Abstract Number: PB2074
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Atrial Fibrillation
Background: Few small studies have evaluated the optimal anticoagulant management of atrial fibrillation (AF) in patients with cancer and direct comparative studies between different oral anticoagulants are lacking. Moreover, cancer-specific conditions such as (intermittent) thrombocytopenia, interaction between oral anticoagulants and systemic anti-cancer treatment, and frequent (surgical) interventions contribute to the clinical challenge of optimal antithrombotic care in this patient category.
Aims: To assess anticoagulant management strategies of cancer patients with AF in the daily practice of a tertiary oncological referral centre.
Methods: Patients with co-existing cancer and AF diagnoses between 01-01-2012 and 31-12-2017 were identified. The choice for initial anticoagulant treatment was extracted from the medical charts, as were cancer-specific circumstances.
Results: We identified 181 cancer patients that subsequently developed AF after 01-01-2012 (cohort 1), and 361 AF patients that subsequently developed cancer after 01-01-2012 (cohort 2). In both cohorts, the majority of patients was treated with vitamin K antagonists, although DOACs were increasingly prescribed from 2016 on (Table 1). LMWH was described in a small number of patients as well (5.3% of all patients). Overall, 104/543 (19%) of patients did not start with therapeutic doses of anticoagulants after the “AF and cancer” diagnosis (Table 2), of whom 12% because of a CHA2DS2-VASc score of 0. In 48 of 104 cases (46%), cancer-specific conditions were the main reason for withholding anticoagulant treatment. Untreated patients were at higher risk of stroke during 2-year follow-up than those treated with anticoagulant therapy (Hazard ratio 4.7; 95%CI 1.6-14).
Conclusions: The majority of patients with AF and cancer was treated with vitamin K antagonists, although a gradual increase in DOAC prescription was seen. A considerable number of patients remained untreated, often because of cancer-specific conditions. Untreated patients were at increased risk for stroke.
2012-2013 | 2013-2014 | 2014-2015 | 2015-2016 | 2016-2017 | 2017-2018 | Total | No anticoagulants | ||
Cohort 1 N=181 | No anticoagulants | 3 | 1 | 13 | 7 | 13 | 11 | 48 | 27% |
LMWH | 0 | 0 | 4 | 3 | 6 | 6 | 19 | ||
VKA | 3 | 11 | 21 | 24 | 13 | 12 | 84 | ||
DOAC | 0 | 0 | 0 | 3 | 9 | 18 | 30 | ||
Cohort 2 N=361 | No anticoagulants | 11 | 3 | 9 | 9 | 9 | 14 | 55 | 15% |
LMWH | 1 | 0 | 3 | 1 | 4 | 1 | 10 | ||
VKA | 27 | 36 | 53 | 44 | 50 | 58 | 268 | ||
DOAC | 0 | 0 | 1 | 1 | 7 | 19 | 28 |
[Table 1. Primary anticoagulant strategy of cancer patients with AF]
Cohort 1 (n=49) | Cohort 2 (n=55) | |
Cancer-related | ||
Perceived increased bleeding risk or active bleeding from tumour site | 20 | 17 |
Recent or planned oncological surgery | 4 | 6 |
Oral administration not possible | 1 | 0 |
Non cancer-related | ||
Perceived increased bleeding risk or active bleeding | 3 | 5 |
CHA2DS2-VASc | 10 | 2 |
No reason specified | 11 | 25 |
[Table 2. Reasons for withholding therapeutic anticoagulant (VKA/DOAC/LMWH) treatment]
To cite this abstract in AMA style:
Chu G, Huisman MV, Gelderblom H, Hemels ME, van der Hulle T, Trines SA, Klok FA. Anticoagulant Management Strategies in Cancer Patients with Atrial Fibrillation in Daily Clinical Practice [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/anticoagulant-management-strategies-in-cancer-patients-with-atrial-fibrillation-in-daily-clinical-practice/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/anticoagulant-management-strategies-in-cancer-patients-with-atrial-fibrillation-in-daily-clinical-practice/