Bleeding and thrombotic events in atrial fibrillation patients with cancer: a systematic review and meta-analysis.
Atrial fibrillation
Bleeding
Cancer
Death
ICH
Ischemic stroke
Myocardial infarction
Journal
Internal and emergency medicine
ISSN: 1970-9366
Titre abrégé: Intern Emerg Med
Pays: Italy
ID NLM: 101263418
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
received:
27
07
2022
accepted:
16
11
2022
pubmed:
9
12
2022
medline:
21
3
2023
entrez:
8
12
2022
Statut:
ppublish
Résumé
Atrial fibrillation (AF) and cancer are frequently coexisting in elderly patients. Pooled metanalytic data on the impact of cancer on clinical outcomes in AF patients are lacking. We performed a systematic review and meta-regression analysis of clinical studies retrieved from Medline (PubMed) and Cochrane (CENTRAL) databases according to PRISMA guidelines. Bleeding endpoints included any, major, gastrointestinal (GI) bleeding and intracranial haemorrhage (ICH). Cardiovascular (CV) endpoints included myocardial infarction (MI), ischemic stroke/systemic embolism (IS/SE), CV and all-cause death. PROSPERO registration number: CRD42022315678. We included 15 studies with 2,868,010 AF patients, of whom 479,571 (16.7%) had cancer. The pooled hazard ratio (HR) for cancer was 1.43 (95% confidence interval [95%CI] 1.42-1.44) for any bleeding, 1.27 (95% CI 1.26-1.29) for major bleeding, 1.17 (95% CI 1.14-1.19) for GI bleeding, and 1.07 (95% CI 1.04-1.11) for ICH. The risk of major bleeding increased with the proportion of breast cancer. Cancer increased the risk of all-cause death (HR 2.00, 95% CI 1.99-2.02) whereas no association with MI and CV death was found. Patients with AF and cancer were less likely to suffer from IS/SE (HR 0.91, 95% CI 0.89-0.94). Cancer complicates the clinical history of AF patients, mainly increasing the risk of bleeding. Further analyses according to the type and stage of cancer are necessary to better stratify bleeding risk in these patients.
Identifiants
pubmed: 36480081
doi: 10.1007/s11739-022-03156-w
pii: 10.1007/s11739-022-03156-w
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
655-665Informations de copyright
© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).
Références
Jakobsen CB et al (2019) Incidence of atrial fibrillation in different major cancer subtypes: a Nationwide population-based 12 year follow up study. BMC Cancer 19(1):1105
doi: 10.1186/s12885-019-6314-9
pubmed: 31726997
pmcid: 6854796
Chu G et al (2019) Atrial fibrillation and cancer—an unexplored field in cardiovascular oncology. Blood Rev 35:59–67
doi: 10.1016/j.blre.2019.03.005
pubmed: 30928168
Menichelli D et al (2021) Cancer and atrial fibrillation: epidemiology, mechanisms, and anticoagulation treatment. Prog Cardiovasc Dis 66:28–36
doi: 10.1016/j.pcad.2021.04.004
pubmed: 33915139
Zamorano JL et al (2017) 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur J Heart Fail 19(1):9–42
doi: 10.1002/ejhf.654
pubmed: 27565769
Menichelli D et al. (2021) Cancer and atrial fibrillation: Epidemiology, mechanisms, and anticoagulation treatment. Prog Cardiovasc Dis 66:28–36
Hung YP et al (2019) Risk and predictors of subsequent cancers of patients with newly-diagnosed atrial fibrillation—a nationwide population-based study. Int J Cardiol 296:81–86
doi: 10.1016/j.ijcard.2019.08.021
pubmed: 31466884
Fanola CL et al (2018) Efficacy and safety of edoxaban in patients with active malignancy and atrial fibrillation: analysis of the ENGAGE AF—TIMI 48 Trial. J Am Heart Assoc 7(16):e008987
doi: 10.1161/JAHA.118.008987
pubmed: 30369307
pmcid: 6201390
Chen, S.T., et al., Efficacy and safety of rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation and a history of cancer: observations from ROCKET AF. Eur Heart J Qual Care Clin Outcomes, 2019; 5(2): 145–152.
Melloni, C., et al., Efficacy and Safety of Apixaban Versus Warfarin in Patients with Atrial Fibrillation and a History of Cancer: Insights from the ARISTOTLE Trial. Am J Med, 2017. 130(12): p. 1440–1448 e1.
