Atrial fibrillation in cancer: thromboembolism and bleeding in daily practice

Gordon Chu; Jaap Seelig; Suzanne C Cannegieter; Hans Gelderblom; Marcel M C Hovens; Menno V Huisman; Tom van der Hulle; Serge A Trines; André J Vlot; Henri H Versteeg; Martin E W Hemels; Frederikus A Klok

doi:10.1016/j.rpth.2023.100096

Atrial fibrillation in cancer: thromboembolism and bleeding in daily practice

Gordon Chu^*, Jaap Seelig, Suzanne C Cannegieter, Hans Gelderblom, Marcel M C Hovens, Menno V Huisman, Tom van der Hulle, Serge A Trines, André J Vlot, Henri H Versteeg, Martin E W Hemels, Frederikus A Klok

^*Corresponding author for this work

Carim - Clinical thrombosis and Haemostasis

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Cancer is suggested to confer thromboembolic and bleeding risk in patients with atrial fibrillation (AF).

OBJECTIVES: 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.

METHODS: 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.

RESULTS: 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 CHA2DS2-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 CHA2DS2-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).

CONCLUSION: 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 CHA2DS2-VASc score.

Original language	English
Article number	100096
Number of pages	11
Journal	Research and practice in thrombosis and haemostasis
Volume	7
Issue number	2
DOIs	https://doi.org/10.1016/j.rpth.2023.100096
Publication status	Published - Feb 2023

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10.1016/j.rpth.2023.100096Licence: CC BY

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Chu, G., Seelig, J., Cannegieter, S. C., Gelderblom, H., Hovens, M. M. C., Huisman, M. V., van der Hulle, T., Trines, S. A., Vlot, A. J., Versteeg, H. H., Hemels, M. E. W., & Klok, F. A. (2023). Atrial fibrillation in cancer: thromboembolism and bleeding in daily practice. Research and practice in thrombosis and haemostasis, 7(2), Article 100096. https://doi.org/10.1016/j.rpth.2023.100096

@article{252e45b3c127404abf877b202c91d5be,

title = "Atrial fibrillation in cancer: thromboembolism and bleeding in daily practice",

abstract = "BACKGROUND: Cancer is suggested to confer thromboembolic and bleeding risk in patients with atrial fibrillation (AF).OBJECTIVES: 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.METHODS: 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.RESULTS: 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 CHA2DS2-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 CHA2DS2-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).CONCLUSION: 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 CHA2DS2-VASc score.",

author = "Gordon Chu and Jaap Seelig and Cannegieter, {Suzanne C} and Hans Gelderblom and Hovens, {Marcel M C} and Huisman, {Menno V} and {van der Hulle}, Tom and Trines, {Serge A} and Vlot, {Andr{\'e} J} and Versteeg, {Henri H} and Hemels, {Martin E W} and Klok, {Frederikus A}",

note = "{\textcopyright} 2023 The Authors.",

year = "2023",

month = feb,

doi = "10.1016/j.rpth.2023.100096",

language = "English",

volume = "7",

journal = "Research and practice in thrombosis and haemostasis",

issn = "2475-0379",

publisher = "Wiley",

number = "2",

}

TY - JOUR

T1 - Atrial fibrillation in cancer

T2 - thromboembolism and bleeding in daily practice

AU - Chu, Gordon

AU - Seelig, Jaap

AU - Cannegieter, Suzanne C

AU - Gelderblom, Hans

AU - Hovens, Marcel M C

AU - Huisman, Menno V

AU - van der Hulle, Tom

AU - Trines, Serge A

AU - Vlot, André J

AU - Versteeg, Henri H

AU - Hemels, Martin E W

AU - Klok, Frederikus A

PY - 2023/2

Y1 - 2023/2

N2 - BACKGROUND: Cancer is suggested to confer thromboembolic and bleeding risk in patients with atrial fibrillation (AF).OBJECTIVES: 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.METHODS: 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.RESULTS: 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 CHA2DS2-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 CHA2DS2-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).CONCLUSION: 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 CHA2DS2-VASc score.

AB - BACKGROUND: Cancer is suggested to confer thromboembolic and bleeding risk in patients with atrial fibrillation (AF).OBJECTIVES: 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.METHODS: 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.RESULTS: 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 CHA2DS2-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 CHA2DS2-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).CONCLUSION: 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 CHA2DS2-VASc score.

U2 - 10.1016/j.rpth.2023.100096

DO - 10.1016/j.rpth.2023.100096

M3 - Article

C2 - 37063771

SN - 2475-0379

VL - 7

JO - Research and practice in thrombosis and haemostasis

JF - Research and practice in thrombosis and haemostasis

IS - 2

M1 - 100096

ER -