Abstract Number: PB2076
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Atrial Fibrillation
Background: Cancer is suspected to impose an increased thromboembolic and bleeding risk in patients with atrial fibrillation (AF). Detailed data on thromboembolic and bleeding complication rates in practice based conditions are however scarce.
Aims: To determine the incidence rates of bleeding and thromboembolic complications in cancer patients with AF.
Methods: Patients with co-existing cancer and AF diagnoses between 01-01-2012 and 31-12-2017 in our hospital (a tertiary oncological referral centre) were identified. Bleeding and thromboembolic complications were assessed during 2 years of follow-up. We calculated incidence rates per 100 patient years for ISTH major bleeding (MB) and/or clinically relevant non-major bleeding (CRNMB), arterial thromboembolism (ATE; e.g. ischemic stroke, myocardial infarction) and venous thromboembolism (VTE). All complications were adjudicated by independent experts.
Results: We identified 181 cancer patients who developed AF (cohort 1), and 361 AF patients who were newly diagnosed with cancer (cohort 2; Figure 1). Of all 542 patients, 161 had a complete 2-year follow-up, 185 patients died, 171 had a shorter follow-up because of complete remission of cancer or AF, and 25 were lost to follow-up. The incidence rates of MB were 7.0 and 5.8 for cohort 1 and 2 respectively (Table 1). Notably, 41% of all bleedings had a cancer-related predisposing factor such as chemotherapy induced thrombocytopenia < 50*109/L, cancer surgery/interventions or bleeding from cancer site. The incidence rates of ATE and VTE were 4 and 2/100PY, and 4.8 and 2/100PY, for cohort 1 and 2, respectively.
Conclusions: The incidence rates of both bleeding and thromboembolic complications were high in our patients. These data suggest that cancer should be an important determinant in the assessment of risk for AF-related complications.
[Figure 1. Patient characteristics of patients with atrial fibrillation and cancer between 1st Jan 2012 and 31st Dec 2017]
| Cohort 1 First Cancer, then AF diagnosis after 01-01-2012 |
Cohort 2 First AF, then cancer diagnosis after 01-01-2012 |
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| Number | 181 | 361 | ||
| Total follow-up (years) | 170 | 379 | ||
| Number | Incidence rate/100 patient years | Number | Incidence rate/100 patient years | |
| Bleeding events | 23 | 13 | 39 | 10 |
| – MB | 12 | 7.0 | 22 | 5.8 |
| – CRNMB | 11 | 6.5 | 17 | 4.5 |
| Arterial thromboembolism | 7 | 4 | 18 | 4.8 |
| Venous thromboembolism | 3 | 2 | 7 | 2 |
| Death | 54 | 32 | 79 | 21 |
[Table 1. Incidence rates per 100 patient years of thrombo-embolic and bleeding events in AF patients with cancer]
To cite this abstract in AMA style:
Chu G, Huisman MV, Gelderblom H, Hemels ME, van der Hulle T, Trines SA, Klok FA. Single Centre Daily Practice Evaluation of Bleeding and Thromboembolic Complications in Cancer Patients with Atrial Fibrillation [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/single-centre-daily-practice-evaluation-of-bleeding-and-thromboembolic-complications-in-cancer-patients-with-atrial-fibrillation/. Accessed September 29, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/single-centre-daily-practice-evaluation-of-bleeding-and-thromboembolic-complications-in-cancer-patients-with-atrial-fibrillation/