Atrial Fibrillation in Cancer Patients who Develop Stroke

Background: Acute ischemic stroke (AIS) and transient ischemic attacks (TIA) are known complications in cancer patients and those with atrial fibrillation (AF). The role AF plays in AIS/TIA in the setting of cancer is unclear.The purpose of this study was to assess the relationship between AF and AIS/TIA in cancer patients. Methods: We conducted a case-control study comparing all patients who developed AIS/TIA from 2014 to 2019 following a cancer diagnosis at King Hussein Cancer Center (KHCC), matched to AIS/TIA-free controls based on age, gender, and cancer site. Results: 272 patients were included (136 per group). The mean age was 63.95 ± 13.06 and 57% were females. The AIS/TIA group had more AF at the time of event (14% vs. 4%, OR: 4.25, 95%-CI: 1.39 - 17.36) and had a larger proportion of death on study conclusion (OR: 9.4, 95%-CI: 3.74 - 23.64). On conditional logistic regression, patients in the AIS/TIA group had higher odds of: AF (OR: 7.93, 95%-CI: 1.6 – 39.18), ischemic stroke before cancer diagnosis (OR: 9.18, 95%-CI: 2.66 – 31.74), being on active cancer treatment (OR: 3.11, 95%-CI: 1.46 – 6.62), dyslipidemia (OR: 3.78, 95%-CI: 1.32 – 10.82), and renal disease (OR: 4.25, 95%-CI: 1.55 – 11.63). On another conditional logistic regression model built to assess the role of the CHA₂DS₂-VASc score, a score of >=2 in males and >=3 in females significantly increased the risk of developing AIS/TIA in cancer patients (OR: 2.45, 95%-CI: 1.08 - 5.58). Conclusion: AF, previous ischemic stroke, active cancer treatment, dyslipidemia, and renal disease are independent risk factors for AIS/TIA and a higher CHA₂DS₂-VASc score significantly increases the risk in cancer patients regardless of AF.