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Atrial fibrillation in patients with active malignancy and use of anticoagulants: Under-prescription but no adverse impact on all-cause mortality.
- Source :
-
European journal of internal medicine [Eur J Intern Med] 2019 Jan; Vol. 59, pp. 27-33. Date of Electronic Publication: 2018 Oct 29. - Publication Year :
- 2019
-
Abstract
- Prescription of anticoagulants (ACs) in patients with cancer and atrial fibrillation (AF) is challenging and the impact on survival is not defined. In this study data prospectively collected in Oncology Units were retrospectively evaluated. Among 4664 patients admitted for malignancy, 394 patients (8.4%) had documented AF (mean age of 74 ± 9) and AC was prescribed to 155 patients (40%). Neither the type of cancer, the stage of the disease (metastatic or not) nor the ongoing treatments were significantly associated with prescription of AC, which was independently associated with BMI (OR 1.10; CI 95% 1.03-1.17; p = .003), valvular heart disease (OR 3.76; CI95% 1.59-8.87; p = .002), and previous venous thromboembolism (OR 6.67; 95%CI 2.67-16.70; p < .001). During a median follow-up of 212 days, survival from all-cause death was 37%, 28% and 18% at 6 months, 1 and 2 years, respectively. Only variables related to neoplastic disease or to patient clinical complexity were independently associated with mortality. A CHA <subscript>2</subscript> DS <subscript>2</subscript> VASc ≥ 4 was significantly associated with mortality (HR 1.33; 95%CI 1.06-1.67; p = .013). Treatment with ACs was not significantly related to mortality, neither in the whole cohort of patients, nor in patients with metastatic malignancies. In conclusion the prescription of ACs in patients with AF and active cancer was suboptimal, with one fourth of the patients not treated with ACs and one third using LMWH at prophylactic, non-therapeutic doses. Only few variables (BMI, valvular heart disease and previous venous thromboembolism) predicted prescription of ACs. Prescription of ACs was not associated with all-cause mortality, even in the subgroup with metastasis.<br /> (Copyright © 2018. Published by Elsevier B.V.)
- Subjects :
- Administration, Oral
Aged
Aged, 80 and over
Female
Heparin, Low-Molecular-Weight therapeutic use
Humans
Italy epidemiology
Male
Retrospective Studies
Risk Assessment
Risk Factors
Survival Analysis
Anticoagulants therapeutic use
Atrial Fibrillation drug therapy
Atrial Fibrillation epidemiology
Mortality
Neoplasms complications
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0828
- Volume :
- 59
- Database :
- MEDLINE
- Journal :
- European journal of internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 30385084
- Full Text :
- https://doi.org/10.1016/j.ejim.2018.10.012