Atrial fibrillation and anticoagulation in patients with breast cancer

Abstract

To examine the long-term risk of thromboembolism and bleeding in patients with atrial fibrillation comparing patients with and without recent breast cancer in subgroups with or without anticoagulation therapy, respectively. Design Using nationwide registries, patients with breast cancer from 1998-2015 and subsequent atrial fibrillation within 3 years were stratified on anticoagulation and matched 1:3 on age, sex and comorbidities with atrial fibrillation patients without breast cancer. Risks of thromboembolism and bleeding were estimated by Aalen-Johansen and multivariable cox regression models. Results Atrial fibrillation patients with and without anticoagulation were matched, respectively (201 and 525 with breast cancer matched with 603 and 1,575 without breast cancer). In patients with CHA 2 DS 2-VASc-score >1 and anticoagulation the three years risks of thromboembolism were 4.2% (95% confidence interval (CI) 1.1-7.3) and 3.2 % (CI 1.5-4.9) in patients with and without breast cancer. The risks of bleeding were 5.3% (CI 1.7-8.9) and 5.1% (CI 3.0-7.1), respectively. Breast cancer was associated with a similar risk of thromboembolism in patients with and without anticoagulation, respectively (Hazard ratio (HR) 1.10, CI 0.63-1.92 and HR 1.11, CI 0.82-1.50) and a similar risk of bleeding in patients with and without anticoagulation, respectively (HR 1.01, CI 0.56-1.84 and HR 0.85, CI 0.57-1.27) compared with the matched controls. Conclusions Breast cancer was not associated with altered risk of thromboembolism or bleeding in patients with atrial fibrillation irrespective of treatment with anticoagulation. Our analyses suggest that atrial fibrillation diagnosed in patients with breast cancer should be considered as primary atrial fibrillation.

Anticoagulation in patients with atrial fibrillation and active cancer: an international survey on patient management

“…[4][5][6][7][8] However, data from registries in specific types of malignancy, such as breast cancer, seem to confirm the safety profile of DOACs also in this type of patients. 9,10 As a result of the generalized concern on bleeding risk, registries such as the EORP-AF long-term general registry highlighted an under-prescription of oral anticoagulants in patients with history of malignancies. 11 The aim of this survey, promoted by the Council of Cardio-Oncology of the European Society of Cardiology (ESC), was to obtain a view of the beliefs, perceptions, and attitudes with a specific focus on the factors considered for prescription of anticoagulants in the management of AF in cancer patients.…”

Atrial Fibrillation, Oral Anticoagulants, and Concomitant Active Cancer: Benefits and Risks

“…In previous studies of OAC-treated AF patients with breast cancer, the bleeding risk did not differ compared with OAC-treated AF patients without cancer. 20 21 However, in contrast to these studies, we recorded more events and studied only active cancers, making direct comparisons with these studies difficult.…”

Oral anticoagulation in patients with active cancer and atrial fibrillation: current challenges

“…Concerning the former, stroke risk is not increased in all cancers, particularly the least aggressive ones [3,5]. Some of the most common cancers, i.e., breast and prostate cancer, have either only a very small or no increase in stroke [3,42,46]. Concerning the latter, patients with metastatic cancer or with a recent diagnosis of cancer have a higher risk of stroke than those that are disease-free [3,4,42,[47][48][49][50].…”