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Semin Thromb Hemost 2018; 44(04): 388-396
DOI: 10.1055/s-0038-1648229
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anticancer Drug-Related Nonvalvular Atrial Fibrillation: Challenges in Management and Antithrombotic Strategies

Antonella Tufano
1   Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy
,
Maurizio Galderisi
2   Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
,
Luca Esposito
2   Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
,
Valentina Trimarco
3   Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università Federico II, Napoli, Italy
,
Daniela Sorriento
2   Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
,
Guy Gerusalem
4   Department of Medical Oncology, CHU Sart Tilman Liège and Liège University, Liège, Belgium
,
Marco Picardi
1   Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy
,
Patrizio Lancellotti
5   University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium
6   Gruppo Villa Maria Care and Research, Anthea, Hospital, Bari, Italy
,
Fabrizio Pane
1   Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
03 May 2018 (online)

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Abstract

Cancer patients may experience nonvalvular atrial fibrillation (AF) as a manifestation of cardiotoxicity. AF may be a direct effect of a neoplasm or, more often, appear as a postsurgical complication, especially after thoracic surgery. AF may also develop as a consequence of anticancer therapy (chemotherapy or radiotherapy), a condition probably underestimated. Cancer patients with AF require a multidisciplinary approach involving oncologists/hematologists, cardiologists, and coagulation experts. An echocardiogram should be performed to detect possible abnormalities of left ventricular systolic and diastolic function, as well as left atrial dilation and the existence of valvular heart disease, to determine pretest probability of sinus rhythm restoration, and identify the best treatment. The choice of antiarrhythmic treatment in cancer patients may be difficult because scanty information is available on the interactions between anticancer agents and antiarrhythmic drugs. A careful evaluation of the antithrombotic strategy with the best efficacy/safety ratio is always needed. The use of vitamin K antagonists (VKAs) may be problematic because of the unpredictable therapeutic response and high bleeding risk in patients with active cancer who are undergoing chemotherapy and who may experience thrombocytopenia and changes in renal or hepatic function. Low molecular weight heparins (in particular for short and intermediate periods) and non-VKA oral anticoagulants (NOACs) should be preferred. However, the possible pharmacological interactions of NOACs with both anticancer and antiarrhythmic drugs should be considered. Based on all these considerations, antiarrhythmic and anticoagulant therapy for AF should be tailored individually for each patient.

Keywords

atrial fibrillation - cancer - drug interaction - stroke - anticoagulants
 

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