The Breast 48 (2019) 98e100 Contents lists available at ScienceDirect The Breast journal homepage: www.elsevier.com/brst Correspondence Use of anticoagulation in patients with breast cancer and atrial fibrillation Keywords: References Breast cancer Atrial fibrillation [1] Pardo Sanz A, Rinco n LM, Guedes Ramallo P, Belarte Tornero LC, de Lara Anticoagulation Delgado G, Tamayo Obregon A, et al. Current status of anticoagulation in pa- tients with breast cancer and atrial fibrillation. Breast 2019;46:163e9. [2] Lip GYH, Rushton-Smith SK, Goldhaber SZ, Fitzmaurice DA, Mantovani LG, Goto S, et al. Does sex affect anticoagulant use for stroke prevention in nonvalv- ular atrial fibrillation? The prospective global anticoagulant registry in the FIELD-Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2015;8:S12e20. Results of the AMBER-AF registry were recently reported [1]. [3] Chapman SA, St Hill CA, Little MM, Swanoski MT, Scheiner SR, Ware KB, et al. The authors find that 80% of patients with atrial fibrillation (AF) Adherence to treatment guidelines: the association between stroke risk strati- and breast cancer and 85% without cancer were prescribed oral fied comparing CHADS2 and CHA2DS2-VASc score levels and warfarin prescrip- tion for adult patients with atrial fibrillation. BMC Health Serv Res 2017;17:127. anticoagulation (OA) at study outset and about 79% and 87%, €rck F, Ek A, Johansson L, Sja €lander A. Warfarin persistence among atrial [4] Bjo respectively, after completion of follow-up [1]. fibrillation patients - why is treatment ended? Cardiovasc Ther 2016;34: The authors emphasize that anticoagulation is underused in pa- 468e74. [5] Raparelli V, Proietti M, Cangemi R, Lip GYH, Lane DA, Basili S. Adherence to oral tients with AF and breast cancer but we find this to be a half-empty anticoagulant therapy in patients with atrial fibrillation. Focus on non-vitamin take on an otherwise quite full glass. Anticoagulation underuse in K antagonist oral anticoagulants. Thromb Haemost 2017;117:209e18. AF is a well-reported concern, with anticoagulation rates<70% in [6] Brown JD, Shewale AR, Talbert JC. Adherence to rivaroxaban, dabigatran, and the general population [2,3]. Similarly, after almost 3 years, 79% apixaban for stroke prevention in incident, treatment-naïve nonvalvular atrial fibrillation. J Manag Care Spec Pharm 2016;22:1319e29. of patients with cancer remained under OA(1% drop) [1]. Steep [7] Gopalakrishnan C, Schneeweiss S, Bartels DB, Zint K, Santiago Ortiz A, discontinuation rates are a constant finding in studies in the gen- Huybrechts KF. Evaluating utilization patterns of oral anticoagulants in routine eral population [4e7]. care. J Thromb Haemost 2019;17:14467. Of course, patients treated in a registry in tertiary healthcare in- stitutions may receive more evidence-based treatment than other Marc Sorigue subgroups but the AMBER-AF results are positive and a solid foun- Department of Hematology Laboratory. ICO-Hospital Germans Trias i dation for randomized trials to optimize management of AF in pa- Pujol. Josep Carreras Leukaemia Research Institute, Universitat tients with cancer/breast cancer. noma de Barcelona, Ctra. Canyet s/n 08916, Badalona, Spain Auto To conclude, we understand the investigators’ disappointment E-mail address: msorigue@iconcologia.net. over use of anticoagulation [1] and we share their concern over the higher stroke rates in patients with breast cancer. However, 12 July 2019 the authors should be commended both for their effort and their Available online 23 July 2019 achievements on evidence-based care. Conflict of interest None. Funding None. https://doi.org/10.1016/j.breast.2019.07.005 © 2019 Elsevier Ltd. This is an open access article under the CC BY- NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). DOI of original article: https://doi.org/10.1016/j.breast.2019.05.017