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Pernod G, Cohen A, Mismetti P, Sanchez O, Mahé I. [Translation into French and republication of: "Cancer-related arterial thromboembolic events"]. Rev Med Interne 2024:S0248-8663(24)00703-3. [PMID: 39097502 DOI: 10.1016/j.revmed.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 08/05/2024]
Abstract
Cancer is associated with a hypercoagulable state and is a well-known independent risk factor for venous thromboembolism, whereas the association between cancer and arterial thromboembolism is less well established. Arterial thromboembolism, primarily defined as myocardial infarction or stroke is significantly more frequent in patients with cancer, independently of vascular risk factors and associated with a three-fold increase in the risk of mortality. Patients with brain cancer, lung cancer, colorectal cancer and pancreatic cancer have the highest relative risk of developing arterial thromboembolism. Antithrombotic treatments should be used with caution due to the increased risk of haemorrhage, as specified in current practice guidelines.
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Affiliation(s)
- Gilles Pernod
- Service de médecine vasculaire, CHU de Grenoble, université Grenoble-Alpes, Grenoble, France; F-CRIN INNOVTE network, Saint-Étienne, France.
| | - Ariel Cohen
- Service de cardiologie, hôpital Saint-Antoine, hôpital Tenon, Assistance publique-Hôpitaux de Paris, Sorbonne université, Paris, France; Inserm, UMRS 1166, unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut hospitalo-universitaire, Institut de cardiométabolisme et nutrition (ICAN), Sorbonne université, 75013 Paris, France
| | - Patrick Mismetti
- F-CRIN INNOVTE network, Saint-Étienne, France; Service de médecine vasculaire et thérapeutique, hôpital Nord, CHU de Saint-Étienne, Saint-Étienne, France
| | - Olivier Sanchez
- F-CRIN INNOVTE network, Saint-Étienne, France; Service de pneumologie et de soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Inserm UMR S1140, innovations thérapeutiques en hémostase, université Paris Cité, Paris, France
| | - Isabelle Mahé
- F-CRIN INNOVTE network, Saint-Étienne, France; Inserm UMR S1140, innovations thérapeutiques en hémostase, université Paris Cité, Paris, France; Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France
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2
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Chen Q, van Rein N, van der Hulle T, Heemelaar JC, Trines SA, Versteeg HH, Klok FA, Cannegieter SC. Coexisting atrial fibrillation and cancer: time trends and associations with mortality in a nationwide Dutch study. Eur Heart J 2024; 45:2201-2213. [PMID: 38619538 PMCID: PMC11231645 DOI: 10.1093/eurheartj/ehae222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/24/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND AND AIMS Coexisting atrial fibrillation (AF) and cancer challenge the management of both. The aim of the study is to comprehensively provide the epidemiology of coexisting AF and cancer. METHODS Using Dutch nationwide statistics, individuals with incident AF (n = 320 139) or cancer (n = 472 745) were identified during the period 2015-19. Dutch inhabitants without a history of AF (n = 320 135) or cancer (n = 472 741) were matched as control cohorts by demographic characteristics. Prevalence of cancer/AF at baseline, 1-year risk of cancer/AF diagnosis, and their time trends were determined. The association of cancer/AF diagnosis with all-cause mortality among those with AF/cancer was estimated by using time-dependent Cox regression. RESULTS The rate of prevalence of cancer in the AF cohort was 12.6% (increasing from 11.9% to 13.2%) compared with 5.6% in the controls; 1-year cancer risk was 2.5% (stable over years) compared with 1.8% in the controls [adjusted hazard ratio (aHR) 1.52, 95% confidence interval (CI) 1.46-1.58], which was similar by cancer type. The rate of prevalence of AF in the cancer cohort was 7.5% (increasing from 6.9% to 8.2%) compared with 4.3% in the controls; 1-year AF risk was 2.8% (stable over years) compared with 1.2% in the controls (aHR 2.78, 95% CI 2.69-2.87), but cancers of the oesophagus, lung, stomach, myeloma, and lymphoma were associated with higher hazards of AF than other cancer types. Both cancer diagnosed after incident AF (aHR 7.77, 95% CI 7.45-8.11) and AF diagnosed after incident cancer (aHR 2.55, 95% CI 2.47-2.63) were associated with all-cause mortality, but the strength of the association varied by cancer type. CONCLUSIONS Atrial fibrillation and cancer were associated bidirectionally and were increasingly coexisting, but AF risk varied by cancer type. Coexisting AF and cancer were negatively associated with survival.
