Best Practices in Cardio-Oncology: Part 2

Authors:
Chang HM, Okwuosa TM, Scarabelli T, Moudgil R, Yeh ET.
Citation:
Cardiovascular Complications of Cancer Therapy. Best Practices in Diagnosis, Prevention, and Management: Part 2. J Am Coll Cardiol 2017;70:2552-2565.

The following are key points to remember from this best practices article on cardiovascular complications of cancer therapy, part 2 of 2:

  1. Newly developed targeted cancer chemotherapy can exert off-target effects causing hypertension, thromboembolism, QT-prolongation, and atrial fibrillation.
  2. Hypertension is a common toxicity of vascular endothelial growth factor signaling pathway (VSP) inhibitors, and requires aggressive management to avoid end-organ damage.
  3. Treatment of cancer therapy-induced hypertension frequently requires more than a single agent. An angiotensin-converting enzyme inhibitor is the preferred first-line therapy due to its beneficial effects on plasminogen activator inhibitor-1 expression and proteinuria.
  4. Pulmonary hypertension is a rare complication of dasatinib treatment. Early diagnosis, discontinuation of dasatinib, and substitution of another tyrosine kinase inhibitor can reduce the morbidity of this complication.
  5. Thromboembolism can be caused by VSP inhibitors and angiogenesis inhibitors, and requires anticoagulation therapy.
  6. Low molecular weight heparin is the anticoagulant agent of choice in patients with malignancy. Compared with the general population, there are fewer data to support the use of direct oral anticoagulants (DOACs) as first-line agents in patients with malignancy; however, limited data suggest that warfarin and DOACs are of equal efficacy when oral anticoagulants are necessary in cancer patients.
  7. QT prolongation is a frequent consequence of drug therapy; however, torsades de pointes is rare unless QTc exceeds 500 ms.
  8. Chemotherapies associated with pericardial diseases include anthracyclines, cyclophosphamide, cytarabine, imatinib, dasatinib, interferon-α, arsenic trioxide, and less frequently, docetaxel and 5-fluorouracil.
  9. Radiation therapy often accelerates atherosclerosis. Furthermore, radiation can damage the heart valves, the conduction system, and pericardium that may take years to manifest clinically.
  10. Long-term follow-up and monitoring are essential in cancer survivors.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardio-Oncology, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Pulmonary Hypertension, Hypertension

Keywords: Angiogenesis Inhibitors, Angiotensin-Converting Enzyme Inhibitors, Anthracyclines, Anticoagulants, Arrhythmias, Cardiac, Atherosclerosis, Atrial Fibrillation, Cardiotoxicity, Cyclophosphamide, Heart Valve Diseases, Heparin, Low-Molecular-Weight, Hypertension, Hypertension, Pulmonary, Neoplasms, Pericardium, Plasminogen Activator Inhibitor 1, Protein-Tyrosine Kinases, Proteinuria, Radiation, Secondary Prevention, Survivors, Thromboembolism, Torsades de Pointes, Vascular Endothelial Growth Factor A, Warfarin


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