Atrial fibrillation in cancer patients who develop stroke

Abstract

Background Acute ischemic stroke (Stroke) and transient ischemic attacks (TIA) are known complications in cancer patients and those with atrial fibrillation (AF). The role AF plays in Stroke/TIA in the setting of cancer is unclear. The purpose of this study was to assess the relationship between AF and Stroke/TIA in cancer patients. Methods We conducted a case-control study comparing all patients who developed Stroke/TIA from 2014 to 2019 following a cancer diagnosis at King Hussein Cancer Center (KHCC), matched to Stroke/TIA-free controls based on age, gender, and cancer site. Results Two hundred seventy-two patients were included (136 per group). The mean age was 63.95 ± 13.06 and 57% were females. The Stroke/TIA group had more AF at the time of event (14% vs. 4%, OR: 4.25, 95%-CI: 1.39 - 17.36) and had a larger proportion of death on study conclusion (OR: 9.4, 95%-CI: 3.74 - 23.64). On conditional logistic regression, patients in the Stroke/TIA group had higher odds of: AF (OR: 7.93, 95%-CI: 1.6 – 39.18), ischemic stroke before cancer diagnosis (OR: 9.18, 95%-CI: 2.66 – 31.74), being on active cancer treatment (OR: 3.11, 95%-CI: 1.46 – 6.62), dyslipidemia (OR: 3.78, 95%-CI: 1.32 – 10.82), and renal disease (OR: 4.25, 95%-CI: 1.55 – 11.63). On another conditional logistic regression model built to assess the role of the CHA2DS2-VASc score, a score of >=2 in males and >=3 in females significantly increased the risk of developing Stroke/TIA in cancer patients (OR: 2.45, 95%-CI: 1.08 - 5.58). Conclusion AF, previous ischemic stroke, active cancer treatment, dyslipidemia, and renal disease are independent risk factors for Stroke/TIA and a higher CHA2DS2-VASc score significantly increases the risk in cancer patients regardless of AF.

Bridging the Gap in Cancer-Related Stroke Management: Update on Therapeutic and Preventive Approaches

“…Another important clinical consideration is atrial fibrillation (AF) in cancer patients who develop stroke [10]. About 2-5% of cancer patients have AF at the time of diagnosis, making it yet another common condition in this population [17][18][19]. A case-controlled study of cancer patients who experience stroke/transient ischaemic attack (TIA) with matched cancer patients without stroke/TIA found that AF, prior ischaemic stroke, ongoing cancer therapy, dyslipidaemia, and renal disease are independent risk factors for stroke/TIA [19].…”

“…About 2-5% of cancer patients have AF at the time of diagnosis, making it yet another common condition in this population [17][18][19]. A case-controlled study of cancer patients who experience stroke/transient ischaemic attack (TIA) with matched cancer patients without stroke/TIA found that AF, prior ischaemic stroke, ongoing cancer therapy, dyslipidaemia, and renal disease are independent risk factors for stroke/TIA [19]. The study also indicated that a higher CHA 2 DS 2 -VASc score significantly potentiates the risk in people with active cancer independent of AF [19].…”

“…A case-controlled study of cancer patients who experience stroke/transient ischaemic attack (TIA) with matched cancer patients without stroke/TIA found that AF, prior ischaemic stroke, ongoing cancer therapy, dyslipidaemia, and renal disease are independent risk factors for stroke/TIA [19]. The study also indicated that a higher CHA 2 DS 2 -VASc score significantly potentiates the risk in people with active cancer independent of AF [19]. This study had several limitations including a retrospective design and a small sample size.…”

“…Timely preventive and therapeutic management of stroke in cancer patients is essential in both improving their prognosis and in reducing the burden that these diseases individually and combined place on the health system. Cancer-specific stroke risk prediction scores/tools need to be developed to aid the prevention of stroke/TIA [19]. Strategies for the prophylactic and emergent management of stroke in cancer patients are discussed below.…”

Oncocardiology: Far beyond the cardiotoxicity

“…Lipshultz, et al [6] found that survivors of childhood cancer, regardless of exposure to cardiotoxic treatments, had cardiovascular abnormalities related not only to abnormal left ventricular structure and function but also to increased traditional risk factors for atherosclerotic disease and systemic in lammation. Most recently, the relationship between atrial ibrillation (AF) and Stroke/ transient ischemic attacks (TIA) in cancer patients was conducted in a case-control study, the CHA 2 DS 2 -VASc score, which components such as heart failure, hypertension, old age, and diabetes mellitus were found to be associated with stroke in the general population, signi icantly increases the risk of stroke in cancer patients regardless of the presence of AF [7].…”