TABLE 30.

Special Considerations for Anticoagulation in Patients With AF on Active Cancer Treatment

Increased bleeding risk	High bleeding risk estimators (eg, HAS-BLED) Thrombocytopenia (platelet <50,000/μL) Intracranial malignancy Gastrointestinal malignancy History of major bleeding Severe kidney dysfunction (eGFR <30 mL/min/1.73 m2)
Drug interactions	P-glycoprotein inducers or inhibitors CYP3A4 inducers or inhibitors

AF indicates atrial fibrillation; eGFR, estimated glomerular filtration rate; and HAS-BLED, hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio (INR), elderly (age ≥65 years), drugs/alcohol concomitantly).