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  • br Acknowledgements br Author contributions br W D L M

    2020-08-18


    Acknowledgements
    Author contributions
    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.
    Appendix A. Supplementary data
    References
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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 HA1077 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.