128
Management
Table 30. Special Considerations for Anticoagulation in
Patients With AF on Active Cancer Treatment
Increased bleeding risk High bleeding risk estimators (eg, HAS-BLED)
Thrombocytopenia (platelet <50,000/uL)
Intracranial malignancy
Gastrointestinal malignancy
History of major bleeding
Severe kidney dysfunction (eGFR <30 mL/min/1.73m
2
)
Drug interactions P-glycoprotein inducers or inhibitors
CYP 3A4 inducers or inhibitors
10.14. Cardio-Oncology and Anticoagulation Considerations
COR LOE
Recommendations
1 C-LD 1. In patients with cancer and AF, multidisciplinary
communication including cardiolog y, oncolog y and other
clinicians, and SDM with the patient is recommended to
optimize cancer and AF treatment and to reduce the risk of
drug-drug interactions, QTc prolongation, proarrhythmia,
bleeding, and thromboembolism.
2a C-LD 2. In patients who are to be initiated on cancer therapies
associated with an increased risk of developing AF, increased
vigilance for incident AF and treatment of contributing
factors is reasonable to decrease morbidity.
2a B-NR 3. In most patients with AF and cancer (remote history or
receiving active cancer treatment), DOACs are reasonable to
choose over VKAs for stroke risk reduction.
