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Review
. 2023 Mar 23;10(4):135.
doi: 10.3390/jcdd10040135.

Dual Antiplatelet Therapy and Cancer; Balancing between Ischemic and Bleeding Risk: A Narrative Review

Grigorios Tsigkas  1 , Angeliki Vakka  1 , Anastasios Apostolos  1   2 , Eleni Bousoula  3 , Nikolaos Vythoulkas-Biotis  1 , Eleni-Evangelia Koufou  1 , Georgios Vasilagkos  1 , Ioannis Tsiafoutis  4 , Michalis Hamilos  5 , Adel Aminian  6 , Periklis Davlouros  1
Affiliations
Review

Dual Antiplatelet Therapy and Cancer; Balancing between Ischemic and Bleeding Risk: A Narrative Review

Grigorios Tsigkas et al. J Cardiovasc Dev Dis. .

Abstract

Cardiovascular (CV) events in patients with cancer can be caused by concomitant CV risk factors, cancer itself, and anticancer therapy. Since malignancy can dysregulate the hemostatic system, predisposing cancer patients to both thrombosis and hemorrhage, the administration of dual antiplatelet therapy (DAPT) to patients with cancer who suffer from acute coronary syndrome (ACS) or undergo percutaneous coronary intervention (PCI) is a clinical challenge to cardiologists. Apart from PCI and ACS, other structural interventions, such as TAVR, PFO-ASD closure, and LAA occlusion, and non-cardiac diseases, such as PAD and CVAs, may require DAPT. The aim of the present review is to review the current literature on the optimal antiplatelet therapy and duration of DAPT for oncologic patients, in order to reduce both the ischemic and bleeding risk in this high-risk population.

Keywords: acute coronary syndrome (ACS); atrial fibrillation (AF); cancer; cardiotoxicity; dual antiplatelet therapy (DAPT); percutaneous coronary intervention (PCI); triple antithrombotic therapy (TAT).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Clinical risk factors for both thromboembolic and bleeding manifestations in patients with cancer.
Figure 2
Figure 2
Strategies regarding the duration of DAPT after elective PCI and ACS in all-comers and cancer patients.
Figure 3
Figure 3
Modified algorithm of Radmilovic et al. for the management of antiplatelet therapy in cancer patients. DES = drug-eluting stent, DAPT = dual antiplatelet therapy, PCI = percutaneous coronary intervention.
See this image and copyright information in PMC

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