TY - JOUR
T1 - Anticoagulation in patients with atrial fibrillation and active cancer
T2 - an international survey on patient management
AU - Council of Cardio-Oncology of the European Society of Cardiology
AU - Boriani, Giuseppe
AU - Lee, Geraldine
AU - Parrini, Iris
AU - Lopez-Fernandez, Teresa
AU - Lyon, Alexander R.
AU - Suter, Thomas
AU - Van der Meer, Peter
AU - Cardinale, Daniela
AU - Lancellotti, Patrizio
AU - Zamorano, Jose Luis
AU - Bax, Jeroen J.
AU - Asteggiano, Riccardo
N1 - Publisher Copyright:
© 2020 The Author(s).
PY - 2021/9/3
Y1 - 2021/9/3
N2 - BACKGROUND: In patients with active cancer and atrial fibrillation (AF) anticoagulation, thrombotic and bleeding risk still entail uncertainty. AIM: We explored the results of an international survey examining the knowledge and behaviours of a large group of physicians. METHODS AND RESULTS: A web-based survey was completed by 960 physicians (82.4% cardiologists, 75.5% from Europe). Among the currently available anticoagulants for stroke prevention in patients with active cancer, direct oral anticoagulants (DOACs) were preferred by 62.6%, with lower values for low molecular weight heparin (LMWH) (24.1%) and for warfarin (only 7.3%). About 46% of respondents considered that DOACs should be used in all types of cancers except in non-operable gastrointestinal cancers. The lack of controlled studies on bleeding risk (33.5% of respondents) and the risk of drug interactions (31.5%) were perceived as problematic issues associated with use of anticoagulants in cancer. The decision on anticoagulation involved a cardiologist in 27.8% of cases, a cardiologist and an oncologist in 41.1%, and a team approach in 21.6%. The patient also was involved in decision-making, according to ∼60% of the respondents. For risk stratification, use of CHA2DS2-VASc and HAS-BLED scores was considered appropriate, although not specifically validated in cancer patients, by 66.7% and 56.4%, respectively. CONCLUSION: This survey highlights that management of anticoagulation in patients with AF and active cancer is challenging, with substantial heterogeneity in therapeutic choices. Direct oral anticoagulants seems having an emerging role but still the use of LMWH remains substantial, despite the absence of long-term data on thromboprophylaxis in AF.
AB - BACKGROUND: In patients with active cancer and atrial fibrillation (AF) anticoagulation, thrombotic and bleeding risk still entail uncertainty. AIM: We explored the results of an international survey examining the knowledge and behaviours of a large group of physicians. METHODS AND RESULTS: A web-based survey was completed by 960 physicians (82.4% cardiologists, 75.5% from Europe). Among the currently available anticoagulants for stroke prevention in patients with active cancer, direct oral anticoagulants (DOACs) were preferred by 62.6%, with lower values for low molecular weight heparin (LMWH) (24.1%) and for warfarin (only 7.3%). About 46% of respondents considered that DOACs should be used in all types of cancers except in non-operable gastrointestinal cancers. The lack of controlled studies on bleeding risk (33.5% of respondents) and the risk of drug interactions (31.5%) were perceived as problematic issues associated with use of anticoagulants in cancer. The decision on anticoagulation involved a cardiologist in 27.8% of cases, a cardiologist and an oncologist in 41.1%, and a team approach in 21.6%. The patient also was involved in decision-making, according to ∼60% of the respondents. For risk stratification, use of CHA2DS2-VASc and HAS-BLED scores was considered appropriate, although not specifically validated in cancer patients, by 66.7% and 56.4%, respectively. CONCLUSION: This survey highlights that management of anticoagulation in patients with AF and active cancer is challenging, with substantial heterogeneity in therapeutic choices. Direct oral anticoagulants seems having an emerging role but still the use of LMWH remains substantial, despite the absence of long-term data on thromboprophylaxis in AF.
KW - Metastasis
KW - Anticoagulation
KW - Atrial fibrillation
KW - Cancer
KW - Direct oral anticoagulants
KW - Low molecular weight heparin
KW - Risk stratification
KW - Stroke
KW - Survey
KW - Survival
KW - Warfarin
UR - http://www.scopus.com/inward/record.url?scp=85107087881&partnerID=8YFLogxK
U2 - 10.1093/eurjpc/zwaa054
DO - 10.1093/eurjpc/zwaa054
M3 - Article
C2 - 33624005
AN - SCOPUS:85107087881
SN - 2047-4881
VL - 28
SP - 611
EP - 621
JO - European journal of preventive cardiology
JF - European journal of preventive cardiology
IS - 6
ER -
