The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome

Cancer patients have an increased risk of cardiovascular disease and, notably, a significant prevalence of acute coronary syndrome (ACS). It has been shown that an elevated presence of cardiovascular risk factors in this setting leads to an interaction between these two conditions, influencing their therapeutic strategies and contributing to higher mortality. Nonetheless, cancer patients have generally not been evaluated in ACS trials, so that the treatment in these cases is still not fully known. We reviewed the current literature and discussed the best management for these very high-risk patients. The treatment strategy must be tailored based on the cancer type and stage, balancing thrombotic and bleeding risks. When the prognosis is longer than six months, especially if a clinical instability coexists, patients with ACS and cancer should be referred for percutaneous coronary intervention (PCI) as soon as possible. Moreover, an invasive strategy should be preferred in STEMI patients as well as in NSTEMI patients who are considered as high risk. On the contrary, in clinically stable NSTEMI patients, a conservative non-invasive strategy could be adopted, especially in cases of a poor life expectancy and/or of high risk of bleeding. Drug-Eluting-Stents (DES) should be the first choice if an invasive strategy is adopted. Conservative therapy could instead be considered in cancer patients with more stable CAD at an increased risk of major bleeding complications. However, the duration of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended, but it should be as short as possible, whereas triple antithrombotic therapy is non-advised because it significantly increases the risk of bleeding. ACS management among cancer patients should be based on an accurate evaluation of the risk of thrombosis and bleeding. Future studies focused on choosing optimal strategies in tumor patients with ACS should be performed to treat this subset of patients better.

show abstract

“…In the general population, NSTEMI is the most common clinical presentation of ACS in cancer patients [ 14 , 70 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Remarkably, the coexistence of ACS and cancer in the same patient strongly influences prognosis [ 13 ]. The treatment in this setting is very challenging, and it should be patient-tailored [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Management of Acute Coronary Syndrome in Cancer Patients: It’s High Time We Dealt with It

Lucà

Parrini²,

Abrignani

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…Unfortunately, most cancer therapies also have a cardiotoxic component. Tumor therapies that can induce acute coronary syndrome include alkylating agents, antimetabolites, anti-microtubule agents, antibiotics, hormonal therapies, monoclonal antibodies, and tyrosine kinase inhibitors (TKIs) [ 41 , 42 , 43 ]. Radiation therapy used for certain types of tumors in the chest can damage the vascular walls and lead to thrombosis, plaque formation, and fibrosis [ 44 , 45 , 46 ].…”

Section: Specific Cancer Treatment and Cardiovascular Side-effectsmentioning

confidence: 99%

“…The following chemotherapeutic agents are used for various types of lymphoma and may in turn cause angina, vasospasm, and ACS: Vinblastine, bleomycin, and rituximab [ 41 ]. Rituximab can also induce takotsubo cardiomyopathy [ 76 ].…”

Section: Specific Cancer Treatment and Cardiovascular Side-effectsmentioning

confidence: 99%

Coronary Artery Disease and Cancer: Treatment and Prognosis Regarding Gender Differences

Lange

Reinecke

2022

Cancers

View full text Add to dashboard Cite

Cardiovascular disease and cancer remain the leading causes of hospitalization and mortality in high-income countries. Survival after myocardial infarction has improved but there is still a difference in clinical outcome, mortality, and developing heart failure to the disadvantage of women with myocardial infarction. Most major cardiology trials and registries have excluded patients with cancer. As a result, there is only very limited information on the effects of coronary artery disease in cancer patients. In particular, the outcomes in women with cancer and coronary artery disease and its management remain empiric. We reviewed studies of over 27 million patients with coronary artery disease and cancer. Our review focused on the most important types of cancer (breast, colon, lung, prostate) and hematological malignancies with particular attention to sex-specific differences in treatment and prognosis.

show abstract

“…It is important to compare the risk of thromboembolism to the risk of bleeding for each individual patient, since cancer patients also have a high risk of bleeding [ 4 ]. Thrombocytopenia, defined as a platelet count below 100,000/mm 3 , is observed in 10–25% of cancer patients [ 101 , 102 , 103 ]. According to the Society for Cardiovascular Angiography and Interventions, cancer patients with thrombocytopenia undergoing coronary angiography do not require prophylactic platelet transfusion unless recommended by their oncology team due to a platelet count below 200,000/mL and one of the following criteria: (a) a high body temperature, (b) leukocytosis, (c) a rapid decrease in the number of platelets, or (d) other coagulation impairments.…”

Section: Treatment Of Cardiovascular Complications During Cancer Therapymentioning

confidence: 99%

Cancer Therapy-Related Cardiovascular Complications in Clinical Practice: Current Perspectives

Bohdan

Kowalczys

Mickiewicz

et al. 2021

JCM

View full text Add to dashboard Cite

Cardiovascular (CV) diseases and cancer are the leading causes of death in Europe and the United States. Both diseases have extensive overlap and share common risk factors, symptoms, and outcomes. As the number of patients with both cancer and CV diseases continues to rise, the field of cardio-oncology is gaining increased attention. A frequent problem during anti-cancer treatment is cardiotoxicity caused by the side-effects of chemo-, immuno-, targeted, and radiation therapies. This problem may manifest as acute coronary syndrome, myocarditis, arrhythmias, or heart failure. Modern cardio-oncology spans many different research areas. While some researchers focus on treating patients that have already developed cardiotoxicity, others aim to identify new methods for preventing cardiotoxicity before, during, and after anti-cancer therapy. Both groups share the common understanding that regular monitoring of cancer patients is the basis for optimal medical treatment. Optimal treatment can only be achieved through close cooperation between cardiologists and oncologists. This review summarizes the current views on cardio-oncology and discusses the cardiotoxicities associated with commonly used chemotherapeutics.

show abstract

The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome

Cited by 12 publications

References 55 publications

Management of Acute Coronary Syndrome in Cancer Patients: It’s High Time We Dealt with It

Management of Acute Coronary Syndrome in Cancer Patients: It’s High Time We Dealt with It

Coronary Artery Disease and Cancer: Treatment and Prognosis Regarding Gender Differences

Cancer Therapy-Related Cardiovascular Complications in Clinical Practice: Current Perspectives

Contact Info

Product

Resources

About