心房颤动/扑动和癌症患者抗血栓治疗相关的大出血和血栓栓塞并发症

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-02-01 DOI:10.1016/j.rpth.2025.102697

Gordon Chu , Nienke van Rein , Menno V Huisman , Lars Pedersen , Henrik T. Sørensen , Suzanne C. Cannegieter , Frederikus A. Klok

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引用次数: 0

摘要

背景：房颤合并活动性癌症患者的抗凝治疗是复杂的，因为癌症增加了血栓形成和出血的风险。以前的研究已经调查了任何类型癌症的影响，而结果可能因特定类型而异。我们进行目前的研究是为了更深入地了解特定类型的癌症对临床结果的影响。目的：研究心房颤动/心房颤动（AF）并发癌症患者的大出血（MB）和血栓栓塞（TE）发生率与抗栓治疗的相关性，并研究癌症类型是否影响MB和TE的风险。方法：这项基于丹麦人群的队列研究纳入了1995年1月1日至2016年12月31日期间所有年龄≥50岁的AF出院患者，并确定了随后发展为癌症的患者。癌症类型、结局和抗血栓暴露的数据来自医院和药物处方数据库。随访从癌症诊断开始一直持续到出现结果或2年随访结束。采用Cox回归计算每100例患者年的发病率（IRs）和相应95% ci的校正风险比。结果共有22996例房颤并发癌症。这些患者的MB （IR, 5.36 [95% CI, 5.09-5.64] vs 2.27 [95% CI, 2.22-2.32]）和TE （IR, 3.91 [95% CI, 3.68-4.15] vs 2.71 [95% CI, 2.66-2.76]）发生率高于无癌患者。在所有抗血栓暴露类别中均观察到较高的MB率。泌尿生殖肿瘤（IR, 6.43 [95% CI, 5.94-6.95]）和颅内肿瘤（IR, 6.36 [95% CI, 3.85-9.76]）的MB发生率最高；血液癌（IR, 4.92 [95% CI, 4.12-5.82]）和胃肠道癌（IR, 4.82 [95% CI, 4.31-5.36]）的TE发生率最高。房颤合并胃肠道肿瘤和三联抗栓治疗的患者的MB率特别高（IR, 39.0 [95% CI, 15.5-79.1]）。结论伴有某些癌症类型的AF患者的MB和TE发生率高于未发生癌症的AF患者。双重/三重抗血栓治疗并发癌症的房颤患者与高出血率相关，特别是胃肠道癌症患者。

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Major bleeding and thromboembolic complications associated with antithrombotic treatment in patients with atrial fibrillation/flutter and incident cancer

Background

Anticoagulant management of patients with atrial fibrillation with active cancer is complex because cancer increases the risk of thrombosis as well as bleeding. Previous studies have investigated the impact of any type of cancer, while outcomes may differ per specific type. We performed the present study to provide more insight into the impact of specific types of cancer on clinical outcomes.

Objectives

We examined major bleeding (MB) and thromboembolism (TE) rates associated with antithrombotic treatment in patients with atrial fibrillation/flutter (AF) who develop cancer and examined whether cancer type affected MB and TE risks.

Methods

This Danish population-based cohort study included all patients aged ≥ 50 years discharged with incident AF between January 1, 1995, and December 31, 2016, and identified those who subsequently developed cancer. Data on cancer type, outcomes, and antithrombotic exposure were obtained from hospital and drug prescription databases. Follow-up continued from the time of cancer diagnosis until the occurrence of an outcome or the end of the 2-year follow-up. Incidence rates (IRs) per 100 patient-years and adjusted hazard ratios with corresponding 95% CIs were calculated using Cox regression.

Results

A total of 22,996 patients with AF with subsequent incident cancer were identified. These patients had higher MB (IR, 5.36 [95% CI, 5.09-5.64] vs 2.27 [95% CI, 2.22-2.32]) and TE (IR, 3.91 [95% CI, 3.68-4.15] vs 2.71 [95% CI, 2.66-2.76]) rates than those without cancer. The higher MB rate was observed across all antithrombotic exposure categories. Urogenital (IR, 6.43 [95% CI, 5.94-6.95]) and intracranial cancer (IR, 6.36 [95% CI, 3.85-9.76]) demonstrated the highest MB rates; hematologic (IR, 4.92 [95% CI, 4.12-5.82]) and gastrointestinal cancer (IR, 4.82 [95% CI, 4.31-5.36]) had the highest TE rates. A particularly high MB rate was observed in patients with AF with gastrointestinal cancer and triple antithrombotic therapy (IR, 39.0 [95% CI, 15.5-79.1]).

Conclusion

Patients with AF with certain incident cancer types experienced higher rates of MB and TE than those without cancer. Dual/triple antithrombotic therapy in patients with AF with incident cancer was associated with high bleeding rates, particularly with gastrointestinal cancer.

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