Anticoagulation Therapy in Cancer Patients With AF

Some studies suggested that cancer patients with AF are at higher risk for adverse thromboembolic events due to hypercoagulability. Others have proposed that the risk of thromboembolism could be restricted to the specific form of cancer. However, these assumptions have yet to be confirmed in high-quality prospective studies.

In addition, some forms of chemotherapy may increase thromboembolic risk in these patients. At present, no studies have compared the efficacy of various anticoagulation therapies in cancer patients with AF, but some post hoc analyses have shown comparable efficacy.

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“The response to anticoagulation may not be predictable either because of potential interaction with concomitant medications or because of metabolic disorders associated with cancer,” Dr Ganatra said.

Clinical Perspectives: AF and Cancer

Most often, patients with new-onset AF are seen by a primary care physician or oncologist, at least in the initial phase of the treatment,” Dr Ganatra told Hematology Advisor. “Cancer-associated AF can pose significant and unique challenges. For prompt recognition as well as appropriate treatment, it is crucial that primary care physicians and oncologists become familiar with the special management considerations for this patient population.”

Dr Ganatra went on to state, “Most importantly, incorporating cardio-oncology education during internal medicine residency should also be considered to prepare the future workforce. [Doing so] will help in dealing with this and similar cardiovascular issues in the growing numbers of cancer survivors worldwide.”

Current evidence suggests that comorbid AF and cancer are coupled with a worse prognosis. Future studies evaluating long-term thromboembolic risk and optimal anticoagulation treatment are needed.


1.     Chu G, Versteeg HH, Verschoor AJ, et al. Atrial fibrillation and cancer – An unexplored field in cardiovascular oncology [published online March 25, 2019]. Blood Rev. doi:10.1016/j.blre.2019.03.005