CHA2DS2-VASc score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer

Maria D'Souza; Nicholas Carlson; Emil Fosbøl; Morten Lamberts; Lærke Smedegaard; Dorte Nielsen; Christian Torp-Pedersen; Gunnar Gislason; Morten Schou

doi:10.1177/2047487318759858

CHA2DS2-VASc score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer

Maria D'Souza, Nicholas Carlson, Emil Fosbøl, Morten Lamberts, Lærke Smedegaard, Dorte Nielsen, Christian Torp-Pedersen, Gunnar Gislason, Morten Schou

Department of Clinical Medicine

29 Citations (Scopus)

Abstract

Background: Cancer may influence the risk of thromboembolism and bleeding associated with the CHA₂DS₂-VASc score. We examined the risk of thromboembolism and bleeding associated with the CHA₂DS₂-VASc score in atrial fibrillation patients with and without recent cancer. Methods and results: Using nationwide registers all patients diagnosed with atrial fibrillation from 2000 to 2015 and not on oral anticoagulation or heparin therapy were included and followed for 2 years. Recent cancer was defined by a cancer diagnosis 5 years or fewer earlier. Risks of thromboembolism and bleeding were estimated in cumulative incidence curves and Cox regression models.We included 122,053 patients with incident atrial fibrillation, 12,014 (10%) had recent cancer. The 2-year cumulative incidence of thromboembolism and bleeding in patients with versus without recent cancer was 1.7% (95% confidence interval (CI) 0.5–2.8) and 4.3% (95% CI 2.4–6.2) versus 1.2% (95% CI 0.9–1.5) and 1.7% (95% CI 1.4–2.0) for CHA₂DS₂-VASc score 0; 3.2% (95%CI 2.2-4.3) and 4.4% (95%CI 3.2-5.6) versus 1.8% (95%CI 1.6-2.1) and 3.0% (95% CI 2.7–3.3) for CHA2DS2-VASc score 1; and 7.1% (95% CI 6.6–7.7) and 6.8% (95% CI 6.3–7.2) versus 10.9% (95% CI 10.7– 11.1) and 6.2% (95% CI 6.1–6.4) for CHA2DS2-VASc score 2 or greater. Although the CHA₂DS₂-VASc score was associated with thromboembolism and bleeding in both patients with and without cancer, the association differed between the groups for thromboembolism (test for interaction, p<0.001) and bleeding (test for interaction, p<0.001). Conclusion: The association of the CHA₂DS₂-VASc score and risk of thromboembolism and bleeding differed between atrial fibrillation patients with and without recent cancer. Therefore, the CHA₂DS₂-VASc score should be used with caution in patients with recent cancer.

Original language	English
Journal	European Journal of Preventive Cardiology
Volume	25
Issue number	6
Pages (from-to)	651-658
Number of pages	8
ISSN	2047-4873
DOIs	https://doi.org/10.1177/2047487318759858
Publication status	Published - Apr 2018

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@article{1fdf4442a2ef4e5d93fdecdec027beb0,

title = "CHA2DS2-VASc score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer",

abstract = "Background: Cancer may influence the risk of thromboembolism and bleeding associated with the CHA2DS2-VASc score. We examined the risk of thromboembolism and bleeding associated with the CHA2DS2-VASc score in atrial fibrillation patients with and without recent cancer. Methods and results: Using nationwide registers all patients diagnosed with atrial fibrillation from 2000 to 2015 and not on oral anticoagulation or heparin therapy were included and followed for 2 years. Recent cancer was defined by a cancer diagnosis 5 years or fewer earlier. Risks of thromboembolism and bleeding were estimated in cumulative incidence curves and Cox regression models.We included 122,053 patients with incident atrial fibrillation, 12,014 (10%) had recent cancer. The 2-year cumulative incidence of thromboembolism and bleeding in patients with versus without recent cancer was 1.7% (95% confidence interval (CI) 0.5–2.8) and 4.3% (95% CI 2.4–6.2) versus 1.2% (95% CI 0.9–1.5) and 1.7% (95% CI 1.4–2.0) for CHA2DS2-VASc score 0; 3.2% (95%CI 2.2-4.3) and 4.4% (95%CI 3.2-5.6) versus 1.8% (95%CI 1.6-2.1) and 3.0% (95% CI 2.7–3.3) for CHA2DS2-VASc score 1; and 7.1% (95% CI 6.6–7.7) and 6.8% (95% CI 6.3–7.2) versus 10.9% (95% CI 10.7– 11.1) and 6.2% (95% CI 6.1–6.4) for CHA2DS2-VASc score 2 or greater. Although the CHA2DS2-VASc score was associated with thromboembolism and bleeding in both patients with and without cancer, the association differed between the groups for thromboembolism (test for interaction, p<0.001) and bleeding (test for interaction, p<0.001). Conclusion: The association of the CHA2DS2-VASc score and risk of thromboembolism and bleeding differed between atrial fibrillation patients with and without recent cancer. Therefore, the CHA2DS2-VASc score should be used with caution in patients with recent cancer.",

