Current status of anticoagulation in patients with breast cancer and atrial fibrillation

• Published in: Breast (Edinburgh) 2019-08, Vol.46, p.163-169
• Main Authors: Pardo Sanz, Ana, Rincón, Luis M., Guedes Ramallo, Paula, Belarte Tornero, Laia Carla, de Lara Delgado, Gregorio, Tamayo Obregon, Alejandra, Cruz-Utrilla, Alejandro, Contreras Mármol, Helena, Martínez-Cámara, Andrea, Huertas Nieto, Sergio, Portero-Portaz, Juan José, Salido Tahoces, Luisa, Zamorano Gómez, José Luis
• Format: Article
• Language: English
• Subjects: 4-Hydroxycoumarins - administration & dosage; Aged; Anticoagulants - administration & dosage; Antithrombotic therapy; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Bleeding risk; Breast Neoplasms - complications; Cardio-oncology; Female; Hemorrhage - epidemiology; Hemorrhage - etiology; Humans; Incidence; Indenes - administration & dosage; Ischemic risk; Middle Aged; Proportional Hazards Models; Stroke - epidemiology; Stroke - etiology; Treatment Outcome; Vitamin K - administration & dosage; Vitamin K - antagonists & inhibitors
• ISSN: 0960-9776; 1532-3080
• DOI: 10.1016/j.breast.2019.05.017

Balance between embolic and bleeding risk is challenging among patients with cancer. There is a lack of specific recommendations for the use of antithrombotic therapy in oncologic patients with atrial fibrillation (AF). We compared the embolic and bleeding risk, the preventive management and the incidence of events between patients with and without cancer. We further evaluated the effectiveness and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) within patients with cancer. The AMBER-AF registry is an observational multicentre study that analysed patients with non-valvular AF treated in Oncology and Cardiology Departments in Spain. 1,237 female patients with AF were enrolled: 637 with breast cancer and 599 without cancer. Mean follow-up was 3.1 years. Both groups were similar in age, embolic risk and bleeding risk. Lack of guidelines-recommended therapies was more frequent among patients with cancer. Compared with patients without cancer, adjusted rates of stroke (hazard ratio [95% confidence interval]) in cancer patients were higher (1.56 [1.04–2.35]), whereas bleeding rates remained similar (1.25 [0.95–1.64]). Within the group of patients with cancer, the use of DOACs vs VKAs did not entail differences in the adjusted rates of stroke (0.91 [0.42–1.99]) or severe bleedings (1.53 [0.93–2.53]). Antithrombotic management of AF frequently differs in patients with breast cancer. While breast cancer is associated with a higher risk of incident stroke, bleeding events remained similar. Patients with cancer treated with DOACs experienced similar rates of stroke and bleeding as those with VKAs. •Atrial fibrillation is highly prevalent and requires anticoagulation, but guidelines lack specific recommendations in cancer.•This multicentre registry provides data from 1,237 female patients with atrial fibrillation with and without breast cancer.•Patients with cancer more frequently receive suboptimal therapies regardless of their stroke risk.•Ischemic stroke rates were higher while major bleeding did not differ compared with patients without cancer.•Direct oral anticoagulants can be a reasonable therapy among patients with atrial fibrillation and breast cancer.