The first ESC cardio-oncology guidelines: Key messages for prevention of bleeding and thromboembolic events in cancer patients


Take Home Messages
  • While PCI has not demonstrated a mortality benefit in cancer patients with NSTEMI compared with optimal medical therapy, immediate coronary angiography and percutaneous coronary intervention are recommended in STEMI if cancer prognosis is ≥6 months or in acute complications of acute coronary syndrome (ACS).
  • Aspirin and clopidogrel are the preferred dual antiplatelet regime in ACS for the shortest duration possible.
  • Non-vitamin K oral anticoagulants are preferred to vitamin K antagonists and low molecular weight heparin for therapeutic anticoagulation of atrial fibrillation.

Management of cardiovascular diseases in cancer patients is complex and challenging (1,2). Patients with cancer are at increased risk of cardiac diseases due to the shared cardiovascular risk factors, cardiovascular toxicity of cancer therapy, along with the proinflammatory and prothrombotic state caused by cancer (3–5). Stratification of the risk of bleeding and thrombosis in cancer patients can be a dilemma to health professionals as the traditional risk scores are not validated in cancer patients (2,6). In order to help professionals adopt the best management approach for cancer patients, the European Society of Cardiology (ESC) published the long-awaited first ESC Guidelines on cardio- oncology (7). The guidelines provide recommendations regarding diagnosis and management of acute and subacute cardiovascular toxicity in patients receiving anticancer treatment, and prevention and monitoring of cardiovascular complications during cancer therapy. The present editorial focuses on the key messages for prevention of bleeding and thromboembolic events in cancer patients from the first ESC cardio-oncology guidelines that can be frequently encountered during daily acute cardiovascular care particularly in patients presenting with acute coronary syndrome (ACS) and atrial fibrillation (AF).