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
