MALIGNANCY AND ATRIAL FIBRILLATION – HARDSHIPS TO MANAGE BLEEDING AND THROMBOEMBOLIC RISK

Atrial fibrillation (AF) and cancer are conditions that often coexist. Both of them, as well as their treatment, are connected with changes in coagulation processes, increasing the risk of bleeding or thromboembolic events. Despite that, the level of evidence supporting existing recommendations remains low. (Lyon et al., 2022) In this study, we focused on analyzing the existing literature on the assessment and management of bleeding and thromboembolic risk, with the aim of establishing an evidence-based approach to managing bleeding and thromboembolic risk in oncology patients with AF. Cancer is widely associated with a hypercoagulability state, but in the case of AF and stroke risk, it does not seem to be higher in general in comparison with non-cancer populations. It changes when individual cancer types are analyzed. As for the bleeding risk, many malignancies seem to increase it. Another challenge is that the existing risk scores often show lower predictive value for patients with recent malignancy. There is a need for individual assessment in every patient, but we lack the tools to make it easier for clinicians. Cardio-oncology guidelines addressing AF do exist, but the level of evidence supporting them remains low; thus, further research in this field is needed.