Fauchier L et al (2015) Cause of death in patients with atrial fibrillation admitted to French hospitals in 2012: a nationwide database study. Open Heart 2(1):e000290
doi: 10.1136/openhrt-2015-000290
pubmed: 26688739
pmcid: 4680587
Gomez-Outes A et al (2016) Causes of death in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol 68(23):2508–2521
doi: 10.1016/j.jacc.2016.09.944
pubmed: 27931607
Pastori, D., et al., The Atrial fibrillation Better Care (ABC) pathway and cardiac complications in atrial fibrillation: a potential sex-based difference. The ATHERO-AF study. Eur J Intern Med, 2021. 85: p. 80–85.
Pastori D et al (2020) Cancer-specific ischemic complications in elderly patients with atrial fibrillation: Data from the prospective ATHERO-AF study. Int J Cancer 147(12):3424–3430
doi: 10.1002/ijc.33179
pubmed: 32588421
Pardo Sanz A et al (2019) Current status of anticoagulation in patients with breast cancer and atrial fibrillation. Breast 46:163–169
doi: 10.1016/j.breast.2019.05.017
pubmed: 31220790
Aspberg S et al (2020) Risk of ischemic stroke and major bleeding in patients with atrial fibrillation and cancer. J Stroke Cerebrovasc Dis 29(3):104560
doi: 10.1016/j.jstrokecerebrovasdis.2019.104560
pubmed: 31889654
Liberati A et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700
doi: 10.1136/bmj.b2700
pubmed: 19622552
pmcid: 2714672
Wells, G.A., et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2014 [cited Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp ; Available from: Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp .
Sterne JA et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919
doi: 10.1136/bmj.i4919
pubmed: 27733354
pmcid: 5062054
Higgins JP et al (2011) The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928
doi: 10.1136/bmj.d5928
pubmed: 22008217
pmcid: 3196245
Tierney JF et al (2007) Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 8:16
doi: 10.1186/1745-6215-8-16
pubmed: 17555582
pmcid: 1920534
de Freitas AS, Alvarez-Larran A (2016) Risk of thrombosis and hemorrhage in patients with polycythemia vera and atrial fibrillation treated with prophylactic oral anticoagulants. Ann Hematol 95(11):1903–1904
doi: 10.1007/s00277-016-2783-y
pubmed: 27518531
Denas G et al (2015) Cancer as a risk factor for stroke in atrial fibrillation patients receiving long-term oral anticoagulant therapy. Thromb Res 136(2):488
doi: 10.1016/j.thromres.2015.06.011
pubmed: 26113017
Melloni C et al (2017) Management and outcomes of patients with atrial fibrillation and a history of cancer: the ORBIT-AF registry. Eur Heart J Qual Care Clin Outcomes 3(3):192–197
doi: 10.1093/ehjqcco/qcx004
pubmed: 28838088
D’Souza M et al (2018) CHA2DS2-VASc score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer. Eur J Prev Cardiol 25(6):651–658
doi: 10.1177/2047487318759858
pubmed: 29482441
D’Souza M et al (2019) Atrial fibrillation and anticoagulation in patients with breast cancer. Scand Cardiovasc J 53(5):247–254
doi: 10.1080/14017431.2019.1638517
pubmed: 31251080
Ording AG et al (2017) Thromboembolic and bleeding complications during oral anticoagulation therapy in cancer patients with atrial fibrillation: a Danish nationwide population-based cohort study. Cancer Med 6(6):1165–1172
doi: 10.1002/cam4.1054
pubmed: 28544489
pmcid: 5463075
Elbadawi A et al (2018) In-hospital cerebrovascular outcomes of patients with atrial fibrillation and cancer (from the national inpatient sample database). Am J Cardiol 121(5):590–595
doi: 10.1016/j.amjcard.2017.11.027
pubmed: 29352566
Vedovati MC et al (2018) Patients with cancer and atrial fibrillation treated with doacs: a prospective cohort study. Int J Cardiol 269:152–157
doi: 10.1016/j.ijcard.2018.07.138
pubmed: 30077526
Pastori D et al (2021) Thromboembolism, mortality, and bleeding in 2,435,541 atrial fibrillation patients with and without cancer: a nationwide cohort study. Cancer 127(12):2122–2129
doi: 10.1002/cncr.33470
pubmed: 33631041
Pastori, D., et al., Thromboembolism, mortality, and bleeding in 2,435,541 atrial fibrillation patients with and without cancer: A nationwide cohort study. Cancer, 2021.