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Affiliation(s)
- Qingui Chen
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Nienke van Rein
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Tom van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Julius C Heemelaar
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Cardiovascular Imaging Research Center, Division of Cardiology, and Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - Serge A Trines
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Henri H Versteeg
- Department of Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Frederikus A Klok
- Department of Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Cheong MA, Leader A. Cancer and arterial thrombosis: therapeutic options. Res Pract Thromb Haemost 2024; 8:102393. [PMID: 38660456 PMCID: PMC11039399 DOI: 10.1016/j.rpth.2024.102393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
A State of the Art lecture titled "Cancer and Arterial Thrombosis: Therapeutic Options" was presented at the International Society on Thrombosis and Haemostasis Congress in 2023. This State of the Art review delves into the complex relationship between cancer and arterial thromboembolism (ATE), encompassing acute coronary syndrome, ischemic strokes, and peripheral arterial disease. The burden of cancer-associated ATE is not well defined, but studies indicate elevated risks, particularly in the 6 months after a cancer diagnosis. Incidence varies among cancer subtypes, with lung cancer displaying the highest rates. Additionally, the pathophysiology of cancer-associated ATE involves a multifaceted interplay of cancer-induced hypercoagulopathy, cancer therapy-related thrombosis, and personal risk factor contributors. ATEs are clinically heterogeneous and in the context of cancer have particular mechanistic differences compared with ATE patients without cancer. This requires modifications in approach and tailored management considerations. Specific etiologies contributing to ATE, such as coronary vasospasm and non-bacterial-thrombotic endocarditis, need to be considered. The diagnosis of cancer alone usually does not contraindicate patients to standard guideline-based therapies for the management of ATE, although nuances in treatment may need to be considered in light of the underlying cancer. Atrial fibrillation in cancer patients further complicates the thrombotic landscape. Cancer patients with atrial fibrillation are at a higher risk of ATE, necessitating careful consideration of anticoagulation therapy as clinical benefits and bleeding risks need to be weighed. ATE may also be a presenting sign of underlying malignancy, which requires increased awareness and focused clinical evaluation for cancer in selected cases. Finally, we summarize relevant new data on this topic presented during the 2023 International Society on Thrombosis and Haemostasis Congress.
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Affiliation(s)
- May Anne Cheong
- Department of Haematology, Singapore General Hospital, Singapore
| | - Avi Leader
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Tamargo J, Villacastín J, Caballero R, Delpón E. Drug-induced atrial fibrillation. A narrative review of a forgotten adverse effect. Pharmacol Res 2024; 200:107077. [PMID: 38244650 DOI: 10.1016/j.phrs.2024.107077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an increased morbidity and mortality. There is clinical evidence that an increasing number of cardiovascular and non-cardiovascular drugs, mainly anticancer drugs, can induce AF either in patients with or without pre-existing cardiac disorders, but drug-induced AF (DIAF) has not received the attention that it might deserve. In many cases DIAF is asymptomatic and paroxysmal and patients recover sinus rhythm spontaneously, but sometimes, DIAF persists, and it is necessary to perform a cardioversion. Furthermore, DIAF is not mentioned in clinical guidelines on the treatment of AF. The risk of DIAF increases in elderly and in patients treated with polypharmacy and with risk factors and comorbidities that commonly coexist with AF. This is the case of cancer patients. Under these circumstances ascribing causality of DIAF to a given drug often represents a clinical challenge. We review the incidence, the pathophysiological mechanisms, risk factors, clinical relevance, and treatment of DIAF. Because of the limited information presently available, further research is needed to obtain a deeper insight into DIAF. Meanwhile, it is important that clinicians are aware of the problem that DIAF represents, recognize which drugs may cause DIAF, and consider the possibility that a drug may be responsible for a new-onset AF episode.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
| | - Julián Villacastín
- Hospital Clínico San Carlos, CardioRed1, Universidad Complutense de Madrid, CIBERCV, 28040 Madrid, Spain
| | - Ricardo Caballero
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain.
| | - Eva Delpón
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
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Kępski J, Szmit S, Lech-Marańda E. Characteristics of patients with newly diagnosed hematological malignancies referred for echocardiography. Front Oncol 2024; 14:1283831. [PMID: 38327743 PMCID: PMC10847336 DOI: 10.3389/fonc.2024.1283831] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
Objective The importance of cardio-hemato-oncology programs is increasing. The main aim of the study was to identify all coexisting cardiovascular disorders in patients with new hematological malignancies referred for echocardiography during baseline evaluation before anticancer therapy. Material and methods The study was based on 900 echocardiographic examinations performed within 12 months at the Institute of Hematology and Transfusion Medicine in Poland: 669 tests (74.3%) were dedicated to hemato-oncology patients at the different stages of cancer therapy, however almost a third of the tests (277, 30.8%) were part of a baseline evaluation before starting first line anticancer therapy due to newly diagnosed hematological malignancies. Results The group of 277 patients with new hematological malignancies (138 women, 49.82%) with a median age of 66 years (interquartile range: 53-72 years) was included in the main analyses. The three most frequent new histopathological diagnoses were: non-Hodgkin lymphoma (63 cases; 22.74%), acute myeloid leukaemia (47 cases; 16.97%), and multiple myeloma (45 cases; 16.25%). The three most common clinical cardiology disorders were arterial hypertension (in 133 patients, 48.01%), arrhythmias (48 patients, 17.33%), and heart failure (39 patients, 14.08%). Among 48 patients with arrhythmias there were 22 cases with atrial fibrillation. The most frequently detected echocardiographic abnormality was Left Atrial Volume Index >34 ml/m2 which was present in 108 of 277 patients (38.99%) and associated with a significantly greater chance of concomitant diagnosis of arrhythmias (OR=1.98; p=0.048) especially atrial fibrillation (OR=3.39; p=0.025). The second most common echocardiographic finding was diastolic dysfunction 2nd or 3rd degree revealed in 43 patients (15.52%) and associated with a greater chance of simultaneous diagnosis of heart failure (OR=8.32; p<0.0001) or arrhythmias (OR=4.44; p<0.0001) including atrial fibrillation (OR=5.40; p=0.0003). Conclusions In patients with newly diagnosed hematological malignancies left ventricular diastolic dysfunction is a common abnormality in echocardiography and may determine diagnoses of heart failure or arrhythmias.
