br The American Journal of Cardiology www ajconline
786 The American Journal of Cardiology (www.ajconline.org)
Temporary interruption of rivaroxaban compared with warfarin in patients with nonvalvular AF imposed a sig-nificant risk for stroke, as demonstrated in the ROCKET-AF trial.17 More than half of the patients with new-onset cancer had a significant period of drug interruption or dis-continuation that exposed the patients to the risk of stroke. The temporary interruption could be attributed to surgery or cancer surveillance. For the patients with new-onset cancer, surgery is usually needed to eliminate the tumor. The bleeding events preceding the diagnosis of new-onset cancer complicates the use of NOACs, and a multidisciplinary AF team might be needed.10,12,18 In the present study, the interruption of NOACs, especially in those with minor bleeding or no bleeding, was signifi-cantly longer than the current recommendation.10,12,18 It remains unclear whether the recommended NOACs use in the current guideline for temporary drug interruption due to surgery or bleeding in AF patients could simply be applied to those with active or new-onset cancers.10 How-ever, the risk of stroke or embolism should not be under-estimated, as the patients with new-onset cancers also had a high stroke risk according to the CHA2DS2-VASc score, and 1 patient with recurrent stroke was also observed. If bleeding risk is high, the bridge of low molecular heparin might be probably considered due to lower bleeding rate in the cancer patients, compared with NOACs.19 NOACs with available antidotes could also be an alternative due to an increased risk of future bleeding. In conclusions, the bleeding in AF patients receiving NOACs could be an alerting sign of new-onset cancer and might prompt the Fasudil of thorough cancer sur-veillance.
The investigators have no conflicts of interest to disclose.
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