Elisa Fantecchi (a), VincenzoLivio Malavasi (a), Francesca Pesce (a), Laura Gianolio (a), Giuseppe Longo (b), Stefano Cascinu (b), Giuseppe Boriani(a) – a) Cardiology Division. University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy b) Oncology Division. University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
Background: Patients with cancer and atrial fibrillation (AF) are at high risk of both tromboembolic and bleeding complicantion. The anticoagulation therapy is therefore a challenge for the clinicians.
Aim: To evaluate variables associated with anticoagulation prescription and its impact on survival in patients with AF and cancer.
Methods: We retrospectively retrieve informations about patients from institutional databases. Inclusion criteria were: (i) patients older than 18 years; (ii) diagnosis of malignancy; (iii) availability of a diagnostic AF electrocardiogram. We collected informations about demographics, clinical and laboratoristic data and therapy. We compared two different groups: anticoagulated and not anticoagulated patients. Univariate and multivariate analysis were made between groups by logistic regression. Survival curves were obtained and compared with univariate and multivariate Cox proportional hazard regression model. A p value < 0.05 was considered statistically significant.
Results: Between 2011 and 2015, 4,664 patients were admitted for malignancy a tour University Hospital. 394 patients (8.4%) had AF, 14 patients were excluded because of incomplete informations.
Patients were mostly males (233; 61.3%), with a mean age of 74±9 years. 155 patients (40%) were anticoagulated. The most represented malignancies were hemolymphopoietic (126 patients; 33.2%), pulmonary (90; 23.7%) and gastroenteric (69; 18.2%) cancer. Neither the kind of cancer nor the stage of the disease or the ongoing treatment was significantly associated with anticoagulants use.
Multivariate logistic regression analysis showed that body mass index (OR 1.09; CI 95% 1.03-1.16; p=0.002), valvular disease (OR 2.80; CI95% 1.30-6.03; p=0.008), pulmonary embolism (OR 5.67; 95%CI 1.97-16.34; p=0.001) were the variables independently associated with anticoagulation.
After a median follow-up of 212 days (interquartile range 92-731 days), 294 patients (77.4%) died. Patients lost to follow-up were 8 (2.1%). Anticoagulation was not related to the mortality neither in the whole cohort of patients (HR 1.11; CI 95% 0.89-1.37; p=0.360) nor in the subgroups at higher risk.
Conclusion: Anticoagulation in patients with AF and cancer was associated with a better notional status, a valvular disease and a history of pulmonary embolism. Anticoagulation does not improve or worsen the prognosis of the patients while the outcome is linked to malignancy and frailty status.
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