Patell R, et al. - Objectives of this study were to identify unique risk factors and to assess the validity of CHADS₂ and CHA₂DS₂-VASc scores to predict the risk of stroke and mortality. Each point increase in CHADS₂ was correlated with nearly 40% greater risk of stroke in patients with cancer and Atrial Fibrillation (AF). Factors associated with worsened survival were found to be increasing CHADS₂ and CHA₂DS₂-VASc scores. Hematologic, gastrointestinal and skin cancers were correlated with a higher risk of stroke.

Methods

• The clinicians performed a retrospective review of all cancer patients with pre-existing AF presenting from 2008 to 2014.
• Ischemic stroke and mortality were included as outcomes.
• They identified prognostic factors with Fine & Gray regression for stroke and Cox proportional hazards analysis for survival.

Results

• The clinicians examined 2,037 patients, after excluding patients with hemorrhagic strokes (n=15).
• Followed by gastrointestinal (GI) (18%), genitourinary cancers were the most common (29%).
• In this study, 52% had CHADS₂ ≥ 2, 68% had hypertension and 35% had vascular disease.
• 74 patients (3.6%) developed an ischemic stroke at a median of 6.4 months (0,93).
• Increased CHADS₂ score was correlated with stroke (HR 1.41; 95% CI 1.19-1.67; p <0.001), stronger than CHA₂DS₂-VASc (HR 1.26; 95% CI 1.11-1.43; p <0.001).
• Primary cancer site (hematologic, GI and skin [HR 2.69; 95% CI 1.29-5.59; p=0.008]) and antiplatelet therapy (HR 1.94; 95% CI 1.23-3.07; p=0.004) were included as other significant factors.
• CHADS₂ score was correlated with mortality (HR 1.24; 95% CI 1.17-1.32; p <0.001) and occurrence of stroke (HR 3.26; 95% CI 2.27-4.67; p <0.001) in multivariable analysis.