2024-03-28T12:59:17Zhttp://repisalud.isciii.es/oai/requestoai:repisalud.isciii.es:20.500.12105/115892022-07-05T07:58:55Zcom_20.500.12105_2145com_20.500.12105_2051com_20.500.12105_2144col_20.500.12105_2146
00925njm 22002777a 4500
dc
Raposeiras-Roubin, Sergio
author
Abu Assi, Emad
author
Barreiro-Pardal, Cristina
author
Cespon-Fernandez, Maria
author
Muñoz-Pousa, Isabel
author
Cobas-Paz, Rafael
author
Parada, Jose Antonio
author
Represa-Montenegro, Marta
author
Melendo-Miu, Maria
author
Blanco-Prieto, Sonia
author
Rossello, Xavier
author
Ibáñez, Borja
author
Iñiguez-Romo, Andres
author
2020-11-17
Background Bleeding is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulant therapy, and may be the first manifestation of underlying cancer. We sought to investigate to what extent bleeding represents the unmasking of an occult cancer in patients with AF treated with oral anticoagulants. Methods and Results Using data from CardioCHUVI-AF (Retrospective Observational Registry of Patients With Atrial Fibrillation From Vigo's Health Area), 8753 patients with AF aged ≥75 years with a diagnosis of AF between 2014 and 2017 were analyzed. Of them, 2171 (24.8%) experienced any clinically relevant bleeding, and 479 (5.5%) were diagnosed with cancer during a follow-up of 3 years. Among 2171 patients who experienced bleeding, 198 (9.1%) were subsequently diagnosed with cancer. Patients with bleeding have a 3-fold higher hazard of being subsequently diagnosed with new cancer compared with those without bleeding (4.7 versus 1.4 per 100 patient-years; adjusted hazard ratio [HR], 3.2 [95% CI, 2.6-3.9]). Gastrointestinal bleeding was associated with a 13-fold higher hazard of new gastrointestinal cancer diagnosis (HR, 13.4; 95% CI, 9.1-19.8); genitourinary bleeding was associated with an 18-fold higher hazard of new genitourinary cancer diagnosis (HR, 18.1; 95% CI, 12.5-26.2); and bronchopulmonary bleeding was associated with a 15-fold higher hazard of new bronchopulmonary cancer diagnosis (HR, 15.8; 95% CI, 6.0-41.3). For other bleeding (nongastrointestinal, nongenitourinary, nonbronchopulmonary), the HR for cancer was 2.3 (95% CI, 1.5-3.6). Conclusions In patients with AF treated with oral anticoagulant therapy, any gastrointestinal, genitourinary, or bronchopulmonary bleeding was associated with higher rates of new cancer diagnosis. These bleeding events should prompt investigation for cancers at those sites.
J Am Heart Assoc. 2020:e016836
2047-9980
http://hdl.handle.net/20.500.12105/11589
33140676
10.1161/jaha.120.016836
Journal of the American Heart Association
New Cancer Diagnosis After Bleeding in Anticoagulated Patients With Atrial Fibrillation.