Long-term anticoagulation in questions and answers.

Which anticoagulants should be used for patients with atrial fibrillation and cancer? In the management of patients with atrial fibrillation (AF) and can‐ cer, VKAs or NOACs can be used for stroke pre‐ vention. However, the effectiveness and safety of treatment with NOACs in this specific group of patients are poorly documented because these pa‐ tients have not been included in large randomized clinical trials on the use of NOACs in AF. How‐ ever, clinical practice shows that NOACs are well tolerated by most cancer patients in good general condition, receiving outpatient cancer treatment, and with low ‐to ‐moderate bleeding risk, and not taking antifungal drugs or cyclosporine. In every‐ day practice, however, LMWH are mostly used in patients with venous thromboembolism (VTE), and not with AF, except when such management is planned only for a short time and because of invasive procedures, nausea, vomiting, or diar‐ rhea, and other complications of an underlying disease. The effectiveness of LMWH (particular‐ ly at prophylactic or moderate doses) in AF, es‐ pecially in high ‐risk patients is unknown; how‐ ever, in high ‐risk cancer inpatients with elevat‐ ed risk of bleeding LMWH should be considered. Anticoagulation strategy should be individualized in cancer patients especially if both bleeding and thrombosis risks are high.