Seth Lakshya, Stabellini Nickolas, Doss Shawn, Patel Vraj, Shah Viraj, Lip Gregory, Dent Susan, Fradley Michael G, Køber Lars, Guha Avirup
Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Department of Hematology-Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA.
J Thromb Thrombolysis. 2025 Apr 26. doi: 10.1007/s11239-025-03104-3.
Atrial fibrillation is the most common cardiac arrhythmia and is a major risk factor for ischemic stroke. Atrial fibrillation and ischemic stroke are major cardiovascular complications in cancer patients, who have a higher burden and worse outcomes than the general population. Clinical risk stratification scores for stroke and bleeding, commonly used in the general population to estimate thromboembolic and bleeding risk, respectively, are less well validated in cancer patients, who have historically been excluded in clinical trials. There is a lack of consensus opinion on how to effectively risk-stratify cancer patients based on the currently available tools and a need for cancer-specific scores that offer a tailored approach to each patient in order to more effectively stratify ischemic stroke and bleeding risk in this cohort of patients. Cancer-mediated physiologic changes and adverse effects of antineoplastic therapy have been implicated as etiologies of the increased risk for both atrial fibrillation and ischemic stroke. Risk stratifying scores such as CHADS-VASc and HAS-BLED, commonly used in the general population, are less well validated in cancer patients. There is a need for cancer-specific scores that can more effectively stratify ischemic stroke and bleeding risk in cancer patients, although given the heterogeneity of cancers, whether a "one score fits all" is uncertain.
心房颤动是最常见的心律失常，也是缺血性卒中的主要危险因素。心房颤动和缺血性卒中是癌症患者的主要心血管并发症，与普通人群相比，他们负担更重，预后更差。一般人群中常用的分别用于评估血栓栓塞风险和出血风险的卒中及出血临床风险分层评分，在癌症患者中的验证效果较差，因为癌症患者在历史上被排除在临床试验之外。对于如何基于现有工具对癌症患者进行有效的风险分层，目前缺乏共识意见，并且需要针对癌症患者的特定评分，以便为每位患者提供量身定制的方法，从而更有效地对该类患者群体的缺血性卒中和出血风险进行分层。癌症介导的生理变化和抗肿瘤治疗的不良反应被认为是心房颤动和缺血性卒中风险增加的病因。一般人群中常用的风险分层评分，如CHADS-VASc和HAS-BLED，在癌症患者中的验证效果较差。虽然鉴于癌症的异质性，“一刀切”的评分是否可行尚不确定，但仍需要能够更有效地对癌症患者的缺血性卒中和出血风险进行分层的针对癌症患者的特定评分。
