Table 1. Summary of atrial fibrillation management in patients with cancer.

Stroke risk assessment CHA2DS2 VASc score (35) CHADS2 Score	Does not take into account the prothrombotic state induced by malignancy or cancer drugs. CHADS2 and CHA2DS2 VASc scores are most commonly used for risk assesment.
Bleeding risk assessment HAS-BLED score	Does not include cancer as an additional variable; thus, may underestimate the risk.
Vitamin K Antagonist	Requires frequent monitoring of the INR. Increased INR variability due to malignancy. Cancer patients have higher incidence of sub-therapeutic INRs. Drug interactions with other medications. Increased incidence of thromboembolic events.
DOACs: Apixaban Dabigatran Rivaroxaban	Data available from observational studies, no robust randomized clinical trials to support evidence. Apixaban and dabigatran are non-inferior to warfarin in reducing the risk of ischemic stroke. Apixaban has shown to have lowest rates of bleeding complications. Derangements in hepatic and renal function requires closer monitoring and dose adjustments. Drug interactions can still occur.
Rate control	Beta blocker and calcium channel blockers.
Rhythm control 　Pharmacologic cardioversion: 　Amiodarone, Flecainide and 　Ibutilide	Amiodarone has a large volume of distribution leading to drug interactions. It increases risk of skin and mucosal damage with radiation in addition to incidence of cancer with amiodarone. Use of Flecainide may be limited by chemotherapy induced structural heart disease. Use of Ibutilide may be limited by use of concurrent QT prolonging medications.
Catheter ablation	Not well studied in cancer patients.
Maze procedure	Can be considered in patients undergoing thoracic surgery.