Cancer and atrial fibrillation: Epidemiology, mechanisms, and anticoagulation treatment

Danilo Menichelli; Tommasa Vicario; Pietro Ameri; Matteo Toma; Francesco Violi; Pasquale Pignatelli; Daniele Pastori

doi:10.1016/j.pcad.2021.04.004

Cancer and atrial fibrillation: Epidemiology, mechanisms, and anticoagulation treatment

Prog Cardiovasc Dis. 2021 May-Jun:66:28-36. doi: 10.1016/j.pcad.2021.04.004. Epub 2021 Apr 26.

Authors

Danilo Menichelli¹, Tommasa Vicario², Pietro Ameri³, Matteo Toma³, Francesco Violi⁴, Pasquale Pignatelli⁴, Daniele Pastori⁵

Affiliations

¹ Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
² Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy; Emergency Department, Policlinico Tor Vergata Hospital, Rome, Italy.
³ Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy.
⁴ Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Naples, Italy.
⁵ Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy. Electronic address: daniele.pastori@uniroma1.it.

PMID: 33915139
DOI: 10.1016/j.pcad.2021.04.004

Abstract

Cancer patients are at an increased risk of developing atrial fibrillation (AF) and thrombosis. However, the management of anticoagulation in patients with both diseases may be challenging, and data on these patients are lacking. We summarize the current evidence on the incidence and prevalence of cancer in AF and vice versa and provide some practical considerations on the management of oral anticoagulation in specific clinical situations. Low-molecular weight heparins are not approved for thromboprophylaxis in AF, and management of warfarin can be difficult. The use of direct oral anticoagulants may be particularly attractive for their rapid onset/offset action and lower bleeding risk.

Keywords: Atrial fibrillation; Cancer; Chemotherapy; DOACs; Oral anticoagulants; Radiotherapy.

Publication types

Review

MeSH terms

Administration, Oral
Anticoagulants / administration & dosage*
Anticoagulants / adverse effects
Atrial Fibrillation / diagnosis
Atrial Fibrillation / drug therapy*
Atrial Fibrillation / epidemiology
Hemorrhage / chemically induced
Humans
Incidence
Neoplasms / diagnosis
Neoplasms / drug therapy*
Neoplasms / epidemiology
Prevalence
Risk Assessment
Risk Factors
Stroke / diagnosis
Stroke / epidemiology
Stroke / prevention & control*
Thrombosis / diagnosis
Thrombosis / epidemiology
Thrombosis / prevention & control*
Treatment Outcome

Substances

Anticoagulants