Chu Gordon, Seelig Jaap, Cannegieter Suzanne C, Gelderblom Hans, Hovens Marcel M C, Huisman Menno V, van der Hulle Tom, Trines Serge A, Vlot André J, Versteeg Henri H, Hemels Martin E W, Klok Frederikus A
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Rijnstate, Arnhem, The Netherlands.
Res Pract Thromb Haemost. 2023 Feb 27;7(2):100096. doi: 10.1016/j.rpth.2023.100096. eCollection 2023 Feb.
Cancer is suggested to confer thromboembolic and bleeding risk in patients with atrial fibrillation (AF).
We aimed to describe current anticoagulant practice in patients with AF and active cancer, present incidences of thromboembolic and bleeding complications, and evaluate the association between cancer type or anticoagulant management strategy with AF-related complications.
This retrospective study identified patients with AF and active cancer in 2 hospitals between January 1, 2012, and December 31, 2017. Follow-up lasted for 2 years. Data on cancer and anticoagulant treatment were collected. The outcomes of interest included ischemic stroke or transient ischemic attack (TIA) and clinically relevant nonmajor bleeding (CRNMB/MB). Incidence rates (IRs) per 100 patient-years and subdistribution hazard ratios (SHRs) with corresponding 95% Cis were estimated.
We identified 878 patients with AF who developed cancer (cohort 1) and 335 patients with cancer who developed AF (cohort 2). IRs for ischemic stroke/TIA and MB/CRNMB were 3.9 (2.8-5.3) and 15.7 (13.3-18.5) for cohort 1 and 4.0 (2.2-6.7) and 16.7 (12.6-21.7) for cohort 2. 14.2% (cohort 1) and 19.1% (cohort 2) of patients with a CHADS-VASc score of ≥2 did not receive anticoagulant treatment. Withholding anticoagulants was associated with thromboembolic complications (SHR: 5.1 [3.20-8.0]). In nonanticoagulated patients with a CHADS-VASc score of <2, IRs for stroke/TIA were 4.5 (0.75-15.0; cohort 1) and 16.0 (5.1-38.7; cohort 2).
Patients with AF and active cancer experience high rates of thromboembolic and bleeding complications, underlying the complexity of anticoagulant management in these patients. Our data suggest that the presence of cancer is an important factor in determining the indication for anticoagulants in patients with a low CHADS-VASc score.
癌症被认为会增加心房颤动（AF）患者的血栓栓塞和出血风险。
我们旨在描述AF合并活动性癌症患者目前的抗凝治疗情况，呈现血栓栓塞和出血并发症的发生率，并评估癌症类型或抗凝管理策略与AF相关并发症之间的关联。
这项回顾性研究纳入了2012年1月1日至2017年12月31日期间两家医院的AF合并活动性癌症患者。随访持续2年。收集癌症和抗凝治疗的数据。感兴趣的结局包括缺血性卒中或短暂性脑缺血发作（TIA）以及临床相关非大出血（CRNMB/MB）。估计每100患者年的发生率（IRs）和相应95%置信区间的亚分布风险比（SHRs）。
我们确定了878例发生癌症的AF患者（队列1）和335例发生AF的癌症患者（队列2）。队列1中缺血性卒中/TIA和MB/CRNMB的IRs分别为3.9（2.8 - 5.3）和15.7（13.3 - 18.5），队列2中分别为4.0（2.2 - 6.7）和16.7（12.6 - 21.7）。CHADS - VASc评分≥2的患者中，14.2%（队列1）和19.1%（队列2）未接受抗凝治疗。停用抗凝剂与血栓栓塞并发症相关（SHR：5.1 [3.20 - 8.0]）。在CHADS - VASc评分<2的未抗凝患者中，队列1和队列2的卒中/TIA的IRs分别为4.5（0.75 - 15.0）和16.0（5.1 - 38.7）。
AF合并活动性癌症患者的血栓栓塞和出血并发症发生率较高，这突显了这些患者抗凝管理的复杂性。我们的数据表明，癌症的存在是决定CHADS - VASc评分低的患者抗凝指征的一个重要因素。
