Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation
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Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation. / Rasmussen, Peter Vibe; Dalgaard, Frederik; Gislason, Gunnar Hilmar; Brandes, Axel; Johnsen, Søren Paaske; Grove, Erik Lerkevang; Torp-Pedersen, Christian; Dybro, Lars; Harboe, Louise; Münster, Anna-Marie Bloch; Pedersen, Lasse; Blanche, Paul; Pallisgaard, Jannik Langtved; Hansen, Morten Lock.
In: European Heart Journal, Vol. 43, No. 7, ehz964, 2022, p. e38–e44.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation
AU - Rasmussen, Peter Vibe
AU - Dalgaard, Frederik
AU - Gislason, Gunnar Hilmar
AU - Brandes, Axel
AU - Johnsen, Søren Paaske
AU - Grove, Erik Lerkevang
AU - Torp-Pedersen, Christian
AU - Dybro, Lars
AU - Harboe, Louise
AU - Münster, Anna-Marie Bloch
AU - Pedersen, Lasse
AU - Blanche, Paul
AU - Pallisgaard, Jannik Langtved
AU - Hansen, Morten Lock
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
U2 - 10.1093/eurheartj/ehz964
DO - 10.1093/eurheartj/ehz964
M3 - Journal article
C2 - 32030399
VL - 43
SP - e38–e44
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 7
M1 - ehz964
ER -
ID: 237795647