[en] BACKGROUND: In patients with active cancer and atrial fibrillation (AF) anticoagulation, thrombotic and bleeding risk still entail uncertainty. AIM: We explored the results of an international survey examining the knowledge and behaviours of a large group of physicians. METHODS AND RESULTS: A web-based survey was completed by 960 physicians (82.4% cardiologists, 75.5% from Europe). Among the currently available anticoagulants for stroke prevention in patients with active cancer, direct oral anticoagulants (DOACs) were preferred by 62.6%, with lower values for low molecular weight heparin (LMWH) (24.1%) and for warfarin (only 7.3%). About 46% of respondents considered that DOACs should be used in all types of cancers except in non-operable gastrointestinal cancers. The lack of controlled studies on bleeding risk (33.5% of respondents) and the risk of drug interactions (31.5%) were perceived as problematic issues associated with use of anticoagulants in cancer. The decision on anticoagulation involved a cardiologist in 27.8% of cases, a cardiologist and an oncologist in 41.1%, and a team approach in 21.6%. The patient also was involved in decision-making, according to ∼60% of the respondents. For risk stratification, use of CHA2DS2-VASc and HAS-BLED scores was considered appropriate, although not specifically validated in cancer patients, by 66.7% and 56.4%, respectively. CONCLUSION: This survey highlights that management of anticoagulation in patients with AF and active cancer is challenging, with substantial heterogeneity in therapeutic choices. Direct oral anticoagulants seems having an emerging role but still the use of LMWH remains substantial, despite the absence of long-term data on thromboprophylaxis in AF.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Boriani, Giuseppe; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences,
Lee, Geraldine; Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's
Lopez-Fernandez, Teresa; Division of Cardiology, Cardiac Imaging and Cardio-Oncology Unit, La Paz
Lyon, Alexander R ; Cardio-Oncology Service, Royal Brompton & Harefield NHS Foundation Trust and the
Suter, Thomas; Cardiology, University Hospital Inselspital, Freiburgstrasse 41G, 3010 Bern,
Van der Meer, Peter; Department of Cardiology, University of Groningen, University Medical Center
Cardinale, Daniela; Cardioncology Unit, European Institute of Oncology, I.R.C.C.S., Via Giuseppe
LANCELLOTTI, Patrizio ; Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie ; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Via Corriera
Zamorano, Jose Luis; University Hospital Ramon y Cajal, CiberCV, Ctra. de Colmenar Viejo km. 9,100
Bax, Jeroen J; Department of Cardiology, Leiden University Medical Centre (LUMC), Albinusdreef
Asteggiano, Riccardo; School of Medicine, University of Insubria, Via Ravasi, 2, 21100 Varese, Italy. ; LARC (Laboratorio Analisi e Ricerca Clinica), Corso Venezia, 10, 10155 Turin,
Council of Cardio-Oncology of the European Society of, Cardiology
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