In patients with coexisting atrial fibrillation and malignancy, stroke risk is similar to non-cancer patients, but bleeding risk is often increased, especially with active malignancy and certain cancer types.
Managing atrial fibrillation in cancer patients requires individualized assessment, as existing risk scores have lower predictive value and current guidelines are based on low-level evidence.
Atrial fibrillation (AF) and cancer are conditions that often coexist. Both of them, as well as their treatment, are connected with changes in coagulation processes, increasing the risk of bleeding or thromboembolic events. Despite that, the level of evidence supporting existing recommendations remains low. (Lyon et al., 2022) In this study, we focused on analyzing the existing literature on the assessment and management of bleeding and thromboembolic risk, with the aim of establishing an evidence-based approach to managing bleeding and thromboembolic risk in oncology patients with AF. Cancer is widely associated with a hypercoagulability state, but in the case of AF and stroke risk, it does not seem to be higher in general in comparison with non-cancer populations. It changes when individual cancer types are analyzed. As for the bleeding risk, many malignancies seem to increase it. Another challenge is that the existing risk scores often show lower predictive value for patients with recent malignancy. There is a need for individual assessment in every patient, but we lack the tools to make it easier for clinicians. Cardio-oncology guidelines addressing AF do exist, but the level of evidence supporting them remains low; thus, further research in this field is needed.
Bogusz et al. (Fri,) conducted a review in Patients with coexisting atrial fibrillation and malignancy (cancer). Oral anticoagulants (including Non-vitamin K oral anticoagulants - NOACs and vitamin K antagonists - VKAs) vs. No anticoagulation or aspirin-only treatment was evaluated on Risk of thromboembolism (stroke) and bleeding events in patients with AF and malignancy. In patients with coexisting atrial fibrillation and malignancy, stroke risk is similar to non-cancer patients, but bleeding risk is often increased, especially with active malignancy and certain cancer types.