Little is known about the prediction of atrial fibrillation (AF) risk scores in patients
with cancer. The aim of this study was to assess the predictive ability of the CHA2DS2-VASc and HAS-BLED scores in patients with AF and cancer. Overall, 16,056 patients
with AF diagnosed between 2014 and 2018 from a Spanish health area, including 1,137
patients with cancer, were observed during a median follow-up of 4.9 years. Although
discrimination was similar between patients with cancer and patients without cancer
who were treated with anticoagulation therapy (0.56 and 0.58), in patients with cancer
who were not treated with anticoagulation therapy, c-statistic of CHA2DS2-VASc was poor and significantly lower than in the patients without cancer (0.42 vs
0.65). The overall precision of the CHA2DS2-VASc score was good throughout the follow-up (Brier score < 0.1), in patients with
and without cancer. Regarding the HAS-BLED score, calibration and discrimination were
poor in patients with cancer (c-statistic 0.51), similar to those in patients without
cancer (c-statistic 0.53). In patients with cancer who were not treated with anticoagulation
therapy, the embolic risk CHA2DS2-VASc score = 1 was similar to CHA2DS2-VASc score ≥ 2. Only patients with AF and cancer and CHA2DS2-VASc score = 0 presented a low risk of embolic events (negative predictive value
100%). A HAS-BLED score > 3 was not associated with higher bleeding risk in patients
with cancer (p > 0.05). In summary, in patients with cancer and with AF, neither the
CHA2DS2-VASc score nor the HAS-BLED score was useful for predicting embolic and hemorrhagic
events, respectively. However, a CHA2DS2-VASc score 0 is useful to identify patients with AF and cancer who are at low embolic
risk.
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References
- Relation between cancer and atrial fibrillation (from the REasons for Geographic And Racial Differences in Stroke Study).Am J Cardiol. 2015; 115: 1090-1094
- Provider specialty, anticoagulation, and stroke risk in patients with atrial fibrillation and cancer.J Am Coll Cardiol. 2018; 72: 1913-1922
- Anticoagulation strategies in patients with cancer: JACC review topic of the week.J Am Coll Cardiol. 2019; 73: 1336-1349
- AF in cancer patients: a different need for anticoagulation?.Eur Cardiol. 2019; 14: 65-67
- 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 Heart J. 2016; 37: 2768-2801
- Atrial fibrillation and stroke risk in patients with cancer: a primer for oncologists.J Oncol Pract. 2019; 15: 641-650
- Role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism: guidance from the SSC of the ISTH.J Thromb Haemost. 2018; 16: 1891-1894
- The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.Ann Surg Oncol. 2010; 17: 1471-1474
- Population-based assessment of determining predictors for quality of prostate cancer surveillance.Cancer. 2015; 121: 4150-4157
- Staging non-Hodgkin lymphoma.CA Cancer J Clin. 2005; 55: 368-376
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.Chest. 2010; 137: 263-272
- A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey.Chest. 2010; 138: 1093-1100
- Standardized Data Collection for Cardiovascular Trials Initiative (SCTI). 2017 cardiovascular and stroke endpoint definitions for clinical trials.J Am Coll Cardiol. 2018; 71: 1021-1034
- Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients.J Thromb Haemost. 2010; 8: 202-204
- Subcommittee on Control of Anticoagulation. Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH.J Thromb Haemost. 2015; 13: 2119-2126
- Thromboembolism, mortality, and bleeding in 2,435,541 atrial fibrillation patients with and without cancer: a nationwide cohort study.Cancer. 2021; 127: 2122-2129
- Council of Cardio-Oncology of the European Society of Cardiology. Anticoagulation in patients with atrial fibrillation and active cancer: an international survey on patient management.Eur J Prev Cardiol. 2021; 28: 611-621
- CHA2DS2-VASc score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer.Eur J Prev Cardiol. 2018; 25: 651-658
- Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish atrial fibrillation cohort study.Eur Heart J. 2012; 33: 1500-1510
- Patterns of anticoagulation for atrial fibrillation in cancer patients referred to cardio-oncological evaluation.Eur J Intern Med. 2020; 82: 128-129
- Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy.Blood Adv. 2019; 3: 3770-3779
- ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2021; 42: 373-498
Article Info
Publication History
Published online: July 29, 2022
Received in revised form:
June 18,
2022
Received:
March 24,
2022
Footnotes
The electronic registry was funded in a nonconditioned way by Daiichi Sankyo, Pfizer-BMS, Bayer, and Boehringer Ingelheim. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Identification
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© 2022 Published by Elsevier Inc.
