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Review
. 2020 Dec 3;9(12):3926.
doi: 10.3390/jcm9123926.

The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome

Juri Radmilovic  1 , Alessandro Di Vilio  1   2 , Antonello D'Andrea  1   2 , Fabio Pastore  1 , Alberto Forni  1 , Alfonso Desiderio  1 , Massimo Ragni  1 , Gaetano Quaranta  1 , Giovanni Cimmino  2 , Vincenzo Russo  2 , Marino Scherillo  3 , Paolo Golino  2
Affiliations
Review

The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome

Juri Radmilovic et al. J Clin Med. .

Abstract

Among acute coronary syndrome (ACS) patients, 15% have concomitant cancer, especially in the first 6 months after their diagnosis, as well as in advanced metastatic stages. Lung, gastric, and pancreatic cancers are the most frequent malignancies associated with ACS. Chemotherapy and radiotherapy exert prothrombotic, vasospastic, and proinflammatory actions. The management of cancer patients with ACS is quite challenging: percutaneous revascularization is often underused, and antiplatelet and anticoagulant pharmacological therapy should be individually tailored to the thrombotic risk and to the bleeding complications. Sometimes oncological patients also show different degrees of thrombocytopenia, which further complicates the pharmacological strategies. The aim of this review is to summarize the current evidence regarding the treatment of ACS in cancer patients and to suggest the optimal management and therapy to reduce the risk of adverse coronary events after ACS in this high-risk population.

Keywords: acute coronary syndrome (ACS); anticoagulant; atrial fibrillation; cancer; double antiplatelet therapy (DAPT); thrombocytopenia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pathogenesis of acute coronary syndrome in cancer patients. ACS: acute coronary syndrome.
Figure 2
Figure 2
Thrombocytopenia management. PCI: percutaneous coronary intervention; ACT: activated coagulation time; UFH: unfractionated heparin; ASA: acetylsalicylic acid.
Figure 3
Figure 3
Management of antiplatelet therapy in cancer patients. DES: drug-eluting stent; ASA: acetylsalicylic acid; DAPT: dual antiplatelet therapy.
Figure 4
Figure 4
Management of anticoagulant therapy in cancer patients. VKA: vitamin K antagonist; NOAC: new oral anticoagulant; LMWH: low-molecular-weight heparin.
Figure 5
Figure 5
Bleeding events management. DAPT: double antiplatelet therapy; SAPT: single antiplatelet therapy; OA: oral anticoagulation; VKA: Vitamin K anticoagulant; UFH: unfractionated heparin; LMWH: low-molecular-weight heparin; NOAC: new oral anticoagulant; PPI: proton pump inhibitor; GI: gastrointestinal; RBC: red blood cell.
See this image and copyright information in PMC

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