In-Hospital Cerebrovascular Outcomes of Patients With Atrial Fibrillation and Cancer (from the National Inpatient Sample Database)

Elbadawi, Ayman; Elgendy, Islam Y.; Ha, Le Dung; Baig, Basarat; Saad, Marwan; Adly, Hussain; Ogunbayo, Gbolahan; Olorunfemi, Odunayo; McKillop, Matthew; Maffett, Scott

doi:10.1016/j.amjcard.2017.11.027

Cited by 16 publications

(7 citation statements)

References 22 publications

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“…Table 1 lists the data from published series assessing the risk of stroke in patients with cancer and AF. [4][5][6][17][18][19][20][21][22][23][24][25][26][27][28][29] Although these studies are heterogeneous, a distinction that seems consistently relevant in terms of risk of stroke is that between baseline AF and new-onset AF.…”

Section: Risk Of Strokementioning

confidence: 99%

Atrial Fibrillation and Stroke Risk in Patients With Cancer: A Primer for Oncologists

Sorigué

Miljković

2019

JOP

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Cancer and atrial fibrillation (AF) are common conditions, but for patients affected with both, there is a lack of data about management of anticoagulation and cerebrovascular outcomes. In the first section of this review, we summarize the most relevant studies on stroke risk and management of AF in patients with active cancer, attempting to answer questions of whether to anticoagulate, whom to anticoagulate, and what agents to use. In the second section of the review, we suggest a decision algorithm on the basis of the available evidence and provide practical recommendations for each of the anticoagulant options. In the third section, we discuss the limitations of the available evidence. On the basis of low-quality evidence, we find that patients with cancer and AF have a risk of stroke similar to that of the general population but a substantially higher risk of bleeding regardless of the anticoagulant agent used; this makes anticoagulation-related decisions complex and evidence from the general population not immediately applicable. In general, we suggest stopping anticoagulation in patients with high risk of bleeding and in those with a moderate bleeding risk without a high thromboembolic risk and recommend anticoagulation as in the general population for patients at a low risk for bleeding. However, regardless of initial therapy, we recommend reassessing whether anticoagulation should be given at each point in the clinical course of the disease. High-quality evidence to guide anticoagulation for AF in patients with cancer is needed.

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Section: Risk Of Strokementioning

confidence: 99%

Atrial Fibrillation and Stroke Risk in Patients With Cancer: A Primer for Oncologists

Sorigué

Miljković

2019

JOP

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“…There is an absence of information on anticoagulation initiation, timing, and implantable AF monitoring devices. We have used surrogates of stroke severity used in multiple prior administrative database studies [34,35]. Fifth, we were unable to exclude other etiologies of AIS, such as large vessel atherosclerosis or small vessel lacunar strokes which may have impacted our findings.…”

Section: Discussionmentioning

confidence: 99%

“…We have used surrogates of stroke severity used in multiple prior administrative database studies. 35 , 36 Fifth, we were unable to exclude other etiologies of AIS, such as large vessel atherosclerosis or small vessel lacunar strokes, which may have impacted our findings. Finally, the bias of unmeasured confounders may have affected the outcome of our study.…”

Section: Limitationsmentioning

confidence: 96%

Atrial Fibrillation and Acute Ischemic Stroke: Evaluation of the Contemporary 2018 National Inpatient Sample Database

et al. 2022

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“…The current study adds important knowledge to the field, as most previous research has investigated the risk of stroke in BC patients regardless of AF [9][10][11] or has focused on the in-hospital risk of cerebrovascular outcomes. [14] A study of 10 year survivors of BC from 1970-1986 [9] and cohort studies on Scandinavian cohort study found a higher risk of stroke in BC patients diagnosed from 1970-2000 compared with the background population (relative risk 1.12 (95% CI 1.07-1.17)). [8] Regarding patients treated with anticoagulation a recent study supports the finding, that thromboembolic and bleeding risks were similar in patients with AF with and without recent cancer, including BC.…”

Section: The Risks Of Thromboembolismmentioning

confidence: 99%

“…Information on risk of thromboembolism in patients with BC is scarce, and both increased [8], similar [9][10][11][12][13], and decreased risks [14] have been reported in studies comparing patients with BC with the background population with no information of presence of AF. A single study has found similar risks of thromboembolism and bleeding associated with anticoagulation in patients with AF and prior BC.…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation and anticoagulation in patients with breast cancer

D’Souza

Smedegaard

Madelaire

et al. 2019

Scandinavian Cardiovascular Journal

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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.

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In-Hospital Cerebrovascular Outcomes of Patients With Atrial Fibrillation and Cancer (from the National Inpatient Sample Database)

Cited by 16 publications

References 22 publications

Atrial Fibrillation and Stroke Risk in Patients With Cancer: A Primer for Oncologists

Atrial Fibrillation and Stroke Risk in Patients With Cancer: A Primer for Oncologists

Atrial Fibrillation and Acute Ischemic Stroke: Evaluation of the Contemporary 2018 National Inpatient Sample Database

Atrial fibrillation and anticoagulation in patients with breast cancer

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