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Affiliation(s)
- Jarosław Kępski
- Department of Cardio-Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Sebastian Szmit
- Department of Cardio-Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Lech-Marańda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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Costa TA, Felix N, Clemente M, Teixeira L, Braga MAP, Silva LTM. Safety and efficacy of catheter ablation for atrial fibrillation in cancer survivors: a systematic review and meta-analysis. J Interv Card Electrophysiol 2024; 67:211-219. [PMID: 37950145 DOI: 10.1007/s10840-023-01677-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Cancer survivors are at increased risk for atrial fibrillation (AF). However, data on the efficacy and safety of catheter ablation (CA) in this population remain limited. Therefore, we aimed to perform a systematic review and meta-analysis comparing outcomes after CA for AF in patients with versus without prior or active cancer. METHODS We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of CA for AF in cancer survivors. Outcomes of interest were bleeding events, late AF recurrence, and need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints. RESULTS We included 5 retrospective cohort studies comprising 998 patients, of whom 41.4% had a history of cancer. Cancer survivors were at significantly higher risk of clinically relevant bleeding (OR 2.17; 95% CI 1.17-4.0; p=0.01) as compared with those without cancer. The efficacy of CA for AF was similar between groups. Late AF recurrence at 12 months was not significantly different between patients with vs. without a history of cancer (OR 1.29; 95% CI 0.78-2.13; p=0.32). Similar findings were observed in the outcome of repeat ablations (OR 0.71; 95% CI 0.37-1.37; p=0.31). CONCLUSIONS These findings suggest that cancer survivors have an increased risk of bleeding after CA for AF relative to patients without cancer, with no significant difference in the efficacy of CA for maintenance of sinus rhythm between groups. STUDY REGISTRATION This systematic review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023394538.
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Affiliation(s)
| | - Nicole Felix
- Federal University of Campina Grande, Campina Grande, Paraiba, Brazil
| | - Mariana Clemente
- Faculdade de Medicina de Petrópolis, Petrópolis, Rio de Janeiro, Brazil
| | - Larissa Teixeira
- Federal University of Campina Grande, Campina Grande, Paraiba, Brazil
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Pernod G, Cohen A, Mismetti P, Sanchez O, Mahé I. Cancer-related arterial thromboembolic events. Arch Cardiovasc Dis 2024; 117:101-113. [PMID: 38057257 DOI: 10.1016/j.acvd.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
Cancer is associated with a hypercoagulable state and is a well-known independent risk factor for venous thromboembolism, whereas the association between cancer and arterial thromboembolism is less well established. Arterial thromboembolism, primarily defined as myocardial infarction or stroke is significantly more frequent in patients with cancer, independently of vascular risk factors and associated with a three-fold increase in the risk of mortality. Patients with brain cancer, lung cancer, colorectal cancer and pancreatic cancer have the highest relative risk of developing arterial thromboembolism. Antithrombotic treatments should be used with caution due to the increased risk of haemorrhage, as specified in current practice guidelines.
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Affiliation(s)
- Gilles Pernod
- Service de Médecine Vasculaire, Université Grenoble-Alpes, Grenoble, France; F-CRIN INNOVTE network, Saint-Etienne, France.
| | - Ariel Cohen
- Service de cardiologie, hôpital Saint-Antoine, hôpital Tenon, Assistance publique-Hôpitaux de Paris, Sorbonne université, Paris, France; Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), 75013, Sorbonne Université, Paris, France
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Olivier Sanchez
- Service de pneumologie et de soins intensifs, AP-HP, hôpital européen Georges-Pompidou, Paris, France; Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; F-CRIN INNOVTE network, Saint-Etienne, France
| | - Isabelle Mahé
- Université Paris Cité, Inserm UMR S1140, innovations thérapeutiques en hémostase, Paris, France; Service de médecine interne, hôpital Louis-Mourier, AP-HP, Colombes, France; F-CRIN INNOVTE network, Saint-Etienne, France
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Addison D, Shaaban A, Habib A. Cardiotoxic Atrial Fibrillation With Novel Cancer Treatment: More Relevant Than We Think. JACC. ADVANCES 2023; 2:100603. [PMID: 38938353 PMCID: PMC11198546 DOI: 10.1016/j.jacadv.2023.100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
- Division of Cancer Prevention and Control, The Ohio State University, Columbus, Ohio, USA
| | - Adnan Shaaban
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Alma Habib
- Division of Hematology, The Ohio State University Medical Center, Columbus, Ohio, USA
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