Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Am J Cardiovasc Drugs. 2024 Nov;24(6):813-821. doi: 10.1007/s40256-024-00676-y. Epub 2024 Sep 6.
In patients with atrial fibrillation (AF), the association between cancer and cardioembolic or bleeding risk during oral anticoagulant therapy still remains unclear.
We aimed to assess the impact of cancer present at baseline (CB) or diagnosed during follow-up (CFU) on bleeding events in patients treated with direct oral anticoagulants (DOACs) for non-valvular AF (NVAF) compared with patients without CB or CFU, respectively.
All consecutive patients with NVAF treated with DOACs for stroke prevention were enrolled between January 2017 and March 2019. Primary outcomes were bleeding events or cardiovascular death, non-fatal stroke and non-fatal myocardial infarction, and the composite endpoint between patients with and without CB and between patients with and without CB.
The study population comprised 1170 patients who were followed for a mean time of 21.6 ± 9.5 months. Overall, 81 patients (6.9%) were affected by CB, while 81 (6.9%) were diagnosed with CFU. Patients with CFU were associated with a higher risk of bleeding events and major bleeding compared with patients without CFU. Such an association was not observed between the CB and no CB populations. In multivariate analysis adjusted for anemia, age, creatinine, CB and CFU, CFU but not CB remained an independent predictor of overall and major bleeding (hazard ratio [HR] 2.67, 95% confidence interval [CI] 1.8-3.89, p < 0.001; HR 3.02, 95% CI 1.6-3.81, p = 0.001, respectively).
During follow-up, newly diagnosed primitive or metastatic cancer in patients with NVAF taking DOACs is a strong predictor of major bleeding regardless of baseline hemorrhagic risk assessment. In contrast, such an association is not observed with malignancy at baseline. Appropriate diagnosis and treatment could therefore reduce the risk of cancer-related bleeding.
在患有心房颤动（AF）的患者中，癌症与口服抗凝剂治疗期间的心源性栓塞或出血风险之间的关联仍不清楚。
我们旨在评估基线时存在的癌症（CB）或随访期间诊断出的癌症（CFU）对接受非瓣膜性心房颤动（NVAF）的直接口服抗凝剂（DOAC）治疗的患者的出血事件的影响，与分别没有 CB 或 CFU 的患者相比。
所有连续接受 DOAC 治疗以预防中风的 NVAF 患者均于 2017 年 1 月至 2019 年 3 月期间入组。主要结局是出血事件或心血管死亡、非致命性中风和非致命性心肌梗死，以及 CB 患者与无 CB 患者之间、CB 患者与无 CFU 患者之间的复合终点。
研究人群包括 1170 名接受平均 21.6±9.5 个月随访的患者。总体而言，81 名患者（6.9%）患有 CB，而 81 名患者（6.9%）被诊断为 CFU。与无 CFU 的患者相比，CFU 患者出血事件和大出血的风险更高。但在调整贫血、年龄、肌酐、CB 和 CFU 后，多变量分析显示，CFU 而非 CB 仍然是总出血和大出血的独立预测因子（风险比[HR]2.67，95%置信区间[CI]1.8-3.89，p<0.001；HR 3.02，95%CI 1.6-3.81，p=0.001）。
在接受 DOAC 治疗的 NVAF 患者中，随访期间新诊断出的原发性或转移性癌症是大出血的强烈预测因子，无论基线出血风险评估如何。相比之下，基线时的恶性肿瘤与这种关联无关。因此，适当的诊断和治疗可以降低癌症相关出血的风险。
