Dual Antiplatelet Therapy and Cancer; Balancing between Ischemic and Bleeding Risk: A Narrative Review

Abstract

Cardiovascular (CV) events in patients with cancer can be caused by concomitant CV risk factors, cancer itself, and anticancer therapy. Since malignancy can dysregulate the hemostatic system, predisposing cancer patients to both thrombosis and hemorrhage, the administration of dual antiplatelet therapy (DAPT) to patients with cancer who suffer from acute coronary syndrome (ACS) or undergo percutaneous coronary intervention (PCI) is a clinical challenge to cardiologists. Apart from PCI and ACS, other structural interventions, such as TAVR, PFO-ASD closure, and LAA occlusion, and non-cardiac diseases, such as PAD and CVAs, may require DAPT. The aim of the present review is to review the current literature on the optimal antiplatelet therapy and duration of DAPT for oncologic patients, in order to reduce both the ischemic and bleeding risk in this high-risk population.

Effects of Proton Pump Inhibitors on Cardiovascular Events and Inflammatory Factors in Patients With Upper Gastrointestinal Bleeding Undergoing Dual Antiplatelet Therapy

“…Furthermore, inflammatory factors play a crucial role in the development and progression of CVDs [25].…”

Bridging the Gap in Cancer-Related Stroke Management: Update on Therapeutic and Preventive Approaches

“…The treatment may consist of thrombolytic therapy, anticoagulant therapy (to prevent further clot formation), or mechanical procedures (such as stents or filters) to remove the clot or prevent the embolisation of the clot [43]. Because cancer patients are at a high risk for both ischaemic and haemorrhagic events due to the dysregulation of their haemostatic system by malignancy, determining the optimal antiplatelet drugs and their duration and dosage in those patients with a history of PCI, AIS, and/or ACS remains a challenge [51]. The use of cutting-edge technologies, such as drug-eluted stents (DESs) and OCT allows for the possibility of decreasing the length of DAPT in all patients, including those with cancer [53,78].…”

“…Antiplatelet therapy is preferred also in lesions that are characterised by atherosclerosis and endothelial injury [49]. Dual antiplatelet therapy (DAPT) may need to be discontinued in cancer patients who have received percutaneous coronary intervention (PCI) or experienced an acute coronary syndrome (ACS) to restart anticancer treatment, perform surgery, or even have biopsies [50,51]. Furthermore, the optimal duration of DAPT in cancer patients remains a challenge owing to the increased risks of thrombosis and haemorrhage associated with cancer [52].…”

Untitled

“…Guo et al demostraron que pacientes con cáncer que requieren una angioplastia, tienen mayor riesgo tanto trombótico como hemorrágico (141). En especial, los pacientes con cáncer de pulmón o de colon tienen un mayor riesgo de reinfarto post angioplastia a los 90 días (142), mientras que las neoplasias con mayor riesgo de sangrado son las de pulmón, cabeza y cuello, gastrointestinal, colorectal, ginecológicas, leucemia aguda, mieloma múltiple y linfoma no Hodgkin (143).…”