Cavallari I et al (2020) Efficacy and safety of nonvitamin k oral anticoagulants in patients with atrial fibrillation and cancer: a study-level meta-analysis. Thromb Haemost 120(2):314–321
doi: 10.1055/s-0039-3400300
pubmed: 31785599
Hajjar LA, Fonseca SMR, Machado TIV (2021) Atrial fibrillation and cancer. Front Cardiovasc Med 8:590768
doi: 10.3389/fcvm.2021.590768
pubmed: 34336939
pmcid: 8319502
Pastori D et al (2019) Tailored practical management of patients with atrial fibrillation: a risk factor-based approach. Front Cardiovasc Med 6:17
doi: 10.3389/fcvm.2019.00017
pubmed: 30915342
pmcid: 6422871
Adamson, J.W., The anemia of inflammation/malignancy: mechanisms and management. Hematology Am Soc Hematol Educ Program, 2008: p. 159–65.
Johnstone C, Rich SE (2018) Bleeding in cancer patients and its treatment: a review. Ann Palliat Med 7(2):265–273
doi: 10.21037/apm.2017.11.01
pubmed: 29307210
Steffel J et al (2021) 2021 European Heart Rhythm Association practical guide on the use of non-vitamin k antagonist oral anticoagulants in patients with atrial fibrillation. Europace 23(10):1612–1676
doi: 10.1093/europace/euab065
pubmed: 33895845
Wang TF et al (2022) Hemorrhage risk among patients with breast cancer receiving concurrent direct oral anticoagulants with tamoxifen vs aromatase inhibitors. JAMA Netw Open 5(6):e2219128
doi: 10.1001/jamanetworkopen.2022.19128
pubmed: 35763294
pmcid: 9240900
Viborg S et al (2016) Lower gastrointestinal bleeding and risk of gastrointestinal cancer. Clin Transl Gastroenterol 7:e162
doi: 10.1038/ctg.2016.16
pubmed: 27054580
pmcid: 4855159
Aisenberg J et al (2018) Gastrointestinal bleeding with edoxaban versus warfarin: results from the ENGAGE AF-TIMI 48 trial (effective anticoagulation with factor Xa next generation in atrial fibrillation-thrombolysis in myocardial infarction). Circ Cardiovasc Qual Outcomes 11(5):e003998
doi: 10.1161/CIRCOUTCOMES.117.003998
pubmed: 29748353
Sherwood MW et al (2015) Gastrointestinal bleeding in patients with atrial fibrillation treated with rivaroxaban or warfarin: ROCKET AF Trial. J Am Coll Cardiol 66(21):2271–2281
doi: 10.1016/j.jacc.2015.09.024
pubmed: 26610874
Deng Y et al (2019) Non-vitamin K antagonist oral anticoagulants versus warfarin in patients with cancer and atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc 8(14):e012540
doi: 10.1161/JAHA.119.012540
pubmed: 31310583
pmcid: 6662149
Westenbrink BD et al (2017) Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. Am Heart J 185:140–149
doi: 10.1016/j.ahj.2016.12.008
pubmed: 28267467
Leader A, Gurevich-Shapiro A, Spectre G (2020) Anticoagulant and antiplatelet treatment in cancer patients with thrombocytopenia. Thromb Res 191(Suppl 1):S68–S73
doi: 10.1016/S0049-3848(20)30400-X
pubmed: 32736782
Fauchier L et al (2016) Causes of death and influencing factors in patients with atrial fibrillation. Am J Med 129(12):1278–1287
doi: 10.1016/j.amjmed.2016.06.045
pubmed: 27476087
Pastori D et al (2021) Long-term risk of major adverse cardiac events in atrial fibrillation patients on direct oral anticoagulants. Mayo Clin Proc 96(3):658–665
doi: 10.1016/j.mayocp.2020.06.057
pubmed: 33308867
Liu, F., et al., Effectiveness and Safety of DOACs vs. VKAs in AF Patients With Cancer: Evidence From Randomized Clinical Trials and Observational Studies. Front Cardiovasc Med, 2021. 8: p. 766377.
Chen, S., et al., Patterns of Anticoagulation Use in Atrial Fibrillation and Active Cancer: Observations From Medicare. Circulation, 2021. 144(A12118).