| Background and ObjectivesTreatment of atrial fibrillation(AF)in cancer patients is a challenge,particularly in terms of antithrombotic therapy for stroke prevention.The purpose of this study was to identify unique risk factors and evaluate the risks of ischemic stroke/systemic embolism,bleeding,and myocardial infarction complications in patients with AF and cancer.MethodsA retrospective review of all patients with cancer and AF presenting from 2000 to 2019 in Beijing Hospital was performed.After excluding patients with missing values,723 patients were analyzed.Cancers were classified as prostate cancers(n=65),breast cancers(n=57),hematological cancers(n=70),gastrointestinal cancers(n=170),and other cancers(n=361).Among 723 patients,181 patients received antiplatelets,88 patients anticoagulation,10 patients received combined antiplatelet and anticoagulant therapy,and 444 patients did not receive any antithrombotic treatment.According to the CHA2DS2-VASc score of each patient,patients were categorized as follows:(1)low score group(male:CHA2DS2-VASc<2,female:CHA2DS2-VASc<3,n=136),(2)high score group(male:CHA2DS2-VASc≥2,female:CHA2DS2-VASc≥3,n=587).The follow-up time lasted until December 31,2019 or to the occurrence of the first event.The mean follow-up time was 34 months(median 23 months,range 0-205 months).Outcomes included ischemic stroke/systemic embolism,bleeding,and myocardial infarction.The risk of clinical outcomes over time was compared using Kaplan-Meier method and log-rank test or Cox proportional hazards regression.ResultsDuring a median follow-up of 23 months,no significant association was found between cancer types and risks of ischemic stroke/systemic embolism,bleeding,or myocardial infarction in patients with AF and cancer.Patients treated with anticoagulants had a significantly lower risk of ischemic stroke/systemic embolism(0.4%vs.2.7%/year,P=0.026)compared with untreated patients.Combined antiplatelet and anticoagulant therapy was associated with increased risk of bleeding(10.3%vs.4.1%/year,P=0.024)compared with no antithrombotic treatment.In addition,risks of ischemic stroke/systemic embolism were similar(1.9%vs.2.0%/year,P=0.867)in low score group and high score group.In multivariable analyses,prior stroke(HR 3.030,95%CI 1.515-6.061,P=0.002),breast cancer(HR 10.075,95%CI 1.234-82.242,P=0.031)and absence of antithrombotic treatment(HR 3.368,95%CI 1.488-7.620,P=0.004)were independently associated with ischemic stroke/systemic embolism.Age≥75 years(HR 2.099,95%CI 1.258-3.500,P=0.004)and eGFR<60ml/min/1.73m2(HR 1.947,95%CI 1.191-3.182,P=0.008)were associated with bleeding.Hypertension(HR 4.166,95%CI 1.233-14.075,P-0.022)and peripheral arterial disease(HR 2.855,95%CI 1.049-7.768,P=0.040)were associated with myocardial infarction.ConclusionsIn patients with AF and cancer:(1)Cancer types were not associated with altered risks of bleeding or myocardial infarction.(2)Both antiplatelet therapy and anticoagulation were associated with a lower risk of ischemic stroke/systemic embolism,while patients treated with combined antiplatelet and anticoagulant therapy were at higher risk of bleeding complication.(3)Risks of ischemic stroke/systemic embolism were similar between patients with and without a high CHA2DS2-VASc score.Therefore,the CHA2DS2-VASc score should be used with caution in AF patients with cancer.(4)Multivariable analyses showed that prior stroke,breast cancer and absence of antithrombotic treatment were independent risk factors for ischemic stroke/systemic embolism.Increasing age and renal dysfunction were risk factors for bleeding complications.While hypertension and peripheral arterial disease were risk factors for myocardial infarction. |
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