Early detection of cancer after bleeding during oral anticoagulant therapy in patients with atrial fibrillation: a new perspective

Abstract

Antithrombotic therapy, in particular oral anticoagulation, is associated with an increased risk of bleeding. During anticoagulant treatment bleedings may also be caused by occult cancer, allowing its early diagnosis. The use of direct oral anticoagulants is associated with a lower risk of bleeding compared to vitamin K antagonists, but in the presence of a cancer lesion the risk of bleeding is not inferior. Atrial fibrillation patients with gastrointestinal bleeding during warfarin therapy are 6 times more likely to be diagnosed with cancer than patients without bleeding. In patients with hematuria, the probability of cancer is almost triple if treated with warfarin. With all the four direct oral anticoagulants newly colon cancer diagnoses have been reported in association with bleedings in phase III randomized clinical trials. In the real world, a 4.5% incidence of newly diagnosed cancer has been reported, mainly in the early stage and preceded by a bleeding event. Gastrointestinal bleeding is associated with a 13 times higher risk of newly diagnosed gastrointestinal cancer, genitourinary bleeding with a 18 times higher risk of newly diagnosed genitourinary cancer, and bronchopulmonary bleeding with a 15 times higher risk of newly diagnosed lung cancer. In the presence of bleeding during oral anticoagulant therapy, a diagnostic screening is warranted in order to detect occult cancer. An adverse event such as bleeding can become a favorable opportunity.