Giuseppe Boriani1, Geraldine Lee2, Iris Parrini3, Teresa Lopez-Fernandez4, Alexander R Lyon5, Thomas Suter6, Peter Van der Meer7, Daniela Cardinale8, Patrizio Lancellotti9,10, Jose Luis Zamorano11, Jeroen J Bax12, Riccardo Asteggiano13,14. 1. Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy. 2. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, 57 Waterloo Road, London SE1 8WA, UK. 3. Cardiology Division, Mauriziano Hospital, Via Magellano 1, 10128, Turin, Italy. 4. Division of Cardiology, Cardiac Imaging and Cardio-Oncology Unit, La Paz University Hospital, IdiPAZ Research Institute, CIBER CV, Calle de Pedro Rico, 6, 28029 Madrid, Spain. 5. Cardio-Oncology Service, Royal Brompton & Harefield NHS Foundation Trust and the National Heart & Lung Institute, Imperial College London, Sydney Street , Greater London, SW3 6NP, UK. 6. Cardiology, University Hospital Inselspital, Freiburgstrasse 41G, 3010 Bern, Switzerland. 7. Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. 8. Cardioncology Unit, European Institute of Oncology, I.R.C.C.S., Via Giuseppe Ripamonti 435, 20141, Milan, Italy. 9. Department of Cardiology, CHU Sart Tilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Avenue de L'Hòpital 1-11, 4000 Liège, Belgium. 10. Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola (Ravenna), and Anthea Hospital, Via Camillo Rosalba, 35/37, 70124 Bari, Italy. 11. University Hospital Ramon y Cajal, CiberCV, Ctra. de Colmenar Viejo km. 9,100 28034 Madrid, Spain. 12. Department of Cardiology, Leiden University Medical Centre (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands. 13. School of Medicine, University of Insubria, Via Ravasi, 2, 21100 Varese, Italy. 14. LARC (Laboratorio Analisi e Ricerca Clinica), Corso Venezia, 10, 10155 Turin, Italy.
Abstract
BACKGROUND: In patients with active cancer and atrial fibrillation (AF) anticoagulation, thrombotic and bleeding risk still entail uncertainty. AIM: We explored the results of an international survey examining the knowledge and behaviours of a large group of physicians. METHODS AND RESULTS: A web-based survey was completed by 960 physicians (82.4% cardiologists, 75.5% from Europe). Among the currently available anticoagulants for stroke prevention in patients with active cancer, direct oral anticoagulants (DOACs) were preferred by 62.6%, with lower values for low molecular weight heparin (LMWH) (24.1%) and for warfarin (only 7.3%). About 46% of respondents considered that DOACs should be used in all types of cancers except in non-operable gastrointestinal cancers. The lack of controlled studies on bleeding risk (33.5% of respondents) and the risk of drug interactions (31.5%) were perceived as problematic issues associated with use of anticoagulants in cancer. The decision on anticoagulation involved a cardiologist in 27.8% of cases, a cardiologist and an oncologist in 41.1%, and a team approach in 21.6%. The patient also was involved in decision-making, according to ∼60% of the respondents. For risk stratification, use of CHA2DS2-VASc and HAS-BLED scores was considered appropriate, although not specifically validated in cancer patients, by 66.7% and 56.4%, respectively. CONCLUSION: This survey highlights that management of anticoagulation in patients with AF and active cancer is challenging, with substantial heterogeneity in therapeutic choices. Direct oral anticoagulants seems having an emerging role but still the use of LMWH remains substantial, despite the absence of long-term data on thromboprophylaxis in AF. Published on behalf of the European Society of Cardiology. All rights reserved.
BACKGROUND: In patients with active cancer and atrial fibrillation (AF) anticoagulation, thrombotic and bleeding risk still entail uncertainty. AIM: We explored the results of an international survey examining the knowledge and behaviours of a large group of physicians. METHODS AND RESULTS: A web-based survey was completed by 960 physicians (82.4% cardiologists, 75.5% from Europe). Among the currently available anticoagulants for stroke prevention in patients with active cancer, direct oral anticoagulants (DOACs) were preferred by 62.6%, with lower values for low molecular weight heparin (LMWH) (24.1%) and for warfarin (only 7.3%). About 46% of respondents considered that DOACs should be used in all types of cancers except in non-operable gastrointestinal cancers. The lack of controlled studies on bleeding risk (33.5% of respondents) and the risk of drug interactions (31.5%) were perceived as problematic issues associated with use of anticoagulants in cancer. The decision on anticoagulation involved a cardiologist in 27.8% of cases, a cardiologist and an oncologist in 41.1%, and a team approach in 21.6%. The patient also was involved in decision-making, according to ∼60% of the respondents. For risk stratification, use of CHA2DS2-VASc and HAS-BLED scores was considered appropriate, although not specifically validated in cancer patients, by 66.7% and 56.4%, respectively. CONCLUSION: This survey highlights that management of anticoagulation in patients with AF and active cancer is challenging, with substantial heterogeneity in therapeutic choices. Direct oral anticoagulants seems having an emerging role but still the use of LMWH remains substantial, despite the absence of long-term data on thromboprophylaxis in AF. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Avirup Guha; Anubhav Jain; Ankita Aggarwal; Amit K Dey; Sourbha Dani; Sarju Ganatra; Francis E Marchlinski; Daniel Addison; Michael G Fradley Journal: BMC Cardiovasc Disord Date: 2022-06-17 Impact factor: 2.174