Anticoagulation for atrial fibrillation in active cancer (Review)

Farmakis,Dimitrios; Papakotoulas,Pavlos; Angelopoulou,Eleni; Bischiniotis,Theodoros; Giannakoulas,George; Kliridis,Panagiotis; Richter,Dimitrios; Paraskevaidis,Ioannis

doi:10.3892/ol.2022.13244

Anticoagulation for atrial fibrillation in active cancer (Review)

Authors:
- Dimitrios Farmakis
- Pavlos Papakotoulas
- Eleni Angelopoulou
- Theodoros Bischiniotis
- George Giannakoulas
- Panagiotis Kliridis
- Dimitrios Richter
- Ioannis Paraskevaidis
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Affiliations: Department of Physiology, University of Cyprus Medical School, Nicosia 2029, Cyprus, First Department of Clinical Oncology, ‘Theagenio’ Anticancer Hospital, Thessaloniki 546 39, Greece, Department of Cardiology, ‘Agioi Anargyroi’ General Oncology Hospital, Athens 145 64, Greece, Department of Cardiology, ‘Theagenio’ Anticancer Hospital, Thessaloniki 546 39, Greece, Department of Cardiology, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki 546 21, Greece, Department of Cardiology, ‘Agios Savvas’ General Anti‑Cancer Hospital, Athens 115 22, Greece, Department of Cardiology, Athens Euroclinic, Athens 115 21, Greece, Department of Therapeutics, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens Medical School, Athens 115 28, Greece
Published online on: February 17, 2022 https://doi.org/10.3892/ol.2022.13244
Article Number: 124
Copyright: © Farmakis et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Atrial fibrillation (AF) may often pre‑exist in patients with newly diagnosed cancer or occur with increased frequency shortly after cancer diagnosis. Patients with active cancer and AF have a particularly high risk of thromboembolic complications, as both conditions carry a risk of thrombosis. Thromboembolic risk is determined by several factors, including advanced age, sex (females), cancer histology (adenocarcinomas), location (e.g., pancreas, stomach), advanced stage, anticancer regimens (e.g., platinum compounds, anti‑angiogenic therapies, immune modulators), comorbidities (e.g., obesity, kidney disease) and concurrent therapies (e.g., surgery, central catheters). Physicians are often reluctant to prescribe anticoagulants to patients with active cancer and AF, mainly due to fear of bleeding complications, which is partly related to the paucity of evidence in the field. Decision making regarding anticoagulation for the prevention of ischemic stroke and systemic embolism in patients with active cancer and AF may be challenging and should not simply rely on the risk prediction scores used in the general AF population. By contrast, the administration and choice of anticoagulants should be based on the comprehensive, individualized and periodic evaluation of thromboembolic and bleeding risk, drug‑drug interactions, patient preferences and access to therapies.

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