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Rasmussen PV, Dalgaard F, Gislason GH, et al. Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation. Eur Heart J. 2020;doi: 10.1093/eurheartj/ehz964.
Rasmussen, P. V., Dalgaard, F., Gislason, G. H., Brandes, A., Johnsen, S. P., Grove, E. L., Torp-Pedersen, C., Dybro, L., Harboe, L., Münster, A. B., Pedersen, L., Blanche, P., Pallisgaard, J. L., & Hansen, M. L. (2020). Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation. European heart journal, . https://doi.org/10.1093/eurheartj/ehz964
Rasmussen, Peter Vibe, et al. "Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation." European heart journal vol. (2020). doi: https://doi.org/10.1093/eurheartj/ehz964
Rasmussen PV, Dalgaard F, Gislason GH, Brandes A, Johnsen SP, Grove EL, Torp-Pedersen C, Dybro L, Harboe L, Münster AB, Pedersen L, Blanche P, Pallisgaard JL, Hansen ML. Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation. Eur Heart J. 2020 Feb 07; doi: 10.1093/eurheartj/ehz964. Epub 2020 Feb 07. PMID: 32030399.
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Eur Heart J. 2020 Feb 07; doi: 10.1093/eurheartj/ehz964. Epub 2020 Feb 07.

Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation.

European heart journal

Peter Vibe Rasmussen, Frederik Dalgaard, Gunnar Hilmar Gislason, Axel Brandes, Søren Paaske Johnsen, Erik Lerkevang Grove, Christian Torp-Pedersen, Lars Dybro, Louise Harboe, Anna-Marie Bloch Münster, Lasse Pedersen, Paul Blanche, Jannik Langtved Pallisgaard, Morten Lock Hansen

Affiliations

  1. Department of Cardiology, Herlev and Gentofte University Hospital, University of Copenhagen, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark.
  2. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Noerre Alle 20, 2200, Copenhagen, Denmark.
  3. The Danish Heart Foundation, Vognmagergade 7, 1120, Copenhagen, Denmark.
  4. Department of Cardiology, Odense University Hospital, Kloevervaenget 47, 5000, Odense, Denmark.
  5. Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Moelleparkvej10, 9000, Aalborg, Denmark.
  6. Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
  7. Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark.
  8. Departments of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Kongens Vænge 2, 3400 Hillerød, Denmark.
  9. Department of Cardiology, Aalborg University Hospital, Hobrobej 18-22, 9000 Aalborg, Denmark.
  10. Bristol-Myers Squibb and Pfizer, Denmark. Hummeltoftevej 49, 2830, Virum and Lautrupvang 8, 2750 Ballerup, Denmark.
  11. Unit for Thrombosis Research, Hospital of SouthWest Denmark, Department of Regional Health Research, University of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
  12. Department of Surgical Gastroenterology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
  13. Department of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, Entrance B, 2nd floor, 1014 Copenhagen, Denmark.

PMID: 32030399 DOI: 10.1093/eurheartj/ehz964

Abstract

AIMS: Gastrointestinal bleeding (GI-bleeding) is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) therapy. We sought to investigate to what extent lower GI-bleeding represents the unmasking of an occult colorectal cancer.

METHODS AND RESULTS: A total of 125 418 Danish AF patients initiating OAC therapy were identified using Danish administrative registers. Non-parametric estimation and semi-parametric absolute risk regression were used to estimate the absolute risks of colorectal cancer in patients with and without lower GI-bleeding. During a maximum of 3 years of follow-up, we identified 2576 patients with lower GI-bleeding of whom 140 patients were subsequently diagnosed with colorectal cancer within the first year of lower GI-bleeding. In all age groups, we observed high risks of colorectal cancer after lower GI-bleeding. The absolute 1-year risk ranged from 3.7% [95% confidence interval (CI) 2.2-6.2] to 8.1% (95% CI 6.1-10.6) in the age groups ≤65 and 76-80 years of age, respectively. When comparing patients with and without lower GI-bleeding, we found increased risk ratios of colorectal cancer across all age groups with a risk ratio of 24.2 (95% CI 14.5-40.4) and 12.3 (95% CI 7.9-19.0) for the youngest and oldest age group of ≤65 and >85 years, respectively.

CONCLUSION: In anticoagulated AF patients, lower GI-bleeding conferred high absolute risks of incident colorectal cancer. Lower GI-bleeding should not be dismissed as a benign consequence of OAC therapy but always examined for a potential underlying malignant cause.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: [email protected].

Keywords: Atrial fibrillation; Colorectal cancer; Gastrointestinal bleeding; Oral anticoagulation

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