Via practica 1/2023

Criteria for the selection of anticoagulant therapy for atrial fibrillation in selected risk groups of patients

Atrial fibrillation is the most common persistent arrhythmia in adulthood, which is associated with significant morbidity and mortality. The category of elderly patients with atrial fibrillation is a specific population characterized by a higher prevalence of coexisting comorbidities, fragility, cognitive impairment and polypragmasis with possible potential drug interactions. Each of these components can lead to a labile risk-benefit ratio of oral anticoagulant therapy. Thromboembolic complications of atrial fibrillation can cause death or severe disability, which is why oral anticoagulant therapy (preferentially direct oral anticoagulant) is recommended in patients with atrial fibrillation, regardless of advanced age. Patients with malignancy and atrial fibrillation have not only an atrial fibrillation related thromboembolic risk, but also their intrinsic risk due to hypercoagulability and a prothrombotic condition that usually occurs with malignancy. In the final decision on the indication of anticoagulant therapy, the individual characteristics of the patient, the specific type and spread of the tumor, drug interactions, the presence of metastases, the expected result and the preferences of patients should be taken into account. Overall, patients with a trial fibrillation and active cancer currently prefer direct oral anticoagulant to warfarin.

Keywords: atrial fibrillation, malignancy, older age, oral anticoagulant therapy, direct oral anticoagulant