1b) With the burgeoning #AFib population worldwide, effective #SPAF is hindered by #adherence issues, #underprescribing, & #underdosing. Meanwhile #cancer-assoc'd #thrombosis #CAT remains a challenge w/ debates over whether we are underestimating risk of #stroke in #cancer pts.
— @onc_ce (@onc_ce) October 18, 2023
2) This program is supported by an unrestricted educational grant from Anthos Therapeutics. Statement of accreditation, faculty disclosures at https://t.co/8oShcATovC. Earn 0.5 hr🆓CE/#CME by following this🧵& follow us for more expert-authored #MedEd. #oncTwitter #FOAMed #oncsm
— @onc_ce (@onc_ce) October 18, 2023
3b) This ⬆️risk of #thrombus formation & arterial #thromboembolism (#ATE), which most commonly manifests as ischemic stroke. A major component of tx for #AF is determination of whether #thromboprophylaxis as #SPAF is indicated for an individual pt.
— @onc_ce (@onc_ce) October 18, 2023
3d) Both #CHADS2 & #CHA2DS2Vasc scores guide clinicians by identifying pts w/highest risk of developing ATE. pic.twitter.com/Vw4ycYvgBs
— @onc_ce (@onc_ce) October 18, 2023
3f) Hu et al (🔓 https://t.co/jWruZAcgpQ) have shown that in #cancer patients with #AFib, CHA2DS2Vasc significantly underestimates the risk of thromboembolism. pic.twitter.com/3dU7z3mzgQ
— @onc_ce (@onc_ce) October 18, 2023
4b) . . . consideration should be given to the addition of cancer to the clinical scoring system, creating a "CCHA2DS2VASc Score" with the first (added) C being #cancer as an additional #RF.
— @onc_ce (@onc_ce) October 18, 2023
4d) The greatest impact of a "C"CHA2DS2VASc score is that cancer’s predictive power was comparable to age > 75, ♀️ sex, & #DM, potentially enabling more patients at risk to start #anticoagulation therapy.
— @onc_ce (@onc_ce) October 18, 2023
5) Finally, a prior meta-analysis measuring the predictive ability of the #CHADS2 & #CHA2DS2VASC scores ➡️the C-statistics were 0.66 at best, suggesting the #RFs included in these models do not explain all of the risk for ischemic stroke in #AF.
— @onc_ce (@onc_ce) October 18, 2023
🔓https://t.co/pomOq670Pj
6b) These authors did point out, though, that a #CHA2DS2VASc score of zero is useful to identify patients with #AF and #cancer who are at low embolic risk. pic.twitter.com/yMxcCTFPaV
— @onc_ce (@onc_ce) October 18, 2023
7b) . . . is assoc'd with an ⬆️ incidence of #stroke, #TIA, or systemic #ATE compared with matched controls without #cancer. pic.twitter.com/HxZyFTXKWV
— @onc_ce (@onc_ce) October 18, 2023
9) So, where are we? Risk and incidence of #cancer, cancer-associated thrombosis #CAT, and #AFib intersect and interact. Cancer pts have a higher bleeding risk when treated with #anticoagulants–whether for #SPAF or for #CAT. Tough spot!
— @onc_ce (@onc_ce) October 18, 2023
11a) #AF often pre-exists in pts with newly dx'd cancer, & occurs w/ ⬆️ frequency shortly after #cancer dx. Patients with active cancer and AF have a particularly high risk of thromboembolic complications, as both conditions carry a risk of #thrombosis.
— @onc_ce (@onc_ce) October 18, 2023
11c) (cont)
— @onc_ce (@onc_ce) October 18, 2023
📈anticancer regimens (e.g., platinum compounds, anti-angiogenic tx, immune modulators)
📈comorbidities (e.g., obesity, kidney disease)
📈concurrent therapies (e.g., surgery, central catheters)https://t.co/Yz3iSiIFMJ
13a) So as seen in recent #tweetorials here (still available for 🆓CE/#CME credit), e.g.:
— @onc_ce (@onc_ce) October 18, 2023
🔗 https://t.co/UlxbZuIgvi
🔗https://t.co/OQZyzk57I2
🔗 https://t.co/UiRKoc7tVo), there may be an emerging option for safer & more predictable #anticoagulation for both #SPAF & #CAT.
13c) Multiple #FXI / #FXIa-targeted agents with different #MOAs are being investigated, none yet approved. Premise is that highly effective #antithrombotic therapy can be delivered w/o compromising #hemostasis.
— @onc_ce (@onc_ce) October 18, 2023
15) #Abelacimabis the only #FXI inhibitor currently being investigated both for the management of #CAT and for #SPAF, and is only one that dually inhibits FXI and FXIa. Phase 2 data in both indications appear promising.
— @onc_ce (@onc_ce) October 18, 2023
17) In fact such management issues as #CAT + #SPAF and managing the #cardiotoxic effects of some #chemotx agents are at the heart of the new specialty of #cardio_oncology!
— @onc_ce (@onc_ce) October 18, 2023
🔓https://t.co/jBUYFxisct
18b) It's b. Cancer, which is itself #prothrombotic & therefore often ➡️ #CAT, is not at all uncommon in pts with #AF, nor is it uncommon for patients recently dx'd w/cancer to develop AF. Anticoagulation in pts w/cancer is > likely to be complicated by 🩸than in pts w/o cancer.
— @onc_ce (@onc_ce) October 18, 2023
19b) It's d. Neither stroke nor bleeding prediction models in AF account adequately for cancer. The ⬆️risk of 🩸in anticoagulated cancer pts is a problem, as are #DDIs between both #VKAs & #DOACs w/ #chemotx. Current #anticoagulants are 🚫 cardiotoxic, tho some chemotx is. pic.twitter.com/w42UZblyOV
— @onc_ce (@onc_ce) October 18, 2023
20) And that's it! You just earned 0.5h 🆓CE/#CME and you can claim your certificate NOW at https://t.co/6AlPPXS71L. Click there, and then click upper right on that FOLLOW button for more expert-led #MedEd! @DrRohitMoudgil and @onc_ce THANK YOU for joining us!
— @onc_ce (@onc_ce) October 18, 2023