author = "Maria D'Souza and Nicholas Carlson and Emil Fosb{\o}l and Morten Lamberts and L{\ae}rke Smedegaard and Dorte Nielsen and Christian Torp-Pedersen and Gunnar Gislason and Morten Schou",

year = "2018",

month = apr,

doi = "10.1177/2047487318759858",

language = "English",

volume = "25",

pages = "651--658",

journal = "European Journal of Preventive Cardiology",

issn = "2047-4873",

publisher = "SAGE Publications",

number = "6",

}

TY - JOUR

T1 - CHA2DS2-VASc score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer

AU - D'Souza, Maria

AU - Carlson, Nicholas

AU - Fosbøl, Emil

AU - Lamberts, Morten

AU - Smedegaard, Lærke

AU - Nielsen, Dorte

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar

AU - Schou, Morten

PY - 2018/4

Y1 - 2018/4

N2 - Background: Cancer may influence the risk of thromboembolism and bleeding associated with the CHA2DS2-VASc score. We examined the risk of thromboembolism and bleeding associated with the CHA2DS2-VASc score in atrial fibrillation patients with and without recent cancer. Methods and results: Using nationwide registers all patients diagnosed with atrial fibrillation from 2000 to 2015 and not on oral anticoagulation or heparin therapy were included and followed for 2 years. Recent cancer was defined by a cancer diagnosis 5 years or fewer earlier. Risks of thromboembolism and bleeding were estimated in cumulative incidence curves and Cox regression models.We included 122,053 patients with incident atrial fibrillation, 12,014 (10%) had recent cancer. The 2-year cumulative incidence of thromboembolism and bleeding in patients with versus without recent cancer was 1.7% (95% confidence interval (CI) 0.5–2.8) and 4.3% (95% CI 2.4–6.2) versus 1.2% (95% CI 0.9–1.5) and 1.7% (95% CI 1.4–2.0) for CHA2DS2-VASc score 0; 3.2% (95%CI 2.2-4.3) and 4.4% (95%CI 3.2-5.6) versus 1.8% (95%CI 1.6-2.1) and 3.0% (95% CI 2.7–3.3) for CHA2DS2-VASc score 1; and 7.1% (95% CI 6.6–7.7) and 6.8% (95% CI 6.3–7.2) versus 10.9% (95% CI 10.7– 11.1) and 6.2% (95% CI 6.1–6.4) for CHA2DS2-VASc score 2 or greater. Although the CHA2DS2-VASc score was associated with thromboembolism and bleeding in both patients with and without cancer, the association differed between the groups for thromboembolism (test for interaction, p<0.001) and bleeding (test for interaction, p<0.001). Conclusion: The association of the CHA2DS2-VASc score and risk of thromboembolism and bleeding differed between atrial fibrillation patients with and without recent cancer. Therefore, the CHA2DS2-VASc score should be used with caution in patients with recent cancer.

AB - Background: Cancer may influence the risk of thromboembolism and bleeding associated with the CHA2DS2-VASc score. We examined the risk of thromboembolism and bleeding associated with the CHA2DS2-VASc score in atrial fibrillation patients with and without recent cancer. Methods and results: Using nationwide registers all patients diagnosed with atrial fibrillation from 2000 to 2015 and not on oral anticoagulation or heparin therapy were included and followed for 2 years. Recent cancer was defined by a cancer diagnosis 5 years or fewer earlier. Risks of thromboembolism and bleeding were estimated in cumulative incidence curves and Cox regression models.We included 122,053 patients with incident atrial fibrillation, 12,014 (10%) had recent cancer. The 2-year cumulative incidence of thromboembolism and bleeding in patients with versus without recent cancer was 1.7% (95% confidence interval (CI) 0.5–2.8) and 4.3% (95% CI 2.4–6.2) versus 1.2% (95% CI 0.9–1.5) and 1.7% (95% CI 1.4–2.0) for CHA2DS2-VASc score 0; 3.2% (95%CI 2.2-4.3) and 4.4% (95%CI 3.2-5.6) versus 1.8% (95%CI 1.6-2.1) and 3.0% (95% CI 2.7–3.3) for CHA2DS2-VASc score 1; and 7.1% (95% CI 6.6–7.7) and 6.8% (95% CI 6.3–7.2) versus 10.9% (95% CI 10.7– 11.1) and 6.2% (95% CI 6.1–6.4) for CHA2DS2-VASc score 2 or greater. Although the CHA2DS2-VASc score was associated with thromboembolism and bleeding in both patients with and without cancer, the association differed between the groups for thromboembolism (test for interaction, p<0.001) and bleeding (test for interaction, p<0.001). Conclusion: The association of the CHA2DS2-VASc score and risk of thromboembolism and bleeding differed between atrial fibrillation patients with and without recent cancer. Therefore, the CHA2DS2-VASc score should be used with caution in patients with recent cancer.

U2 - 10.1177/2047487318759858

DO - 10.1177/2047487318759858

M3 - Journal article

C2 - 29482441

SN - 2047-4873

VL - 25

SP - 651

EP - 658

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 6

ER -

CHA2DS2-VASc score and risk of thromboembolism and bleeding in patients with atrial fibrillation and recent cancer

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