke (2.3%/year) and two CRNMBs (4.6%/year) were observed on apixaban. One TIA (1.3%/year), three major bleedings and two CRNMBs (6.7%/year, combined) were reported on rivaroxaban. Three VTE were documented in dabigatran treated individuals (7.8%/year), without any bleeding or cerebrovascular events. Women with thromboembolic events had higher body mass index (32 [29-33]) vs. 26 [24-29]) kg/m, p = 0.02) and CHADS-VASc score (3 [3]) vs. 2 [1-3]), p = 0.02). Most thromboembolic complications (n = 4, 80%) and all three major bleedings were observed in tamoxifen users, while three of four CRNMBs occurred on aromatase inhibitors. Mortality rates were low (apixaban, n = 1 [2.3%/year], rivaroxaban, n = 3 [5.22%/ year], and dabigatran, n = 2 [4%/ year]). No death was related to bleeding.
This study suggests that DOACs are an effective and safe therapeutic option in breast cancer patients with AF during adjuvant hormonal therapy.
心房颤动（AF）是恶性肿瘤患者常见的合并症。抗癌治疗使抗凝策略复杂化。我们评估了长期使用直接口服抗凝剂（DOAC）在乳腺癌女性中的安全性和有效性。
在一项前瞻性队列研究中，我们纳入了 48 例接受根治性治疗的伴有 AF（中位年龄 63 [25-69] 岁，CHADS-VASc 2 [2,3] 分）和辅助激素治疗的乳腺癌女性。在随访期间记录血栓栓塞并发症（中风、短暂性脑缺血发作 [TIA]、静脉血栓栓塞 [VTE]）和出血事件（主要和临床相关非主要出血 [CRNMB]）。
在中位随访 40（25-50.5）个月期间，13 例（27%）患者接受阿哌沙班、22 例（46%）接受利伐沙班、13 例（27%）接受达比加群。阿哌沙班观察到 1 例中风（2.3%/年）和 2 例 CRNMB（4.6%/年）。利伐沙班报告 1 例 TIA（1.3%/年）、3 例大出血和 2 例 CRNMB（6.7%/年，合并）。达比加群治疗的 3 例患者发生 VTE（7.8%/年），无出血或脑血管事件。发生血栓栓塞事件的女性体重指数较高（32 [29-33] 与 26 [24-29]，p=0.02）和 CHADS-VASc 评分较高（3 [3] 与 2 [1-3]，p=0.02）。大多数血栓栓塞并发症（n=4，80%）和所有 3 例大出血均发生在他莫昔芬使用者中，而 4 例 CRNMB 中有 3 例发生在芳香化酶抑制剂使用者中。死亡率较低（阿哌沙班，n=1 [2.3%/年]；利伐沙班，n=3 [5.22%/年]；达比加群，n=2 [4%/年]）。没有死亡与出血有关。
这项研究表明，在接受辅助激素治疗的乳腺癌合并 AF 患者中，DOAC 是一种有效且安全的治疗选择。
