Systematic Review and Meta-Analysis of Oral Anticoagulant Therapy in Atrial Fibrillation Cancer Patients.
Alberto Francesco CeredaStefano LucreziottiAntonio Gabriele FranchinaAlessandra LaricchiaValentina De RegibusBarbara ConconiMatteo CarlàAndrea SpangaroMatteo RocchettiLuca PontiAlessandro MinardiElena SalaGiuseppe Massimo SangiorgiGabriele TumminelloLucia BarbieriStefano CarugoPaolo AseniPublished in: Cancers (2023)
(1) Introduction: Cancer and atrial fibrillation (AF) are increasingly coexisting medical challenges. These two conditions share an increased thrombotic and bleeding risk. Although optimal regimens of the most suitable anti-thrombotic therapy are now affirmed in the general population, cancer patients are still particularly understudied on the matter; (2) Aims And Methodology: This metanalysis (11 studies (incl. 266,865 patients)) aims at evaluating the ischemic-hemorrhagic risk profile of oncologic patients with AF treated with oral anticoagulants (vitamin K antagonists vs. direct oral anticoagulants); (3) Results: In the oncological population, DOACs confer a benefit in terms of the reduction in ischemic, hemorrhagic and venous thromboembolic events. However, ischemic prevention has a non-insignificant bleeding risk, lower than Warfarin but significant and higher than the non-oncological patients; (4) Conclusions: Anticoagulation with DOACs provides a higher safety profile with respect to VKAs in terms of stroke reduction and a relative bleeding reduction risk. Further studies are needed to better assess the optimal anticoagulation strategy in cancer patients with AF.
Keyphrases
- atrial fibrillation
- direct oral anticoagulants
- oral anticoagulants
- catheter ablation
- left atrial
- left atrial appendage
- end stage renal disease
- heart failure
- newly diagnosed
- venous thromboembolism
- ejection fraction
- percutaneous coronary intervention
- chronic kidney disease
- ischemia reperfusion injury
- healthcare
- prognostic factors
- rectal cancer
- papillary thyroid
- peritoneal dialysis
- patient reported outcomes
- mesenchymal stem cells
- left ventricular
- squamous cell
- stem cells
- subarachnoid hemorrhage
- mitral valve
- young adults
- coronary artery disease
- lymph node metastasis