Background: Atrial fibrillation (AF) is associated with ischemic stroke and is frequent in cancer patients. Selection of antithrombotic treatment for stroke prevention in patients with cancer and AF is challenging. Vitamin K antagonists (VKA) have been the mainstay of such therapy; yet, their use in cancer patients may be problematic. In clinical practice, low-molecular-weight heparin and direct oral anticoagulants are employed in this setting. However, data regarding anticoagulation outcomes and adverse events in such patients are lacking.

Aims: To evaluate the outcome of anticoagulation treatment, its thromboembolic and bleeding complications in cancer patients with AF.

Methods: In this retrospective study (IRB approval #300-18-RMB), Rambam electronic medical records were searched for the information regarding all patients with active malignancy who received anticoagulation for AF. The following data were analyzed: patient demographics, cancer type, anticoagulants and antiaggregants used, incidence of thromboembolic events and treatment-related bleeding.

Results: Between 2010-2019, 1538 cancer patients with AF were followed at Rambam. Patients with basal cell carcinoma were excluded (n=181) from the analysis. No data were available for 361 patients. Data on 996 patients were analyzed. Thirty-four percent (n=337) of patients did not receive anticoagulation, with 45% of them receiving antiaggregants. Out of 659 patients on anticoagulants, 341 patients received VKA, 110 – apixaban and 94 – enoxaparin. The highest percentage of bleeding events was recorded among patients treated with dabigatran and VKA (16% and 15%, respectively). Intracranial hemorrhage occurred in 2.6% of patients receiving VKA and in none of those receiving dabigatran (p=0.001). Stroke was more frequent in patients on enoxaparin than in patients on antiaggregants only (9.6% versus 0; p=0.001). The highest clinical benefit (stroke-% versus any bleeding-%) was observed in patients receiving rivaroxaban and apixaban.

Conclusions: For cancer patients with AF, treatment with Factor Xa inhibitors may be more beneficial than VKA, dabigatran or antiaggregants only.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-optimal-treatment-of-atrial-fibrillation-in-patients-with-cancer/