Antithrombotic agents for secondary ischemic stroke prevention in cancer patients with atrial fibrillation

The coexistence of cancer and atrial fibrillation (AF) significantly exacerbates the risk of stroke recurrence and associated complications. The complex interplay between these conditions elevated the thromboembolic burden, bleeding risk, and all-cause mortality. However, the optimal antithrombotic strategy for secondary prevention in this population remains ill-defined. This study aims to compare the therapeutic outcomes of anticoagulant versus antiplatelet therapies in cancer patients with AF. This retrospective study identified ischemic stroke (IS) patients with both cancer and AF at a single medical center from January 2018 to June 2023. Patients receiving antithrombotic treatment for <1 month were excluded. The outcomes of interest included all-cause mortality, major bleeding, and recurrent ischemic events. Kaplan–Meier survival analysis and Cox regression models were utilized to compare outcomes between the 2 treatment groups. The cohort comprised 53 patients, with 38 receiving anticoagulants, and 15 receiving antiplatelets. Antiplatelet therapy was associated with a significantly higher mortality risk compared to anticoagulant therapy (hazard ratio [HR]:3.72; 95% confidence interval [CI]:1.39–9.94, P = .009). There were no significant differences between the groups regarding recurrent IS events (HR: 0.035; 95% CI: 0–69.96; P = .388) or major bleeding events (HR: 1.44; 95% CI: 0.38–5.46, P = .594). This study suggests that anticoagulant therapy is associated with superior survival outcomes without an increased risk of bleeding compared to antiplatelet treatment. These findings may assist clinical decision-making regarding thromboembolism management and bleeding risk in IS patients with concurrent cancer and AF.