br Acknowledgements br Author contributions br W D L M
W.D., L.M. and G.L. conceived the idea and whole experimental project. G.L. and H.T. carried out the synthesis, characterization and data analysis. J.Q., M.L. and X.W. assisted with data analysis and in-terpretation. G.L. wrote the manuscript. W.D., L.M. and X.Z provided revisions.
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10 Bleeding and New-Onset Cancers in Patients With Atrial Fibrillation Receiving Nonvitamin K Antagonist Oral Anticoagulants
Whether bleeding should be considered a sufficient sign to justify thorough cancer surveil-lance in atrial fibrillation (AF) patients receiving nonvitamin K antagonist oral anticoagu-lants (NOACs) remains unclear. We investigated the relationships between bleeding events and new-onset cancers in AF patients receiving NOACs in a prospective cohort (n = 395, mean follow-up duration of 2.8 years). There were 18 patients who were diag-nosed with new-onset cancers 584 § 372 days after the initiation of NOACs. The patients with new-onset cancers had higher HAS-BLED scores (no, preexisting and new-onset can-cer: 1.51 § 0.81, 1.69 § 0.87, and 2.11 § 0.96, respectively; p = 0.006) and a higher inci-dence of bleeding events (22%, 33%, 67%, respectively; p < 0.001) than did patients without new-onset cancers. Bleeding events that preceded the diagnosis of new-onset can-cers were independently correlated with new-onset cancers (odds ratio: 7.89, p = 0.001) in the multivariate logistic regression. More than half of the patients (61%) with new-onset cancers had either a significant period of drug interruption for at least 2 months or discontinued NOACs. In conclusions, bleeding in AF patients receiving NOACs could be an alerting sign of new-onset cancers and should prompt the initiation of thorough surveillance to detect early cancers. © 2018 Elsevier Inc. All rights reserved. (Am J Cardiol 2019;123:782−786)
There is an increased risk of malignant cancer in the patients with atrial fibrillation (AF), which contributes to the majority of noncardiovascular death.1−3 Routine screening is not suggested.2,4 Bleeding has been considered an alerting sign to reveal preexisting gastrointestinal (GI) cancers.5−7 However, in patients receiving nonvitamin K antagonist oral anticoagulants (NOACs), bleeding is not an uncommon complication,8 and it can generally be attributed to coagulopathy or a variety of benign pathology.9,10 Whether bleeding should be considered a sufficient sign to justify thorough cancer surveillance as in those without
aHeart Rhythm Center, Division of Cardiology, Department of Medi-cine, Taipei Veterans General Hospital, Taipei, Taiwan; bFaculty of Medi-cine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; cDepartment of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan; and dDepartment of Critical Care Medicine, Taipei Veter-ans General Hospital, Taipei, Taiwan. Manuscript received August 31, 2018; revised manuscript received and accepted November 28, 2018.